A prospective evaluation of clinical and instrumental features before and after ventriculo-peritoneal shunt in patients with idiopathic Normal pressure hydrocephalus: The Bologna PRO-Hydro study

the BOLOGNA PRO-HYDRO Study Group

Research output: Contribution to journalArticle

Abstract

Introduction: Idiopathic Normal Pressure Hydrocephalus (iNPH) is a complex and often misdiagnosed syndrome, whose major challenge is to identify which patients will benefit from surgery. Previous studies reported a variability in positive surgery response. The role of tap test(TT) in screening patients suitable for shunting is controversial. The primary aim of this study was to describe the clinical/instrumental features and their longitudinal progression after surgery in iNPH patients. Secondarily, we aimed to investigate the response of the three iNPH domains and the best time of outcome assessment after TT. Methods: Patients compatible with iNPH underwent a 3-T-MRI and an inpatients program with TT including standardized clinical evaluations, neuropsychological assessments and instrumental gait analysis pre- and after-(24-h and 72-h) TT. The multidisciplinary team selected candidates for surgery. Patients were evaluated 6- and 12-months after surgery. Results: A total of 154 consecutive patients were included from 2015 to 2018, 76 with an iNPH diagnosis (43 underwent surgery, 35 were evaluated after 6-months). Clinical and instrumented quantitative gait measures and urinary symptoms improved over time along with some neuropsychological functions. Concerning pre- and post-TT analyses, the three iNPH domains showed a different response after TT, the delayed motor assessment was more appropriate than the early one and the instrumental measures highlighted the motor improvement. Conclusion: iNPH patients improved after surgery, when accurately selected. A multidisciplinary team focused on this disease and a standardized protocol helped in achieving a correct diagnosis and management of iNPH. Our results could impact the management of this disease.

Original languageEnglish
Pages (from-to)117-124
Number of pages8
JournalParkinsonism and Related Disorders
Volume66
DOIs
Publication statusPublished - Sep 2019

Fingerprint

Normal Pressure Hydrocephalus
Ventriculoperitoneal Shunt
Gait
Disease Management
Diagnostic Errors
Inpatients
Outcome Assessment (Health Care)

Keywords

  • Clinical practice
  • Idiopathic Normal pressure hydrocephalus
  • Movement disorders
  • Neuropsychological features
  • Observational prospective study
  • Ventriculo-peritoneal shunt

ASJC Scopus subject areas

  • Neurology
  • Geriatrics and Gerontology
  • Clinical Neurology

Cite this

@article{39f13953962e40da959fa0854de6ed32,
title = "A prospective evaluation of clinical and instrumental features before and after ventriculo-peritoneal shunt in patients with idiopathic Normal pressure hydrocephalus: The Bologna PRO-Hydro study",
abstract = "Introduction: Idiopathic Normal Pressure Hydrocephalus (iNPH) is a complex and often misdiagnosed syndrome, whose major challenge is to identify which patients will benefit from surgery. Previous studies reported a variability in positive surgery response. The role of tap test(TT) in screening patients suitable for shunting is controversial. The primary aim of this study was to describe the clinical/instrumental features and their longitudinal progression after surgery in iNPH patients. Secondarily, we aimed to investigate the response of the three iNPH domains and the best time of outcome assessment after TT. Methods: Patients compatible with iNPH underwent a 3-T-MRI and an inpatients program with TT including standardized clinical evaluations, neuropsychological assessments and instrumental gait analysis pre- and after-(24-h and 72-h) TT. The multidisciplinary team selected candidates for surgery. Patients were evaluated 6- and 12-months after surgery. Results: A total of 154 consecutive patients were included from 2015 to 2018, 76 with an iNPH diagnosis (43 underwent surgery, 35 were evaluated after 6-months). Clinical and instrumented quantitative gait measures and urinary symptoms improved over time along with some neuropsychological functions. Concerning pre- and post-TT analyses, the three iNPH domains showed a different response after TT, the delayed motor assessment was more appropriate than the early one and the instrumental measures highlighted the motor improvement. Conclusion: iNPH patients improved after surgery, when accurately selected. A multidisciplinary team focused on this disease and a standardized protocol helped in achieving a correct diagnosis and management of iNPH. Our results could impact the management of this disease.",
keywords = "Clinical practice, Idiopathic Normal pressure hydrocephalus, Movement disorders, Neuropsychological features, Observational prospective study, Ventriculo-peritoneal shunt",
author = "Giulia Giannini and Giorgio Palandri and Alberto Ferrari and Federico Oppi and David Milletti and Luca Albini-Riccioli and Paolo Mantovani and Stefania Magnoni and Lorenzo Chiari and Pietro Cortelli and Sabina Cevoli and {the BOLOGNA PRO-HYDRO Study Group} and Raffaele Agati and Giovanna Calandra-Buonaura and Sabina Capellari and Piero Parchi and Michelangelo Stanzani-Maserati and Marliani, {Anna Federica} and Margherita Merola and Piserchia, {Vito Antonio} and Luisa Sambati and Carmelo Sturiale and Antonella Supino and Monica Nicola and Tiziana Urli",
note = "Ricercatore distaccato presso IRCCS a seguito Convenzione esclusiva con Universit{\`a} di Bologna (Cortelli Pietro)",
year = "2019",
month = "9",
doi = "10.1016/j.parkreldis.2019.07.021",
language = "English",
volume = "66",
pages = "117--124",
journal = "Parkinsonism and Related Disorders",
issn = "1353-8020",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - A prospective evaluation of clinical and instrumental features before and after ventriculo-peritoneal shunt in patients with idiopathic Normal pressure hydrocephalus

T2 - The Bologna PRO-Hydro study

AU - Giannini, Giulia

AU - Palandri, Giorgio

AU - Ferrari, Alberto

AU - Oppi, Federico

AU - Milletti, David

AU - Albini-Riccioli, Luca

AU - Mantovani, Paolo

AU - Magnoni, Stefania

AU - Chiari, Lorenzo

AU - Cortelli, Pietro

AU - Cevoli, Sabina

AU - the BOLOGNA PRO-HYDRO Study Group

AU - Agati, Raffaele

AU - Calandra-Buonaura, Giovanna

AU - Capellari, Sabina

AU - Parchi, Piero

AU - Stanzani-Maserati, Michelangelo

AU - Marliani, Anna Federica

AU - Merola, Margherita

AU - Piserchia, Vito Antonio

AU - Sambati, Luisa

AU - Sturiale, Carmelo

AU - Supino, Antonella

AU - Nicola, Monica

AU - Urli, Tiziana

N1 - Ricercatore distaccato presso IRCCS a seguito Convenzione esclusiva con Università di Bologna (Cortelli Pietro)

PY - 2019/9

Y1 - 2019/9

N2 - Introduction: Idiopathic Normal Pressure Hydrocephalus (iNPH) is a complex and often misdiagnosed syndrome, whose major challenge is to identify which patients will benefit from surgery. Previous studies reported a variability in positive surgery response. The role of tap test(TT) in screening patients suitable for shunting is controversial. The primary aim of this study was to describe the clinical/instrumental features and their longitudinal progression after surgery in iNPH patients. Secondarily, we aimed to investigate the response of the three iNPH domains and the best time of outcome assessment after TT. Methods: Patients compatible with iNPH underwent a 3-T-MRI and an inpatients program with TT including standardized clinical evaluations, neuropsychological assessments and instrumental gait analysis pre- and after-(24-h and 72-h) TT. The multidisciplinary team selected candidates for surgery. Patients were evaluated 6- and 12-months after surgery. Results: A total of 154 consecutive patients were included from 2015 to 2018, 76 with an iNPH diagnosis (43 underwent surgery, 35 were evaluated after 6-months). Clinical and instrumented quantitative gait measures and urinary symptoms improved over time along with some neuropsychological functions. Concerning pre- and post-TT analyses, the three iNPH domains showed a different response after TT, the delayed motor assessment was more appropriate than the early one and the instrumental measures highlighted the motor improvement. Conclusion: iNPH patients improved after surgery, when accurately selected. A multidisciplinary team focused on this disease and a standardized protocol helped in achieving a correct diagnosis and management of iNPH. Our results could impact the management of this disease.

AB - Introduction: Idiopathic Normal Pressure Hydrocephalus (iNPH) is a complex and often misdiagnosed syndrome, whose major challenge is to identify which patients will benefit from surgery. Previous studies reported a variability in positive surgery response. The role of tap test(TT) in screening patients suitable for shunting is controversial. The primary aim of this study was to describe the clinical/instrumental features and their longitudinal progression after surgery in iNPH patients. Secondarily, we aimed to investigate the response of the three iNPH domains and the best time of outcome assessment after TT. Methods: Patients compatible with iNPH underwent a 3-T-MRI and an inpatients program with TT including standardized clinical evaluations, neuropsychological assessments and instrumental gait analysis pre- and after-(24-h and 72-h) TT. The multidisciplinary team selected candidates for surgery. Patients were evaluated 6- and 12-months after surgery. Results: A total of 154 consecutive patients were included from 2015 to 2018, 76 with an iNPH diagnosis (43 underwent surgery, 35 were evaluated after 6-months). Clinical and instrumented quantitative gait measures and urinary symptoms improved over time along with some neuropsychological functions. Concerning pre- and post-TT analyses, the three iNPH domains showed a different response after TT, the delayed motor assessment was more appropriate than the early one and the instrumental measures highlighted the motor improvement. Conclusion: iNPH patients improved after surgery, when accurately selected. A multidisciplinary team focused on this disease and a standardized protocol helped in achieving a correct diagnosis and management of iNPH. Our results could impact the management of this disease.

KW - Clinical practice

KW - Idiopathic Normal pressure hydrocephalus

KW - Movement disorders

KW - Neuropsychological features

KW - Observational prospective study

KW - Ventriculo-peritoneal shunt

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U2 - 10.1016/j.parkreldis.2019.07.021

DO - 10.1016/j.parkreldis.2019.07.021

M3 - Article

C2 - 31358442

AN - SCOPUS:85069689297

VL - 66

SP - 117

EP - 124

JO - Parkinsonism and Related Disorders

JF - Parkinsonism and Related Disorders

SN - 1353-8020

ER -