title: Mortality and risk of dementia in normal-pressure hydrocephalus: A population study.
abstract: BACKGROUND
  We examined mortality, dementia, and progression of hydrocephalic symptoms among untreated individuals with idiopathic normal-pressure hydrocephalus (iNPH) in a population-based sample.
  
  
  METHODS
  A total of 1235 persons were examined between 1986 and 2012. Shunted individuals were excluded. We examined 53 persons with hydrocephalic ventricular enlargement (probable iNPH: n = 24, asymptomatic or possible iNPH: n = 29). Comparisons were made with individuals without hydrocephalic ventricular enlargement.
  
  
  RESULTS
  The 5-year mortality was 87.5% among those with probable iNPH. The hazard ratio (HR) for death was 3.8 (95% confidence interval [CI]: 2.5-6.0) for probable iNPH. Those with possible iNPH and asymptomatic hydrocephalic ventricular enlargement had increased risk of developing dementia, HR 2.8 (95% CI: 1.5-5.2). Only two individuals with hydrocephalic ventricular enlargement remained asymptomatic.
  
  
  CONCLUSIONS
  In the present sample, persons with clinical and imaging signs of iNPH had excess mortality and an increased risk of dementia. The data also suggest that radiological signs of iNPH might be more important than previously supposed.
authors.affiliation: Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Neuropsychiatric Epidemiology Research Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Mölndal, Sweden; Department of Clinical Neuroscience, Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden. Electronic address: daniel.jaraj@vgregion.se.
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaraj
authors.affiliation: Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Neuroscience, Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Carsten
authors.initials: C
authors.lastname: Wikkelsø
authors.affiliation: Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Neuroscience, Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Katrin
authors.initials: K
authors.lastname: Rabiei
authors.affiliation: Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Neuropsychiatric Epidemiology Research Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Mölndal, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Marlow
authors.affiliation: Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Jensen
authors.affiliation: Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Neuropsychiatric Epidemiology Research Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Mölndal, Sweden.
authors.forename: Svante
authors.initials: S
authors.lastname: Östling
authors.affiliation: Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Neuropsychiatric Epidemiology Research Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Mölndal, Sweden.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Skoog
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D003704:Dementia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000523:psychology; D053208:Kaplan-Meier Estimate; D008297:Male; D000073216:Mental Status and Dementia Tests; D011446:Prospective Studies; D012306:Risk; D014057:Tomography, X-Ray Computed
keywords: Dementia; Epidemiology; Long-term outcome; Mortality; Natural course; Normal-pressure hydrocephalus; Outcome