5-Year health-related quality of life outcome in patients with idiopathic normal pressure hydrocephalus

• Published in: Journal of neurology Vol. 268; no. 9; pp. 3283 - 3293
• Main Authors: Junkkari, A., Sintonen, H., Danner, N., Jyrkkänen, H. K., Rauramaa, T., Luikku, A. J., Koivisto, A. M., Roine, R. P., Viinamäki, H., Soininen, H., Jääskeläinen, J. E., Leinonen, V.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2021; Springer Nature B.V
• Subjects: Aging; Body mass index; Body weight; Cerebrospinal fluid; Cognitive ability; Hydrocephalus; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosciences; Original Communication; Overweight; Patients; Quality of life; Surgery; 15D; Health-related quality of life; Charlson Age Comorbidity Index; Frontal cortical biopsy; Comorbidity; Idiopathic normal pressure hydrocephalus
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-021-10477-x

Background
Health-related quality of life (HRQoL) is severely impaired in persons with idiopathic normal pressure hydrocephalus (iNPH). The HRQoL improves in a number of patients after the placement of a cerebrospinal fluid (CSF) shunt, but long-term follow-up of HRQoL is rare.
Methods
Extended follow-up (60 months) of a prospective cohort study involving 189 patients with iNPH who underwent shunt surgery. Preoperative variables were used to predict favorable HRQoL outcome (improvement or non-deterioration) measured by the 15D instrument 5 years after shunting.
Results
Out of the 189 initially enrolled study participants, 88 had completed 5-year HRQoL follow-up (46%), 64 had died (34%), and 37 (20%) failed to complete the HRQoL follow-up but were alive at the end of the study. After initial post-operative HRQoL improvement, HRQoL deteriorated so that 37/88 participants (42%) had a favorable HRQoL outcome 5 years after shunting. Multivariate binary logistic regression analysis indicated that younger age (adjusted OR 0.86, 95% CI 0.77–0.95;
p
 < 0.005), lower body mass index (adjusted OR 0.87, 95% CI 0.77–0.98;
p
 < 0.05) and better Mini-Mental State Examination performance (adjusted OR 1.16, 95% CI 1.01–1.32;
p
 < 0.05) before surgery predicted favorable 5-year outcome.
Conclusions
This extended follow-up showed that the self-evaluated HRQoL outcome is associated with iNPH patients’ pre-operative cognitive status, overweight and age. The post-operative deterioration may reflect the natural progression of iNPH, but also derive from aging and comorbidities. It indicates a need for long-term follow-up.