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Symptom Burden and Intervention Outcomes in Idiopathic Normal Pressure Hydrocephalus: A Multicenter Retrospective
Joshua Amaya1, Zachary D Griffin1, Curran Reddy1
1Graduate Medical Education, Baylor Scott & White All Saints Medical Center, Fort Worth, USA.
Introduction:
Normal pressure hydrocephalus (NPH) is a potentially reversible cause of dementia, characterized by a clinical triad of gait disturbance, urinary incontinence, and cognitive decline. Despite suggestive radiologic findings, many patients remain untreated. This study aimed to determine the clinical correlation between radiographic findings of NPH and clinical symptoms. It also investigated whether the number of NPH symptoms predicts the likelihood of intervention and clinical improvement (in any of the triad of symptoms), and assessed gender-based disparities in treatment.
Methods:
We conducted a multicenter retrospective chart review across three hospitals, identifying patients with radiologic evidence of NPH between 2019 and 2023. We recorded symptom burden, intervention rates (shunt placement or lumbar puncture), and post-intervention outcomes.
Results:
Among 385 included patients, both intervention rates and response to therapy increased with symptom count. Gender differences were noted, with men more likely to receive treatment. However, improvement rates did not significantly differ based on the number of symptoms.
Conclusion:
Of all patients with radiology findings of normal pressure hydrocephalus, 317 (82.3%) had at least one symptom classically associated with NPH. A proportion of iNPH patients may be undertreated. Symptom burden and gender disparities appear to influence clinical decision-making and warrant further investigation.
