iNPH QUEST Study: quantifying a battery of gait, cognitive and radiological examinations to improve identification of shunt candidates from the cerebrospinal fluid tap test
Bibliographic record
Abstract
Idiopathic normal Pressure hydrocephalus (iNPH), a condition resulting in abnormalities of gait, cognition and continence, is treated by the placement of a ventricular peritoneal (VP) shunt to drain cerebrospinal fluid (CSF). To identify surgical candidates the CSF tap test (TT) was devised to mimic VP shunt insertion. The CSF TT involves drainage of a small volume of CSF to assess for symptom improvement. Additionally, measurements of CSF flow on MRI imaging have been devised to identify VP shunt candidates. Limited research has investigated assessing what outcome measures can identify change from a CSF TT. Neither the tests capable of definitively identifying change from a CSF TT nor the degree of change required on any test constituting a clinically important difference have been extensively investigated. Additionally, whether any measure on MRI CSF flow studies can identify change using outcome measures has not been explored. This thesis aims to: 1. Identify a battery of standardised gait and balance outcome measures which can identify change from a CSF TT. 2. Identify a battery of standardised upper limb and cognitive outcome measures which can identify change from a CSF TT. 3. Develop minimally clinically important differences (MCIDs) for a battery of outcome measures. 4. Identify radiological markers on MRI CSF flow studies that are prognostic of response to CSF drainage. The ability of the Timed up and go (TUG), Timed up and go cognition (TUG-C), performance oriented mobility assessment (Tinetti), Berg balance scale (BBS), 10 metre walk test (10MWT), Montreal cognitive assessment (MoCA) and 9 hole peg test (9HPT) to identify change from a CSF TT was assessed. These studies demonstrated that the TUG, TUG-C, Tinetti and BBS could identify change from a CSF TT. Calculated MCIDs were 3.63sec for the TUG, 2.60sec for the TUG-C, 4 points for the Tinetti and 4 points for the BBS represent MCIDs for improvement from a CSF TT. Additionally, we have shown that the measurements of the sagittal sinus circumference and area can differentiate improvement in gait as a result of CSF drainage. Further research is required to evaluate the utility of these MCID values in identifying improvement following VP shunt insertion.
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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) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.008 | 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".