Long-Term Follow-up in Idiopathic Normal Pressure Hydrocephalus—Towards a more Comprehensive Disease Outcome
Bibliographic record
Abstract
BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is characterized by a slowly progressive clinical triad of gait disorder, cognitive decline, and urinary incontinence combined with ventricular dilation and normal mean intracranial pressure. We aimed to evaluate the 6-year follow-up after shunt implantation in patients with iNPH. METHODS: We retrospectively reviewed the data of all patients with iNPH treated with shunt surgery over a 6-year follow-up period. Outcomes were assessed using the Kiefer Scale and the NPH-Recovery Rate (NPH-RR). Secondarily, the number of steps needed for 180° turn as a measure of gait disturbance, the Montreal Cognitive Assessment (MoCA) score as a measure of cognitive decline, and the urinary continence status of patients were recorded. RESULTS: A total of 165 patients (mean age 74.7 ± 7.4 years) were included in this study. The mean preoperative Kiefer Score was 7.3 ± 3.1, significantly higher than the Kiefer Score 6 months, and 1, 2, 3, 4, 5 (P < 0.001) and 6 years (P = 0.006) after shunting procedure. The NPH-RR in the first 3 years after shunting procedure was greater than 5 and therefore representing a good clinical outcome. The number of steps for 180° turn decreased from 4.4 ± 1.9 preoperatively to 2.8 ± 1.6 postoperatively. In this cohort, 28 of 165 patients (17.0%) underwent MoCA testing both pre- and postoperatively, with 9 patients (32.1%) showing significant improvement. The proportion of urinary incontinent patients decreased from 70.4% to 29.6%. CONCLUSIONS: Patients with iNPH benefit significantly from shunt therapy up to 6 years postoperatively, with improvements noted among all components of the clinical triad.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".