title: Improvement in social function and health-related quality of life after shunt surgery for idiopathic normal-pressure hydrocephalus.
abstract: OBJECTIVE
  To investigate the impact of shunt surgery on the activity, participation, autonomy, and health-related quality of life (HRQOL) of patients with idiopathic normal-pressure hydrocephalus (iNPH) as well as the effect on caregiver burden.
  
  
  METHODS
  Thirty-seven patients (median age 70 years, range 50-89 years) with iNPH were evaluated before and 6 months after surgery. Symptoms and signs were assessed by the iNPH scale, activities of daily living (ADL) with the Functional Independence Measure (FIM) and Assessment of Motor and Process Skills (AMPS), autonomy and participation with Impact on Participation and Autonomy (IPA), and caregiver burden with the Caregiver Burden Scale (CBS). HRQOL was evaluated with the EQ-5D (EuroQol Group-5 Dimension health survey).
  
  
  RESULTS
  Twenty-four patients (65%) improved clinically (iNPH scale score) and 31 (86%) improved their HRQOL after surgery, almost to the same level as found in the normal population. The patients became more independent in physical and cognitive activities, and participation and autonomy improved. The caregiver burden was decreased among caregivers to male patients but remained unchanged on the overall group level.
  
  
  CONCLUSIONS
  After shunt surgery, patients with iNPH showed improvement in most aspects of social life, they became more independent, and their quality of life returned to nearly normal.
authors.affiliation: Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Jakob
authors.initials: J
authors.lastname: Petersen
authors.forename: Per
authors.initials: P
authors.lastname: Hellström
authors.forename: Carsten
authors.initials: C
authors.lastname: Wikkelsø
authors.forename: Asa
authors.initials: A
authors.lastname: Lundgren-Nilsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D058992:Social Participation; D017287:Ventriculoperitoneal Shunt
keywords: ADL = activities of daily living; AMPS = Assessment of Motor and Process Skills; CBS = Caregiver Burden Scale; EQ-VAS = EQ-5D visual analog scale; FIM = Functional Independence Measure; HRQOL = health-related quality of life; ICF = International Classification of Functioning, Disability and Health; ICP = intracranial pressure; IPA = Impact on Participation and Autonomy; TTO = time trade off; ZBI = Zarit burden interview; activity; autonomy; caregiver burden; iNPH = idiopathic normal-pressure hydrocephalus; idiopathic normal pressure hydrocephalus; participation; quality of life