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Normal-Pressure Hydrocephalus: Onset of Gait Abnormality Before Dementia Predicts Good Surgical Outcome

Normal-Pressure Hydrocephalus: Onset of Gait Abnormality Before Dementia Predicts Good Surgical... Abstract • In 1977, Fisher reported that in patients with possible normal-pressure hydrocephalus (NPH), if the gait abnormality preceded dementia, surgery usually had a favorable outcome and vice versa. We studied this finding in 21 patients shunted for possible NPH. By evaluating serial videotapes of gait, neuropsychological tests, and Katz index ratings, preoperatively and at approximately two months and six months postoperatively, we judged 16 patients improved. In the improved group, the families reported that the gait abnormality preceded the dementia in 11 patients and occurred at the same time in five. In the unimproved group, dementia was noted first in three patients, gait abnormality first in one patient, and gait abnormality and dementia at the same time in one patient. Using Fisher's exact test, we compared the improved and unimproved groups for gait abnormality or dementia onset first and found a significant difference. We conclude that the history of gait abnormality occurring before or after dementia in patients with possible NPH is an important prognostic factor for surgical outcome. References 1. Symon L, Hinzpeter T: The enigma of normal pressure hydrocephalus: Tests to select patients for surgery and to predict shunt function . Clin Neurosurg 1977;24:285-315. 2. Laws ER, Mokri B: Occult hydrocephalus: Results of shunting correlated with diagnostic tests . Clin Neurosurg 1977;24:316-333. 3. Huckman MS: Normal pressure hydrocephalus: Evaluation of diagnostic and prognostic tests . AJNR 1981;2:385-395. 4. Fisher CM: The clinical picture in occult hydrocephalus . Clin Neurosurg 1977;24:270-315. 5. Børgesen SE, Gjerris F: The predictive value of conductance to outflow of CSF in normal pressure hydrocephalus . Brain 1982;105:65-86.Crossref 6. Wechsler DA: Wechsler Adult Intelligence Scale (revised). New York, The Psychological Corp, 1981. 7. Benton AL, Hamsher K, Varney N, et al: Contributions to Neuropsychological Assessment: A Clinical Manual . New York, Oxford University Press Inc, 1983. 8. Benton AL: Revised Visual Retention Test , ed 4. New York, The Psychological Corp, 1974. 9. Rey A: L'examen clinique en psychologie , ed 2. Paris, Presses Universitaires de France, 1964. 10. Benton AL, Hamsher K: Multilingual Aphasia Examination . Iowa City, Department of Neurology, University of Iowa Hospitals, 1978. 11. Osterrieth PA: Le test de copie d'une figure complexe . Arch Psychol 1945;30:205-353. 12. Benton AL, Varney NR, Hamsher K: Visuospatial judgment . Arch Neurol 1978;35:364-367.Crossref 13. Kane RA, Kane RL: Assessing the Elderly: A Practical Guide to Measurements . Lexington, Mass, DC Heath & Co, 1981. 14. Peterson RC, Mokri B, Laws ER: Surgical treatment of idiopathic hydrocephalus in elderly patients . Neurology 1985;35:307-311.Crossref 15. Mortimer JA, Shuman LM, French LR: Epidemiology of dementing illness , in Mortimer JA, Shuman LM (eds): The Epidemiology of Dementia . New York, Oxford University Press Inc, 1981. 16. Yarnell JW, St Leger AS: The prevalence, severity, and factors associated with urinary incontinence in a random sample of the elderly . Age Ageing 1979;8:81-85.Crossref 17. Sudarsky L, Ronthal M: Gait disorders among elderly patients: A survey study of 50 patients . Arch Neurol 1983;40:740-743.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Normal-Pressure Hydrocephalus: Onset of Gait Abnormality Before Dementia Predicts Good Surgical Outcome

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1986.00520090068020
Publisher site
See Article on Publisher Site

Abstract

Abstract • In 1977, Fisher reported that in patients with possible normal-pressure hydrocephalus (NPH), if the gait abnormality preceded dementia, surgery usually had a favorable outcome and vice versa. We studied this finding in 21 patients shunted for possible NPH. By evaluating serial videotapes of gait, neuropsychological tests, and Katz index ratings, preoperatively and at approximately two months and six months postoperatively, we judged 16 patients improved. In the improved group, the families reported that the gait abnormality preceded the dementia in 11 patients and occurred at the same time in five. In the unimproved group, dementia was noted first in three patients, gait abnormality first in one patient, and gait abnormality and dementia at the same time in one patient. Using Fisher's exact test, we compared the improved and unimproved groups for gait abnormality or dementia onset first and found a significant difference. We conclude that the history of gait abnormality occurring before or after dementia in patients with possible NPH is an important prognostic factor for surgical outcome. References 1. Symon L, Hinzpeter T: The enigma of normal pressure hydrocephalus: Tests to select patients for surgery and to predict shunt function . Clin Neurosurg 1977;24:285-315. 2. Laws ER, Mokri B: Occult hydrocephalus: Results of shunting correlated with diagnostic tests . Clin Neurosurg 1977;24:316-333. 3. Huckman MS: Normal pressure hydrocephalus: Evaluation of diagnostic and prognostic tests . AJNR 1981;2:385-395. 4. Fisher CM: The clinical picture in occult hydrocephalus . Clin Neurosurg 1977;24:270-315. 5. Børgesen SE, Gjerris F: The predictive value of conductance to outflow of CSF in normal pressure hydrocephalus . Brain 1982;105:65-86.Crossref 6. Wechsler DA: Wechsler Adult Intelligence Scale (revised). New York, The Psychological Corp, 1981. 7. Benton AL, Hamsher K, Varney N, et al: Contributions to Neuropsychological Assessment: A Clinical Manual . New York, Oxford University Press Inc, 1983. 8. Benton AL: Revised Visual Retention Test , ed 4. New York, The Psychological Corp, 1974. 9. Rey A: L'examen clinique en psychologie , ed 2. Paris, Presses Universitaires de France, 1964. 10. Benton AL, Hamsher K: Multilingual Aphasia Examination . Iowa City, Department of Neurology, University of Iowa Hospitals, 1978. 11. Osterrieth PA: Le test de copie d'une figure complexe . Arch Psychol 1945;30:205-353. 12. Benton AL, Varney NR, Hamsher K: Visuospatial judgment . Arch Neurol 1978;35:364-367.Crossref 13. Kane RA, Kane RL: Assessing the Elderly: A Practical Guide to Measurements . Lexington, Mass, DC Heath & Co, 1981. 14. Peterson RC, Mokri B, Laws ER: Surgical treatment of idiopathic hydrocephalus in elderly patients . Neurology 1985;35:307-311.Crossref 15. Mortimer JA, Shuman LM, French LR: Epidemiology of dementing illness , in Mortimer JA, Shuman LM (eds): The Epidemiology of Dementia . New York, Oxford University Press Inc, 1981. 16. Yarnell JW, St Leger AS: The prevalence, severity, and factors associated with urinary incontinence in a random sample of the elderly . Age Ageing 1979;8:81-85.Crossref 17. Sudarsky L, Ronthal M: Gait disorders among elderly patients: A survey study of 50 patients . Arch Neurol 1983;40:740-743.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Sep 1, 1986

References