Objective: To explore the clinical characteristics and predictors for longer benefit of gait after cerebrospinal fluid (CSF) decompression test in patients with normal pressure hydrocephalus (NPH).

Background: In light of a paucity of effective medical therapy, the CSF decompression is one of the most effective treatment for patients with NPH in reality. Elderly patients, however, who is older than 75 have not normally been favored for surgical shunt procedure. Given the single or repetitive CSF drainage as an only therapeutic option for those subpopulations, we sought to investigate the clinical characteristics of the patients who presented prolonged benefit from single CSF decompression and its predictors.

Method: The current registry-based retrospective cohort study investigated 53 NPH patients who underwent CSF decompression by spinal tap test. We stratified all the individuals based on a prolonged effect of gait improvement, including up to 3, 6, and 12 months. We had assessed clinical parameters including gait by means of the Timed Up and Go (TUG) test and 10-meter walking test, mini mental status examination (MMSE) for cognition, and radiological parameters such as Evans index (EI), frontal-occipital horn ratio (FOHR), callosal angle (CA), callosal height (CH), and temporal horn width (THW).

Results: We had identified 15, 21, and 17 patients for group of 3-, 6-, and over 12-months of benefit duration, respectively. The 12-months group demonstrated a younger age (vs 3 and 6 moths; 64.3 ± 10.6 vs 68.9 ± 12.5 and 71.5 ± 14.3; p < 0.05), less occurrence of festination or FOG (2/17(11.8 %) vs 7/21 (33.3 %) and 7/15 (46.7 %); p < 0.001), and higher score of MMSE (24.1 ± 5.4 vs 21.4 ± 4.7 and 20.6 ± 7.4; p < 0.05). Evans index was not significantly different. Meanwhile combined group of both 6- and 12-months group demonstrated higher prevalence of DESH sign (33/38 (86.8 %) vs 4/15 (26.7 %); p < 0.001) and lower callosal angle (96.8 ± 12.8 vs 113.4 ± 15.6; p < 0.05) than those of 3-months group.

Conclusion: Our data demonstrated that NPH patients with younger age, better cognition, and lack of both festination and FOG had a longer benefit of gait after CSF decompression. Presence of DESH sign and callosal bowing predicted outcome of CSF drainage better than Evans index.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-and-radiologic-predictors-for-a-longer-benefit-of-cerebrospinal-fluid-decompression-in-normal-pressure-hydrocephalus/