Protocolizing the Work-up for Idiopathic Normal Pressure Hydrocephalus Improves Outcomes
Citation Manager Formats
Make Comment
See Comments

ABSTRACT
Background: The work-up for idiopathic normal pressure hydrocephalus (INPH) can be difficult to coordinate and determining appropriate patients for ventriculoperitoneal shunting can be challenging, so we hypothesized that implementing a formalized protocol can improve patient selection for shunt. In conjunction with neurology and neurosurgery, we instituted a standardized means of assessing patients whose presentation is concerning for INPH and compared their work-up with similar patients seen without the protocol (i.e., “pre-protocol” or PP) regarding baseline characteristics, assessment, and outcomes.
Methods: Twenty-six PP patients were compared with 40 protocol patients on measures, including baseline deficits, work-up, neurosurgical evaluation, and response to shunt.
Results: Average age was similar between groups and percentage of patients who had a decline in gait, cognition, and/or incontinence was not statistically different (p>0.05). Significantly more protocol patients underwent high-volume lumbar puncture (HVLP; 97.5%; PP, 61.5%; p<0.001) and received formalized gait assessment with The Gait Scale (90%; PP, 0%, p<0.001) and standardized cognitive testing (95%; PP, 38.5%; p<0.001). Significantly more protocol patients had no improvement after HVLP (33.3%; PP 6.25%, p<0.045); subsequently, fewer got shunted (57.5%; PP, 84.6%; p<0.030). More protocol patients who were shunted reported gait improvement (100%; PP, 72.7%; p=0.009), though there was no difference in cognition (59.2%; PP, 82.6%, p=0.108) or incontinence (18.2%; PP, 39.1%, p=0.189).
Conclusions: Implementing an INPH protocol leads to standardized and more extensive assessment and better patient selection for and subsequent outcomes from shunting, specifically regarding gait.
- Received August 28, 2020.
- Accepted October 22, 2020.
- © 2020 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
The Nerve!: Rapid online correspondence
NOTE: All contributors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.cp.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.
- Stay timely. Submit only on articles published within the last 8 weeks.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- 200 words maximum.
- 5 references maximum. Reference 1 must be the article on which you are commenting.
- 5 authors maximum. Exception: replies can include all original authors of the article.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Related Articles
- No related articles found.