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Prevalence of idiopathic normal pressure hydrocephalus: A prospective, population-based study
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.ORCID-id: 0000-0002-4107-3818
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.ORCID-id: 0000-0002-4686-0941
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
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2019 (Engelska)Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 14, nr 5, artikel-id e0217705Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Idiopathic normal pressure hydrocephalus (iNPH) causing gait impairment, dementia and urinary incontinence among the elderly, is probably under-diagnosed and under-treated. Despite being known since the 1960s, there is still a lack of prospective, population-based studies on the prevalence of iNPH. Such studies are warranted to minimize selection bias and estimate the true prevalence of the disease.

Methods: The prevalence of iNPH was determined in a randomly selected sample of residents, aged 65 years and older, in the Swedish county of Jämtland. Out of 1,000 individuals invited to participate, 673 (67.3%) completed a questionnaire with seven questions on iNPH symptoms. A subgroup, with and without self-reported symptoms, participated in clinical and radiological evaluations and were diagnosed according to international guidelines. Measurement of cerebrospinal fluid opening pressure was not performed as it was considered too invasive.

Results: Those who reported at least two symptoms in the questionnaire (n = 117) and 51 randomly selected individuals with 0–1 symptom participated in further examinations. Out of them, 25 individuals received the diagnosis probable iNPH according to American-European guidelines (except for the criterion of CSF opening pressure) corresponding to a prevalence of 3.7%. The prevalence of iNPH was four times higher among those aged 80 years and older (8.9%) than among those aged 65–79 years (2.1%) (p <0.001). The difference in prevalence between men (4.6%) and women (2.9%) was not significant (p = 0.24). When iNPH was diagnosed according to the Japanese guidelines the prevalence was 1.5%

Conclusions: In this prospective, population-based study the prevalence of iNPH was 3.7% among individuals 65 years and older, and more common in the higher age group, 80 years and above. INPH should be increasingly recognized since it is a fairly common condition and an important cause of gait impairment and dementia among the elderly that can be effectively treated by shunt surgery.

Ort, förlag, år, upplaga, sidor
Public Library Science , 2019. Vol. 14, nr 5, artikel-id e0217705
Nationell ämneskategori
Geriatrik Neurologi
Identifikatorer
URN: urn:nbn:se:umu:diva-160294DOI: 10.1371/journal.pone.0217705ISI: 000469323000074PubMedID: 31141553Scopus ID: 2-s2.0-85067114888OAI: oai:DiVA.org:umu-160294DiVA, id: diva2:1325975
Tillgänglig från: 2019-06-17 Skapad: 2019-06-17 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
Ingår i avhandling
1. Idiopathic normal pressure hydrocephalus: epidemiology and diagnostics
Öppna denna publikation i ny flik eller fönster >>Idiopathic normal pressure hydrocephalus: epidemiology and diagnostics
2021 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Idiopatisk normaltryckshydrocephalus : epidemiologi och diagnostik
Abstract [en]

Idiopathic normal pressure hydrocephalus (iNPH) is a progressive neurological condition characterized by a deterioration of gait, cognition, and continence. The diagnosis is based on a combination of enlarged ventricles seen in neuroimaging, with typical clinical findings. iNPH often affects elderly individuals (i.e., over the age of 65). Shunt insertion is the only available treatment, with an improvement rate of up to 80%.

The prevalence has previously been reported to be between 0.5 and 3% among individuals over age 65. However, most previous studies have been conducted on hospital-based materials, and there is a lack of epidemiological studies based on the general population. One of the challenges of diagnosing iNPH is that there are no common, widely accepted diagnostic criteria. There are currently two different diagnostic guidelines: the American-European guidelines and the Japanese ones, which makes it harder to compare different studies.

The aim of this thesis was to determine the prevalence of iNPH in population-based materials and to evaluate the differences between the diagnostic guidelines. Furthermore, we wanted to assess the quality of life and depressive symptoms among individuals with iNPH compared to those without. In addition, we assessed longitudinal changes in the clinical and radiological findings of iNPH.

We asked 1,000 individuals aged 65 and older to participate in the study by answering a questionnaire containing typical iNPH symptoms. We invited all participants who had marked at least two symptoms on the questionnaire for further investigation, in addition to a randomly selected group with fewer than two symptoms. A total of 168 participants underwent clinical examinations and computed tomography (CT) of the brain. We followed up with the same cohort two years later with repeated testing, with the addition of questionnaires on depressive symptoms and quality of life. A total of 122 individuals remained in the 2-year follow-up cohort. The clinical examinations included an iNPH-specific grading scale for symptoms and neurological examinations.

The prevalence of iNPH for those 65 years and older was 3.7% according to the American-European guidelines and 1.5% according to the Japanese guidelines. The prevalence was higher for those over age 80, with no differences between the sexes. Furthermore, participants with iNPH had more depressive symptoms and lower quality of life than those without iNPH. Radiological findings and symptoms progressed slightly over two years, and those with symptom deterioration had an even higher degree of radiological progress compared to those with stationary or improved symptoms.

This thesis shows that iNPH is fairly common in a normal population of elderly individuals. There is disagreement between the current diagnostic guidelines, which underscores the need for revisions, preferably into one common diagnostic system. In this thesis, individuals with iNPH had a lower functional status, more depressive symptoms, and lower quality of life than those without iNPH.

Moreover, iNPH progresses slightly in both symptoms and radiological signs over two years, which underlines the value of clinical follow-up for asymptomatic individuals with radiological signs of iNPH. Finally, iNPH is probably underdiagnosed and an important diagnosis to consider in an elderly person with gait and balance impairments.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2021. s. 92
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2156
Nyckelord
idiopathic normal pressure hydrocephalus, epidemiology, prevalence, gait disorders, neuroimaging cognitive impairment, urinary incontinence, quality of life, depression
Nationell ämneskategori
Neurologi
Identifikatorer
urn:nbn:se:umu:diva-189510 (URN)978-91-7855-652-6 (ISBN)978-91-7855-653-3 (ISBN)
Disputation
2021-12-10, Betula, målpunkt L0, byggnad 6M, Umeå, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2021-11-19 Skapad: 2021-11-13 Senast uppdaterad: 2022-03-14Bibliografiskt granskad

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