title: Vascular factors in suspected normal pressure hydrocephalus: A population-based study.
abstract: OBJECTIVE
  We examined clinical and imaging findings of suspected idiopathic normal pressure hydrocephalus (iNPH) in relation to vascular risk factors and white matter lesions (WMLs), using a nested case-control design in a representative, population-based sample.
  
  
  METHODS
  From a population-based sample, 1,235 persons aged 70 years or older were examined with CT of the brain between 1986 and 2000. We identified 55 persons with hydrocephalic ventricular enlargement, i.e., radiologic findings consistent with iNPH. Among these, 26 had clinical signs that fulfilled international guideline criteria for probable iNPH. These cases were labeled suspected iNPH. Each case was matched to 5 controls from the same sample, based on age, sex, and study cohort. Data on risk factors were obtained from clinical examinations and the Swedish Hospital Discharge Register. History of hypertension, diabetes mellitus (DM), smoking, overweight, history of coronary artery disease, stroke/TIA, and WMLs on CT were examined. Risk factors associated with iNPH with a p value <0.1 in χ2 tests were included in conditional logistic regression models.
  
  
  RESULTS
  In the regression analyses, suspected iNPH was related to moderate to severe WMLs (odds ratio [OR] 5.2; 95% confidence interval [CI]: 1.5-17.6), while hydrocephalic ventricular enlargement was related to hypertension (OR 2.7; 95% CI: 1.1-6.8), moderate to severe WMLs (OR 6.5; 95% CI: 2.1-20.3), and DM (OR 4.3; 95% CI: 1.1-16.3).
  
  
  CONCLUSIONS
  Hypertension, WMLs, and DM were related to clinical and imaging features of iNPH, suggesting that vascular mechanisms are involved in the pathophysiology. These findings might have implications for understanding disease mechanisms in iNPH and possibly prevention.
authors.affiliation: From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden. daniel.jaraj@vgregion.se.
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaraj
authors.affiliation: From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden.
authors.forename: Simon
authors.initials: S
authors.lastname: Agerskov
authors.affiliation: From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden.
authors.forename: Katrin
authors.initials: K
authors.lastname: Rabiei
authors.affiliation: From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Marlow
authors.affiliation: From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Jensen
authors.affiliation: From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden.
authors.forename: Xinxin
authors.initials: X
authors.lastname: Guo
authors.affiliation: From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden.
authors.forename: Silke
authors.initials: S
authors.lastname: Kern
authors.affiliation: From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden.
authors.forename: Carsten
authors.initials: C
authors.lastname: Wikkelsø
authors.affiliation: From the Institute of Neuroscience and Physiology (D.J., S.A., K.R., T.M., X.G., S.K., C.W., I.S.), Neuropsychiatric Epidemiology Research Unit (D.J., T.M., X.G., S.K., I.S.), Hydrocephalus Research Unit (D.J., S.A., K.R., C.W.), and Institute of Clinical Sciences (C.J.), University of Gothenburg, Sweden.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Skoog
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D066127:White Matter / Q000000981:diagnostic imaging