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 machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".