HydrocephalusThe Dutch Normal-Pressure Hydrocephalus Study: How to select patients for shunting? AN ANALYSIS OF FOUR DIAGNOSTIC CRITERIA
Section snippets
Measurement of gait disturbance and dementia
Gait disturbance was quantified by a gait scale that evaluates the presence of 10 features of gait and measures the number of steps and seconds required for a 10-meter walk (range, 2–40). Dementia was assessed by means of a dementia scale comprising the 10-word test, digit span forwards and backwards, trail making, and finger tapping (range, 4–40). Both scales are described in detail elsewhere [14]. To create one neurological outcome measure the scores for gait and dementia were added, yielding
Results
A summary of the primary outcome measures for the negative and positive outcome of each test is given in Table 1. The proportion of patients classified as improved was significantly greater for those with positive than with negative test results. The highest percentage of shunt responders in the NPH scale was found for patients with an Rcsf measurement ≥ 18 mmHg/ml/minute. CT yielded the largest difference between positive and negative test outcomes in the Rankin scale. The number of patients
Clinical and computed tomographic findings
Because only patients with a diagnosis of NPH were eligible for our study, the classification of their clinical and CT findings as compatible with or typical of NPH requires explanation. Both the clinical and CT diagnoses of NPH are notoriously difficult. The gait disturbance, for instance, has specific features such as a wide-based, apraxic gait with small steps and feet appearing glued to the floor. On the other hand, NPH gait resembles in many ways the aspecific senile gait disorder with
Acknowledgements
This study was supported by grants from the Dr. Ed. Hoelen Stichting and an anonymous foundation.
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