title: NPH Log: Validation of a New Assessment Tool Leading to Earlier Diagnosis of Normal Pressure Hydrocephalus.
abstract: BACKGROUND
  Early treatment of normal pressure hydrocephalus (NPH) yields better postoperative outcomes. Our current tests often fail to detect significant changes at early stages. We developed a new scoring system (LP log score) to determine if this tool is more sensitive in detecting clinical differences than current tests.
  
  
  METHODS
  Sixty-two consecutive new patients with suspected idiopathic NPH were studied. Secondary, previously treated and obstructive cases were not included. We collected age, pre- and post-lumbar puncture (LP) Tinetti, Timed Up and Go (TUG) Test, European NPH scale, and LP log scores. The LP log score is recorded at baseline and for seven consecutive days after removing 40 cc of cerebrospinal fluid (CSF) via LP. We studied the diagnostic accuracy of the tests for surgical indication.
  
  
  RESULTS
  The post-LP log showed improvement in 90% of people with good baseline gait tests and in 93% of people who did not show any pre-LP and post-LP change in gait tests. Sensitivity, specificity, and accuracy to detect intention to treat when positive post-LP improvements were 4%, 100%, and 24%, respectively, for TUG, 21%, 86%, and 34%, respectively, for the Tinetti Mobility Test, 66%, 29%, and 58%, respectively, for Medical College of Virginia (MCV) grade, and 98%, 33%, and 85%, respectively, for LP log score. Pre-LP and post-LP TUG improvement and pre-LP and post-LP Tinetti improvement were not associated with a surgical indication (p > 0.05). LP log improvement was associated with surgical indication odds ratio (OR): 24.5 95% CI (2.4-248.12) (p = 0.007).
  
  
  CONCLUSIONS
  LP log showed better sensitivity, diagnostic accuracy, and association with surgical indication than the current diagnostic approach. An LP log may be useful detecting NPH patients at earlier stages and, therefore, yield better surgical outcomes.
authors.affiliation: Department of Neurosurgery, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Jusué-Torres
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine.
authors.forename: Jamie
authors.initials: J
authors.lastname: Robison
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine.
authors.forename: Jamie B
authors.initials: JB
authors.lastname: Hoffberger
authors.affiliation: Department of Oncology, The Johns Hopkins University School of Medicine.
authors.forename: Alicia
authors.initials: A
authors.lastname: Hulbert
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health.
authors.forename: Abanti
authors.initials: A
authors.lastname: Sanyal
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine.
authors.forename: Jan
authors.initials: J
authors.lastname: Wemmer
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Elder
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine ; Department of Radiation Oncology, The Johns Hopkins University School of Medicine.
authors.forename: Daniele
authors.initials: D
authors.lastname: Rigamonti
keywords: diagnostic accuracy; early diagnosis; normal pressure hydrocephalus; sensitivity; specificity