The influence of co-morbidity on the postoperative outcomes of patients with idiopathic normal pressure hydrocephalus (iNPH)

  • U. Meier
  • J. Lemcke
Part of the Acta Neurochirurgica Supplementum book series (NEUROCHIRURGICA, volume 102)

Background A critical question in the diagnosis and treatment of idiopathic normal pressure hydrocephalus (iNPH) is that of which preoperative factors can most reliably predict outcomes following shunt insertion. The number and type of co-morbidities are increasingly being viewed as important predictive indicators.

Methods Between 1997 and 2004, 95 patients were implanted with a gravitational ventriculo-peritoneal shunt as treatment for iNPH. All coincident disease processes were recorded. Eighty-two of these patients underwent follow-up 2 years postoperatively. The results of this prospective follow-up examination (Kiefer Score, NPH Recovery Rate) were compared with the preoperative Co-Morbidity Index (CMI).

Findings Of the patients with a CMI score of 0–1 (n=18), 67% experienced an excellent outcome, 28% a good outcome and 5% and 0% a fair and poor outcome respectively. A CMI score of 2–3 was associated with markedly poorer outcomes (n=33); 42% excellent, 30% good, 18% fair and 10% poor. A score of 4–5 was related to 14% excellent, 27% good, 23% fair and 36% poor outcomes (n=22). Remarkably few patients scoring between 6 and 8 on the CMI scale experienced a favourable outcome. The outcomes for this latter group were 0% excellent, 10% good, 45% fair and 45% poor (n=9).

Conclusions Co-morbidity is a statistically significant predictor of the quality of clinical outcome for patients with iNPH undergoing shunt therapy.


Idiopathic normal pressure hydrocephalus Co-Morbidity Index (CMI) Shunt surgery Outcome Co-morbidity iNPH 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bech RA, Waldemar G, Gjerris F (1999) Shunting effects in patients with idiopathic normal pressure hydrocephalus: correlations with cerebral and leptomeningeal biopsy findings. Acta Neurochir (Wien) 141:633–639CrossRefGoogle Scholar
  2. 2.
    Boon AJ, Tans JT, Delwei EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Hermans J (1999) Dutch Normal Pressure Hydro-cephalus Study: the role of cerebrovascular disease. J Neurosurg 90(2):221–226PubMedCrossRefGoogle Scholar
  3. 3.
    Borgesen SE (1984) Conductance to outflow of CSF in normal pressure hydrocephalus. Acta Neurochir (Wien) 71:1–15CrossRefGoogle Scholar
  4. 4.
    Golomb J, Wisoff J, Miller DC, Boksay I, Kluger A, Weiner H, Salton J, Graves W (2000) Alzheimer's disease comorbidity in normal pressure hydrocephalus: prevalence and shunt response. J Neurol Neurosurg Psychiatry 68(6):778–81PubMedCrossRefGoogle Scholar
  5. 5.
    Hebb AO, Cusimano MD (2001) Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 49:1166–1186PubMedCrossRefGoogle Scholar
  6. 6.
    Kiefer M, Eymann R, Meier U (2002) Five years experience with gravitational shunts in chronic hydrocephalus of adults. Acta Neurochir (Wien) 144:755–767CrossRefGoogle Scholar
  7. 7.
    Kiefer M, Eymann R, Steudel WI (2006) Outcome predictors for normal pressure hydrocephalus. Acta Neurochir Suppl 96:364–367PubMedCrossRefGoogle Scholar
  8. 8.
    Meier U, Kiefer M, Sprung C (2003) Normal-pressure hydro-cephalus: pathology, pathophysiology, diagnostics, therapeutics and clinical course. PVV Science, RatingenGoogle Scholar
  9. 9.
    Meier U, Zeilinger FS, Kintzel D (1999) Signs, symptoms and course of normal pressure hydrocephalus in comparison with cerebral atrophy. Acta Neurochir (Wien) 141(10):1039–1048CrossRefGoogle Scholar
  10. 10.
    Savolainen S, Paljarvi L, Vapalahti M (1999) Prevalence of Alzheimer's disease in patients investigated for presumed normal pressure hydrocephalus: a clinical and neuropathological study. Acta Neurochir (Wien) 141(8):849–583CrossRefGoogle Scholar
  11. 11.
    Tulberg M (2000) CSF sulfatide distinguishes between NPH and subcortical ateriosclerotic encephalopathy. J Neurol Neurosurg Psychiatry 69:74–81CrossRefGoogle Scholar
  12. 12.
    Vanneste JA (2000) Diagnosis ad management of normal-pressure hydrocephalus. J Neurol 247(1):5–14PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2008

Authors and Affiliations

  • U. Meier
    • 1
  • J. Lemcke
    • 1
  1. 1.Department of NeurosurgeryUnfallkrankenhaus BerlinBerlinGermany

Personalised recommendations