The Outcomes Of Serial Cerebrospinal Fluid Removal In Elderly Patients With Idiopathic Normal Pressure Hydrocephalus

Ahmet Turan Isik,1 Derya Kaya,1 Esra Ates Bulut,1 Ozge Dokuzlar,1 Pinar Soysal2 1Unit for Aging Brain and Dementia, Department of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbu...

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Autores principales:	Isik AT, Kaya D, Ates Bulut E, Dokuzlar O, Soysal P
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	normal pressure hydrocephalus elderly disability gait balance tap test Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/7ba785fcf1014e23aeaa494ec39a7917
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spelling	oai:doaj.org-article:7ba785fcf1014e23aeaa494ec39a79172021-12-02T12:03:06ZThe Outcomes Of Serial Cerebrospinal Fluid Removal In Elderly Patients With Idiopathic Normal Pressure Hydrocephalus1178-1998https://doaj.org/article/7ba785fcf1014e23aeaa494ec39a79172019-11-01T00:00:00Zhttps://www.dovepress.com/the-outcomes-of-serial-cerebrospinal-fluid-removal-in-elderly-patients-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Ahmet Turan Isik,1 Derya Kaya,1 Esra Ates Bulut,1 Ozge Dokuzlar,1 Pinar Soysal2 1Unit for Aging Brain and Dementia, Department of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, TurkeyCorrespondence: Ahmet Turan IsikUnit for Brain Aging and Dementia, Department of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Balcova, Izmir 35340, TurkeyTel +90 232 412 43 41Fax +90 232 412 43 49Email atisik@yahoo.comPurpose: Elderly patients with iNPH (idiopathic normal pressure hydrocephalus) might be potentially high-risk surgical patients. Our purpose was to investigate the outcome of serial removal of cerebrospinal fluid (CSF) in the patients with iNPH who refused to have the ventriculoperitoneal or lumboperitoneal shunt surgery or had contraindications to them.Patients and methods: There were 42 patients, with a median age of 78 years. Recurrent CSF removal was performed when the patients had deteriorated gait which was defined as >10% pre-removal change on the average of two walking trials during timed up and go (TUG). All the patients underwent mini-mental status examination (MMSE), frontal assessment battery (FAB), Stroop test, Tinetti Performance Oriented Mobility Assessment (POMA), TUG and nine-hole peg test (NHPT) with the dominant hand, before and after CSF removal.Results: Thirty-five patients had two CSF removal procedures with a mean interim period of 7.4 months ranging from 1.5 to 35 months. Thirteen patients had three CSF removal procedures. The mean TUG scores were decreased after the first, second and third procedures (p<0.001; p<0.001; p=0.007; respectively). The POMA scores including both gait and balance components improved after the first and second procedures (p<0.05; for each). After the third procedure, the increase in POMA-balance score was statistically significant (p<0.05). After the first procedure, the FAB scores and NHPT scores were significantly improved (p<0.02). The median follow-up duration of the patients was 34.5 months.Conclusion: The deterioration of gait disturbance may be improved, and cognitive decline may be stabilized, at least postponed, by applying recurrent CSF removal in those unshunted patients with iNPH.Keywords: normal pressure hydrocephalus, elderly, disability, gait, balance, tap test  Isik ATKaya DAtes Bulut EDokuzlar OSoysal PDove Medical Pressarticlenormal pressure hydrocephaluselderlydisabilitygaitbalancetap testGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 14, Pp 2063-2069 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	normal pressure hydrocephalus elderly disability gait balance tap test Geriatrics RC952-954.6
spellingShingle	normal pressure hydrocephalus elderly disability gait balance tap test Geriatrics RC952-954.6 Isik AT Kaya D Ates Bulut E Dokuzlar O Soysal P The Outcomes Of Serial Cerebrospinal Fluid Removal In Elderly Patients With Idiopathic Normal Pressure Hydrocephalus
description	Ahmet Turan Isik,1 Derya Kaya,1 Esra Ates Bulut,1 Ozge Dokuzlar,1 Pinar Soysal2 1Unit for Aging Brain and Dementia, Department of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, TurkeyCorrespondence: Ahmet Turan IsikUnit for Brain Aging and Dementia, Department of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Balcova, Izmir 35340, TurkeyTel +90 232 412 43 41Fax +90 232 412 43 49Email atisik@yahoo.comPurpose: Elderly patients with iNPH (idiopathic normal pressure hydrocephalus) might be potentially high-risk surgical patients. Our purpose was to investigate the outcome of serial removal of cerebrospinal fluid (CSF) in the patients with iNPH who refused to have the ventriculoperitoneal or lumboperitoneal shunt surgery or had contraindications to them.Patients and methods: There were 42 patients, with a median age of 78 years. Recurrent CSF removal was performed when the patients had deteriorated gait which was defined as >10% pre-removal change on the average of two walking trials during timed up and go (TUG). All the patients underwent mini-mental status examination (MMSE), frontal assessment battery (FAB), Stroop test, Tinetti Performance Oriented Mobility Assessment (POMA), TUG and nine-hole peg test (NHPT) with the dominant hand, before and after CSF removal.Results: Thirty-five patients had two CSF removal procedures with a mean interim period of 7.4 months ranging from 1.5 to 35 months. Thirteen patients had three CSF removal procedures. The mean TUG scores were decreased after the first, second and third procedures (p<0.001; p<0.001; p=0.007; respectively). The POMA scores including both gait and balance components improved after the first and second procedures (p<0.05; for each). After the third procedure, the increase in POMA-balance score was statistically significant (p<0.05). After the first procedure, the FAB scores and NHPT scores were significantly improved (p<0.02). The median follow-up duration of the patients was 34.5 months.Conclusion: The deterioration of gait disturbance may be improved, and cognitive decline may be stabilized, at least postponed, by applying recurrent CSF removal in those unshunted patients with iNPH.Keywords: normal pressure hydrocephalus, elderly, disability, gait, balance, tap test
format	article
author	Isik AT Kaya D Ates Bulut E Dokuzlar O Soysal P
author_facet	Isik AT Kaya D Ates Bulut E Dokuzlar O Soysal P
author_sort	Isik AT
title	The Outcomes Of Serial Cerebrospinal Fluid Removal In Elderly Patients With Idiopathic Normal Pressure Hydrocephalus
title_short	The Outcomes Of Serial Cerebrospinal Fluid Removal In Elderly Patients With Idiopathic Normal Pressure Hydrocephalus
title_full	The Outcomes Of Serial Cerebrospinal Fluid Removal In Elderly Patients With Idiopathic Normal Pressure Hydrocephalus
title_fullStr	The Outcomes Of Serial Cerebrospinal Fluid Removal In Elderly Patients With Idiopathic Normal Pressure Hydrocephalus
title_full_unstemmed	The Outcomes Of Serial Cerebrospinal Fluid Removal In Elderly Patients With Idiopathic Normal Pressure Hydrocephalus
title_sort	outcomes of serial cerebrospinal fluid removal in elderly patients with idiopathic normal pressure hydrocephalus
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/7ba785fcf1014e23aeaa494ec39a7917
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The Outcomes Of Serial Cerebrospinal Fluid Removal In Elderly Patients With Idiopathic Normal Pressure Hydrocephalus

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