title: One-year outcome in the European multicentre study on iNPH.
abstract: OBJECTIVE
  To assess the 1-year outcome after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH).
  
  
  METHODS
  Patients (n = 142) were prospectively included in the European multicentre study by 13 centres. Diagnoses were based solely on clinical and radiological findings. All received a programmable ventriculoperitoneal shunt. Re-examinations, 12 months after surgery, were performed in 115 patients, and the outcome was assessed by the modified Rankin scale (mRs) and a new iNPH grading scale. Improvement was defined as ≥1 step on the mRs and ≥5 points on the iNPH scale.
  
  
  RESULTS
  The scores on both scales were significantly improved after 1 year of shunt treatment (Ps < 0.001). Sixty-nine per cent of the patients were improved according to the mRs and 84% according to the iNPH scale. The proportion able to live independently (scores 0-2 on the mRs) was increased from 53% before to 82% 12 months after surgery (P < 0.001). Neither classification (typical or questionable) nor comorbidity affected the level of improvement. Patients not completing the study were worse off with regard to their clinical condition at entry than completers. Twenty-eight per cent of the patients experienced complications and were either conservatively (13%) or surgically (15%) treated.
  
  
  CONCLUSIONS
  The results of this prospective multicentre study on patients with iNPH diagnosed solely on clinical and radiological criteria support shunt surgery in patients presenting with symptoms and signs and MRI findings suggestive of iNPH.
authors.affiliation: Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, USA.
authors.forename: P
authors.initials: P
authors.lastname: Klinge
authors.forename: P
authors.initials: P
authors.lastname: Hellström
authors.forename: J
authors.initials: J
authors.lastname: Tans
authors.forename: C
authors.initials: C
authors.lastname: Wikkelsø
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*