Vascular factors in suspected normal pressure hydrocephalus: A population-based study

Area of Science:

• Neurology
• Radiology
• Epidemiology

Background:

• Idiopathic normal pressure hydrocephalus (iNPH) is a neurological condition characterized by gait disturbance, urinary incontinence, and cognitive impairment.
• The exact pathophysiology of iNPH remains unclear, but vascular factors are increasingly suspected to play a role.

Purpose of the Study:

• To investigate the association between clinical and imaging findings of suspected iNPH and vascular risk factors.
• To explore the relationship between white matter lesions (WMLs) and suspected iNPH in a population-based sample.

Main Methods:

• A nested case-control study was conducted using a population-based sample of 1,235 individuals aged 70 years and older.
• Brain CT scans were used to identify 55 individuals with hydrocephalic ventricular enlargement, of whom 26 met criteria for probable iNPH (suspected iNPH).
• Cases were matched with 5 controls, and data on vascular risk factors (hypertension, DM, smoking, etc.) and WMLs were analyzed using conditional logistic regression.

Main Results:

• Suspected iNPH was significantly associated with moderate to severe WMLs (OR 5.2).
• Hydrocephalic ventricular enlargement showed associations with hypertension (OR 2.7), moderate to severe WMLs (OR 6.5), and DM (OR 4.3).

Conclusions:

• Hypertension, WMLs, and DM are associated with both clinical and imaging features of iNPH.
• These findings support the involvement of vascular mechanisms in the pathophysiology of iNPH.
• The results may contribute to a better understanding of iNPH disease mechanisms and potential prevention strategies.