Medical Student Drexel University College of Medicine
Introduction: Studies have delineated gait outcomes in patients with idiopathic normal pressure hydrocephalus (iNPH) after ventriculoperitoneal shunting (VPS), but gait outcomes in neurodegenerative normal pressure hydrocephalus (ndNPH) after VPS is underexplored. This study compares post-VPS gait response between patients with iNPH and ndNPH.
Methods: We retrospectively analyzed records of patients at a single institution who underwent a lumbar tap trial (LTT) between 2016 and 2024, and categorized those who completed VPS subsequently into iNPH, secondary (sNPH), or ndNPH groups. We excluded sNPH patients, patients with less than 90 days of follow-up post-VPS, and patients reclassified from iNPH to ndNPH during follow up sessions post-VPS. Timed up and go (TUG) and 10-meter timed walk (TW) test results were collected as gait metrics prior to LTT and in follow-up sessions post-VPS. Data were sorted into short-term (≤ 6 mos.) and annual intervals (1 ± 0.5 yrs., 2 ± 0.5 yrs., etc.) post-VPS. For each interval, average TW and TUG changes between pre-LTT and post-VPS were compared to the clinical cutoffs (TW: 20% reduction; TUG: 3.5 sec. reduction) by a one-sampled t test to evaluate patient improvement (p < 0.05).
Results: There were 45 patients classified as iNPH and 23 as ndNPH. The iNPH group had improved average TW changes for short-term and 1-year follow-ups post-VPS (p = 0.0019 and p < 0.0001, respectively) and improved average TUG changes for short-term and 1-year follow-up post-VPS (p = 0.0027 and p = 0.0066, respectively). The ndNPH group only had short-term improved average TW changes (p = 0.013) and improved average TUG changes at 1 year follow-up post-VPS (p = 0.031).
Conclusion : As patients with ndNPH only had short-term improved TW outcomes and improvement at 1 year follow up for TUG outcomes post-VPS than iNPH patients, these findings can help clinicians inform ndNPH patients about their VPS outcomes.
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