Association between shunt-responsive idiopathic normal pressure hydrocephalus and alcohol.
OBJECTIVE Idiopathic normal pressure hydrocephalus (iNPH) is characterized by ventriculomegaly, gait difficulty, incontinence, and dementia. The symptoms can be ameliorated by CSF drainage. The object of this study was to identify factors associated with shunt-responsive iNPH. METHODS The authors reviewed the medical records of 529 patients who underwent shunt placement for iNPH at their institution between July 2001 and March 2015. Variables associated with shunt-responsive iNPH were identified using bivariate and multivariate analyses. Detailed alcohol consumption information was obtained for 328 patients and was used to examine the relationship between alcohol and shunt-responsive iNPH. A computerized patient registry from 2 academic medical centers was queried to determine the prevalence of alcohol abuse among 1665 iNPH patients. RESULTS Bivariate analysis identified associations between shunt-responsive iNPH and gait difficulty (OR 4.59, 95% CI 2.32-9.09; p < 0.0001), dementia (OR 1.79, 95% CI 1.14-2.80; p = 0.01), incontinence (OR 1.77, 95% CI 1.13-2.76; p = 0.01), and alcohol use (OR 1.98, 95% CI 1.23-3.16; p = 0.03). Borderline significance was observed for hyperlipidemia (OR 1.56, 95% CI 0.99-2.45; p = 0.054), a family history of hyperlipidemia (OR 3.09, 95% CI 0.93-10.26, p = 0.054), and diabetes (OR 1.83, 95% CI 0.96-3.51; p = 0.064). Multivariate analysis identified associations with gait difficulty (OR 3.98, 95% CI 1.81-8.77; p = 0.0006) and alcohol (OR 1.94, 95% CI 1.10-3.39; p = 0.04). Increased alcohol intake correlated with greater improvement after CSF drainage. Alcohol abuse was 2.5 times more prevalent among iNPH patients than matched controls. CONCLUSIONS Alcohol consumption is associated with the development of shunt-responsive iNPH.
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Thu-Trang
TT
Hickman
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Matthew E
ME
Shuman
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Tatyana A
TA
Johnson
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Felix
F
Yang
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Rebecca R
RR
Rice
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Isaac M
IM
Rice
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Esther H
EH
Chung
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Robert
R
Wiemann
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.|Department of Rehabilitation Services, Brigham and Women's Hospital; and.
Megan
M
Tinl
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.|Department of Rehabilitation Services, Brigham and Women's Hospital; and.
Christine
C
Iracheta
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.|Department of Rehabilitation Services, Brigham and Women's Hospital; and.
Grace
G
Chen
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.|Department of Rehabilitation Services, Brigham and Women's Hospital; and.
Patricia
P
Flynn
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Mary Beth
MB
Mondello
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Jillian
J
Thompson
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.|Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Mary-Ellen
ME
Meadows
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Rona S
RS
Carroll
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Hong Wei
HW
Yang
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Hongyan
H
Xing
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.|Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
David
D
Pilgrim
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
E Antonio
EA
Chiocca
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Ian F
IF
Dunn
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Alexandra J
AJ
Golby
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School.
Mark D
MD
Johnson
D000368:Aged; D000437:Alcoholism / Q000150:complications*; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000150:complications* / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt
TUG = Timed Up and Go; aging; alcohol; cognitive impairment; gait disorders; iNPH = idiopathic normal pressure hydrocephalus; incontinence; normal pressure hydrocephalus
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