title: Multimodal analysis to predict shunt surgery outcome of 284 patients with suspected idiopathic normal pressure hydrocephalus.
abstract: Optimal selection of idiopathic normal pressure hydrocephalus (iNPH) patients for shunt surgery is challenging. Disease State Index (DSI) is a statistical method that merges multimodal data to assist clinical decision-making. It has previously been shown to be useful in predicting progression in mild cognitive impairment and differentiating Alzheimer's disease (AD) and frontotemporal dementia. In this study, we use the DSI method to predict shunt surgery response for patients with iNPH.
  
  
  
  In this retrospective cohort study, a total of 284 patients (230 shunt responders and 54 non-responders) from the Kuopio NPH registry were analyzed with the DSI. Analysis included data from patients' memory disorder assessments, age, clinical symptoms, comorbidities, medications, frontal cortical biopsy, CT/MRI imaging (visual scoring of disproportion between Sylvian and suprasylvian subarachnoid spaces, atrophy of medial temporal lobe, superior medial subarachnoid spaces), APOE genotyping, CSF AD biomarkers, and intracranial pressure.
  
  
  
  Our analysis showed that shunt responders cannot be differentiated from non-responders reliably even with the large dataset available (AUC = 0.58).
  
  
  
  Prediction of the treatment response in iNPH is challenging even with our extensive dataset and refined analysis. Further research of biomarkers and indicators predicting shunt responsiveness is still needed.
authors.affiliation: Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.|Neurosurgery of Neuro Center, Kuopio University Hospital, PO Box 100 FIN-70029 KYS, Kuopio, Finland.
authors.forename: Antti J
authors.initials: AJ
authors.lastname: Luikku
authors.affiliation: Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.
authors.forename: Anette
authors.initials: A
authors.lastname: Hall
authors.affiliation: Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.|Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Ossi
authors.initials: O
authors.lastname: Nerg
authors.affiliation: Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.|Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Koivisto
authors.affiliation: Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.|Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.|Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Hiltunen
authors.affiliation: Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Helisalmi
authors.affiliation: Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.|Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Sanna-Kaisa
authors.initials: SK
authors.lastname: Herukka
authors.affiliation: Department of Radiology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Anna
authors.initials: A
authors.lastname: Sutela
authors.affiliation: Neurosurgery of Neuro Center, Kuopio University Hospital, PO Box 100 FIN-70029 KYS, Kuopio, Finland.|Department of Radiology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Maria
authors.initials: M
authors.lastname: Kojoukhova
authors.affiliation: VTT Technical Research Centre of Finland, Tampere, Finland.|Combinostics Ltd, Tampere, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Mattila
authors.affiliation: VTT Technical Research Centre of Finland, Tampere, Finland.|Combinostics Ltd, Tampere, Finland.
authors.forename: Jyrki
authors.initials: J
authors.lastname: Lötjönen
authors.affiliation: Department of Pathology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Rummukainen
authors.affiliation: Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.|Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University and Department of Pathology and Cytology, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Irina
authors.initials: I
authors.lastname: Alafuzoff
authors.affiliation: Neurosurgery of Neuro Center, Kuopio University Hospital, PO Box 100 FIN-70029 KYS, Kuopio, Finland.
authors.forename: Juha E
authors.initials: JE
authors.lastname: Jääskeläinen
authors.affiliation: Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.|Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Remes
authors.affiliation: Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.|Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Hilkka
authors.initials: H
authors.lastname: Soininen
authors.affiliation: Neurosurgery of Neuro Center, Kuopio University Hospital, PO Box 100 FIN-70029 KYS, Kuopio, Finland. ville.leinonen@kuh.fi.
authors.forename: Ville
authors.identifier: 0000-0002-4282-4687
authors.initials: V
authors.lastname: Leinonen
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects* / Q000379:methods; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D007427:Intracranial Pressure; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D018579:Patient Selection; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers
keywords: Cognitive decline; Computer-assisted diagnosis; Idiopathic normal pressure hydrocephalus; Prognosis; Shunt response