The Outcomes Of Serial Cerebrospinal Fluid Removal In Elderly Patients With Idiopathic Normal Pressure Hydrocephalus
Received 22 August 2019
Accepted for publication 19 September 2019
Published 19 November 2019 Volume 2019:14 Pages 2063—2069
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Richard Walker
Ahmet Turan Isik,1 Derya Kaya,1 Esra Ates Bulut,1 Ozge Dokuzlar,1 Pinar Soysal2
1Unit for Aging Brain and Dementia, Department of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
Correspondence: Ahmet Turan Isik
Unit for Brain Aging and Dementia, Department of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Balcova, Izmir 35340, Turkey
Tel +90 232 412 43 41
Fax +90 232 412 43 49
Purpose: Elderly patients with iNPH (idiopathic normal pressure hydrocephalus) might be potentially high-risk surgical patients. Our purpose was to investigate the outcome of serial removal of cerebrospinal fluid (CSF) in the patients with iNPH who refused to have the ventriculoperitoneal or lumboperitoneal shunt surgery or had contraindications to them.
Patients and methods: There were 42 patients, with a median age of 78 years. Recurrent CSF removal was performed when the patients had deteriorated gait which was defined as >10% pre-removal change on the average of two walking trials during timed up and go (TUG). All the patients underwent mini-mental status examination (MMSE), frontal assessment battery (FAB), Stroop test, Tinetti Performance Oriented Mobility Assessment (POMA), TUG and nine-hole peg test (NHPT) with the dominant hand, before and after CSF removal.
Results: Thirty-five patients had two CSF removal procedures with a mean interim period of 7.4 months ranging from 1.5 to 35 months. Thirteen patients had three CSF removal procedures. The mean TUG scores were decreased after the first, second and third procedures (p<0.001; p<0.001; p=0.007; respectively). The POMA scores including both gait and balance components improved after the first and second procedures (p<0.05; for each). After the third procedure, the increase in POMA-balance score was statistically significant (p<0.05). After the first procedure, the FAB scores and NHPT scores were significantly improved (p<0.02). The median follow-up duration of the patients was 34.5 months.
Conclusion: The deterioration of gait disturbance may be improved, and cognitive decline may be stabilized, at least postponed, by applying recurrent CSF removal in those unshunted patients with iNPH.
Keywords: normal pressure hydrocephalus, elderly, disability, gait, balance, tap test
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