title: The Dynamic Gait Index in Evaluating Patients with Normal Pressure Hydrocephalus for Cerebrospinal Fluid Diversion.
abstract: BACKGROUND
  Diagnosing normal pressure hydrocephalus (NPH) remains challenging. Most clinical tests currently used to evaluate suspected NPH patients for shunt surgery are invasive, require inpatient admission, and are not without complications. An objective, noninvasive, and low-cost alternative would be ideal.
  
  
  METHODS
  A retrospective review was performed of prospectively collected dynamic gait index (DGI) scores, obtained at baseline and on every day of a 3- to 5-day lumbar cerebrospinal fluid (CSF) drainage trial on patients with suspected NPH at our institution.
  
  
  RESULTS
  Between 2003 and 2014, 170 patients were suspected to have primary NPH (166, 97.6%) or secondary NPH (4, 2.4%). Using responsiveness to lumbar CSF drainage and subsequent shunting as the reference standard, we found that a baseline DGI ≥ 7 was found to have significant ability in selecting patients for permanent CSF diverting shunt surgery: sensitivity of 84.2% (95% confidence interval [95% CI]: 75.6%-90.2%), specificity of 80.6% (95% CI 70.0%-88.0%), and diagnostic odds ratio of 22.1 (95% CI 9.9-49.3).
  
  
  CONCLUSIONS
  A baseline DGI ≥ 7 appears to provide an objective, low-cost, noninvasive measure to select patients with suspected NPH for a positive response to CSF diversion with high sensitivity, specificity and diagnostic odds ratio.
authors: Department of Neurological Surgery, University of California Los Angeles, Los Angeles, California, USA. Electronic address: schivukula@mednet.ucla.edu.
authors: Srinivas
authors: S
authors: Chivukula
authors: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: Zachary J
authors: ZJ
authors: Tempel
authors: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: Nathan T
authors: NT
authors: Zwagerman
authors: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: W Christopher
authors: WC
authors: Newman
authors: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: Samuel S
authors: SS
authors: Shin
authors: Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
authors: Ching-Jen
authors: CJ
authors: Chen
authors: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: Paul A
authors: PA
authors: Gardner
authors: Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: Eric M
authors: EM
authors: McDade
authors: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: Andrew F
authors: AF
authors: Ducruet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002557:Cerebrospinal Fluid Shunts; D003704:Dementia / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005684:Gait; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Dementia; Gait; Normal pressure hydrocephalus; Surgery