Clinical outcomes after ventriculoatrial shunting for idiopathic normal pressure hydrocephalus

Ann Liu, Eric W. Sankey, Ignacio Jusué-Torres, Mira A. Patel, Benjamin D. Elder, C. Rory Goodwin, Jamie Hoffberger, Jennifer Lu, Daniele Rigamonti

Research output: Contribution to journalArticle

Abstract

Introduction Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder that classically presents with a triad of progressive gait impairment, urinary incontinence, and cognitive deterioration. Treatment predominantly involves ventriculoperitoneal (VP) shunting, but one alternative is ventriculoatrial (VA) shunting. This study sought to describe and evaluate the clinical outcomes of patients with iNPH primarily treated with VA shunting. Materials and Methods A retrospective review of patients with iNPH who were treated with VA shunting at a single institution, from 2003 to 2013, was performed. Results 58 patients with iNPH underwent primary VA shunting at a median age of 74 (IQR: 70-80) years. The most common comorbidities included hypertension (n = 39, 67%) and diabetes mellitus (n = 11, 19%). Median duration of symptoms prior to VA shunting was 24 (IQR: 12-36) months. All patients had gait impairment, 52 (90%) had cognitive decline, and 43 (74%) had urinary incontinence. Forty-three (74%) patients had all three symptoms. At a median last follow-up of 16 (IQR: 7-26) months, median iNPH score improved from 6 to 3 (p <0.0001), mini mental status exam (MMSE) tended to increase from 26 to 29 (p = 0.082), timed up-and-go (TUG) improved from 18 to 13 s (p <0.0001), and Tinetti score improved from 19 to 25 (p <0.0001) after VA shunting. 78% of patients had improvement in at least one of their symptoms with 66% of patients having improvement in gait, 53% having improvement in their cognition, and 52% having improved urinary incontinence. A total of 21 patients (36%) had improvement in all 3 symptoms. Conclusions There were significant improvements in functional outcomes as evaluated via the iNPH score, TUG, and Tinetti score, while improvement in MMSE trended toward significance. Patients also had improvement of clinical symptoms related to gait, urinary function and cognition. These results suggest that VA shunting can be an effective primary treatment alternative to VP shunting for iNPH.

Original languageEnglish (US)
Pages (from-to)34-38
Number of pages5
JournalClinical Neurology and Neurosurgery
Volume143
DOIs
StatePublished - Apr 1 2016

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Normal Pressure Hydrocephalus
Gait
Urinary Incontinence
Cognition
Nervous System Diseases
Comorbidity
Diabetes Mellitus
Hypertension

Keywords

  • Cerebrospinal fluid shunt
  • Cognitive dysfunction
  • Gait
  • Idiopathic normal pressure hydrocephalus
  • Outcomes
  • Ventriculoatrial shunt

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Clinical outcomes after ventriculoatrial shunting for idiopathic normal pressure hydrocephalus. / Liu, Ann; Sankey, Eric W.; Jusué-Torres, Ignacio; Patel, Mira A.; Elder, Benjamin D.; Goodwin, C. Rory; Hoffberger, Jamie; Lu, Jennifer; Rigamonti, Daniele.

In: Clinical Neurology and Neurosurgery, Vol. 143, 01.04.2016, p. 34-38.

Research output: Contribution to journalArticle

Liu, A, Sankey, EW, Jusué-Torres, I, Patel, MA, Elder, BD, Goodwin, CR, Hoffberger, J, Lu, J & Rigamonti, D 2016, 'Clinical outcomes after ventriculoatrial shunting for idiopathic normal pressure hydrocephalus', Clinical Neurology and Neurosurgery, vol. 143, pp. 34-38. https://doi.org/10.1016/j.clineuro.2016.02.013
Liu, Ann ; Sankey, Eric W. ; Jusué-Torres, Ignacio ; Patel, Mira A. ; Elder, Benjamin D. ; Goodwin, C. Rory ; Hoffberger, Jamie ; Lu, Jennifer ; Rigamonti, Daniele. / Clinical outcomes after ventriculoatrial shunting for idiopathic normal pressure hydrocephalus. In: Clinical Neurology and Neurosurgery. 2016 ; Vol. 143. pp. 34-38.
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abstract = "Introduction Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder that classically presents with a triad of progressive gait impairment, urinary incontinence, and cognitive deterioration. Treatment predominantly involves ventriculoperitoneal (VP) shunting, but one alternative is ventriculoatrial (VA) shunting. This study sought to describe and evaluate the clinical outcomes of patients with iNPH primarily treated with VA shunting. Materials and Methods A retrospective review of patients with iNPH who were treated with VA shunting at a single institution, from 2003 to 2013, was performed. Results 58 patients with iNPH underwent primary VA shunting at a median age of 74 (IQR: 70-80) years. The most common comorbidities included hypertension (n = 39, 67{\%}) and diabetes mellitus (n = 11, 19{\%}). Median duration of symptoms prior to VA shunting was 24 (IQR: 12-36) months. All patients had gait impairment, 52 (90{\%}) had cognitive decline, and 43 (74{\%}) had urinary incontinence. Forty-three (74{\%}) patients had all three symptoms. At a median last follow-up of 16 (IQR: 7-26) months, median iNPH score improved from 6 to 3 (p <0.0001), mini mental status exam (MMSE) tended to increase from 26 to 29 (p = 0.082), timed up-and-go (TUG) improved from 18 to 13 s (p <0.0001), and Tinetti score improved from 19 to 25 (p <0.0001) after VA shunting. 78{\%} of patients had improvement in at least one of their symptoms with 66{\%} of patients having improvement in gait, 53{\%} having improvement in their cognition, and 52{\%} having improved urinary incontinence. A total of 21 patients (36{\%}) had improvement in all 3 symptoms. Conclusions There were significant improvements in functional outcomes as evaluated via the iNPH score, TUG, and Tinetti score, while improvement in MMSE trended toward significance. Patients also had improvement of clinical symptoms related to gait, urinary function and cognition. These results suggest that VA shunting can be an effective primary treatment alternative to VP shunting for iNPH.",
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AU - Sankey, Eric W.

AU - Jusué-Torres, Ignacio

AU - Patel, Mira A.

AU - Elder, Benjamin D.

AU - Goodwin, C. Rory

AU - Hoffberger, Jamie

AU - Lu, Jennifer

AU - Rigamonti, Daniele

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N2 - Introduction Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder that classically presents with a triad of progressive gait impairment, urinary incontinence, and cognitive deterioration. Treatment predominantly involves ventriculoperitoneal (VP) shunting, but one alternative is ventriculoatrial (VA) shunting. This study sought to describe and evaluate the clinical outcomes of patients with iNPH primarily treated with VA shunting. Materials and Methods A retrospective review of patients with iNPH who were treated with VA shunting at a single institution, from 2003 to 2013, was performed. Results 58 patients with iNPH underwent primary VA shunting at a median age of 74 (IQR: 70-80) years. The most common comorbidities included hypertension (n = 39, 67%) and diabetes mellitus (n = 11, 19%). Median duration of symptoms prior to VA shunting was 24 (IQR: 12-36) months. All patients had gait impairment, 52 (90%) had cognitive decline, and 43 (74%) had urinary incontinence. Forty-three (74%) patients had all three symptoms. At a median last follow-up of 16 (IQR: 7-26) months, median iNPH score improved from 6 to 3 (p <0.0001), mini mental status exam (MMSE) tended to increase from 26 to 29 (p = 0.082), timed up-and-go (TUG) improved from 18 to 13 s (p <0.0001), and Tinetti score improved from 19 to 25 (p <0.0001) after VA shunting. 78% of patients had improvement in at least one of their symptoms with 66% of patients having improvement in gait, 53% having improvement in their cognition, and 52% having improved urinary incontinence. A total of 21 patients (36%) had improvement in all 3 symptoms. Conclusions There were significant improvements in functional outcomes as evaluated via the iNPH score, TUG, and Tinetti score, while improvement in MMSE trended toward significance. Patients also had improvement of clinical symptoms related to gait, urinary function and cognition. These results suggest that VA shunting can be an effective primary treatment alternative to VP shunting for iNPH.

AB - Introduction Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder that classically presents with a triad of progressive gait impairment, urinary incontinence, and cognitive deterioration. Treatment predominantly involves ventriculoperitoneal (VP) shunting, but one alternative is ventriculoatrial (VA) shunting. This study sought to describe and evaluate the clinical outcomes of patients with iNPH primarily treated with VA shunting. Materials and Methods A retrospective review of patients with iNPH who were treated with VA shunting at a single institution, from 2003 to 2013, was performed. Results 58 patients with iNPH underwent primary VA shunting at a median age of 74 (IQR: 70-80) years. The most common comorbidities included hypertension (n = 39, 67%) and diabetes mellitus (n = 11, 19%). Median duration of symptoms prior to VA shunting was 24 (IQR: 12-36) months. All patients had gait impairment, 52 (90%) had cognitive decline, and 43 (74%) had urinary incontinence. Forty-three (74%) patients had all three symptoms. At a median last follow-up of 16 (IQR: 7-26) months, median iNPH score improved from 6 to 3 (p <0.0001), mini mental status exam (MMSE) tended to increase from 26 to 29 (p = 0.082), timed up-and-go (TUG) improved from 18 to 13 s (p <0.0001), and Tinetti score improved from 19 to 25 (p <0.0001) after VA shunting. 78% of patients had improvement in at least one of their symptoms with 66% of patients having improvement in gait, 53% having improvement in their cognition, and 52% having improved urinary incontinence. A total of 21 patients (36%) had improvement in all 3 symptoms. Conclusions There were significant improvements in functional outcomes as evaluated via the iNPH score, TUG, and Tinetti score, while improvement in MMSE trended toward significance. Patients also had improvement of clinical symptoms related to gait, urinary function and cognition. These results suggest that VA shunting can be an effective primary treatment alternative to VP shunting for iNPH.

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