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Five-year outcome of normal pressure hydrocephalus with or without a shunt: predictive value of the clinical signs, neuropsychological evaluation and infusion test
Savolainen S, Hurskainen H, Paljärvi L, Alafuzoff I, Vapalahti M.. Acta neurochirurgica, 2002-06-01
Topic: Risk, prevention and care in population studies
Background Between 1993-1995, 51 patients under 75 years of age with clinical symptoms and CT-based diagnosis of normal pressure hydrocephalus were investigated prospectively in order to clarify the value of neuropsychological tests, clinical symptoms and signs and infusion test in the differential diagnosis and prediction of outcome in normal pressure hydrocephalus. Methods Patients had a thorough neurological examination, and neuropsychological evaluation. A 24-hour intraventricular ICP-measurement, infusion test, neurophysiological investigations and MRI study were performed, and a cortical biopsy was obtained. The ICP measurement defined the need for a shunt. All 51 patients were re-examined three and twelve months later. The final follow-up was accomplished five years postoperatively. Findings 25 of the patients needed a shunt operation. One year after a shunt placement 72% of these patients had a good recovery concerning activities of daily living, 58% benefited in their urinary incontinence and 57% walked better. During the 5 years of follow-up 8 patients with shunt and 9 without shunt had died. Positive effect of shunting remained. Only one neuropsychological test, recognition of words test, distinguishes the patients with the need for a shunt. Simple mini mental examination test was not different in those who improved. In the postoperative follow-up patients with shunt showed no change in neuropsychological tests even if they were subjectively better. The infusion test was of no value in diagnosing NPH. The 16 patients with Alzheimer's disease did worse after one year than those without pathological changes, but the mortality was not increased. Interpretation Specific neuropsychological tests are of little value in diagnosing NPH. Mini-Mental status examination was neither of value in diagnosing NPH nor in prediction of the outcome. In this study the infusion test did not improve diagnostic accuracy of NPH, but shunt placement relieves urinary incontinence and walking disability in patients with increased ICP. The patients with positive Alzheimer diagnosis on biopsy did not improve.
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APA 7th
Savolainen, S., Hurskainen, H., Paljärvi, L., Alafuzoff, I., & Vapalahti, M. (2002). Five-year outcome of normal pressure hydrocephalus with or without a shunt: predictive value of the clinical signs, neuropsychological evaluation and infusion test. Acta neurochirurgica. https://doi.org/10.1007/s00701-002-0936-3
Vancouver
Savolainen S, Hurskainen H, Paljärvi L, Alafuzoff I, Vapalahti M. Five-year outcome of normal pressure hydrocephalus with or without a shunt: predictive value of the clinical signs, neuropsychological evaluation and infusion test. Acta neurochirurgica. 2002. doi:10.1007/s00701-002-0936-3. PMID: 12111484.
BibTeX
@article{savolainen2002-12111484,
author = {Savolainen, S. and Hurskainen, H. and Paljärvi, L. and Alafuzoff, I. and Vapalahti, M.},
title = {{Five-year outcome of normal pressure hydrocephalus with or without a shunt: predictive value of the clinical signs, neuropsychological evaluation and infusion test}},
journal = {Acta neurochirurgica},
year = {2002},
doi = {10.1007/s00701-002-0936-3},
pmid = {12111484},
url = {https://doi.org/10.1007/s00701-002-0936-3}
}
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Key findings
- The 16 patients with Alzheimer's disease did worse after one year than those without pathological changes, but the mortality was not increased.
- Interpretation Specific neuropsychological tests are of little value in diagnosing NPH.
- Mini-Mental status examination was neither of value in diagnosing NPH nor in prediction of the outcome.
- In this study the infusion test did not improve diagnostic accuracy of NPH, but shunt placement relieves urinary incontinence and walking disability in patients with increased ICP.
- The patients with positive Alzheimer diagnosis on biopsy did not improve.
Why it matters
In patients with normal pressure hydrocephalus, shunt placement relieved urinary incontinence and walking disability, and the positive effect remained over five years. The 16 patients who also had Alzheimer's disease did worse after one year, and the study concerns hydrocephalus rather than Alzheimer's treatment.
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Study details
- Participants51
- Evidence strengthLow
How this study scored 40/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Acta neurochirurgica) |
| Journal's citation record | 1 / 4 | Acta Neurochirurgica: journal h-index 149 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2002 — older than 20 years, still counted |
| Sample size | 1 / 4 | 51 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 183 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 7.0 citations a year over 26 year(s) since 2002 |
| Impact for its field and year | 2 / 6 | Cited 1.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 2 / 4 | Cited 19 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Matti P. Vapalahti: h-index 38 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | Kuopio University Hospital: institution h-index 529 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 12111484) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 40 / 100 | — |
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