Long-term 4 Years Follow-up Study of 482 Patients Who Underwent Shunting for Idiopathic Normal Pressure Hydrocephalus -Course of Symptoms and Shunt Efficacy Rates Compared by Age Group-

A total of 482 operated idiopathic normal pressure hydrocephalus (iNPH) patients were divided into those aged <80 years at the time of surgery (group A: 400 cases; and male-to-female ratio, 259: 141) and >= 80 years (group B: 82 cases; male-to-female ratio, 43: 39) and comparatively investigated based on the following variables: (1) temporal changes in shunt efficacy rates, and (2) temporal changes in each symptom, including the patient's fall frequency and preoperative modified Rankin Scale (mRS) score and during follow-up at 3, 6 months, 1-4 years postoperatively. (1) The shunt efficacy rates at 3 months and 4 years postoperatively were 93% and 82%, respectively, in group A and 92.3% and 70.7%, respectively, in group B. This demonstrates a decrease in shunt efficacy at 4 years postoperatively, regardless of the persistence of shunt function or adjustments in setting pressure. This trend was particularly observed in group B. In group A, 41 (9.8%) cases had decreased efficacy rate, compared with 21 (25.6%) cases in group B, which occurred due to complications with an extracranial or intracranial disease. (2) Gait disturbance (G) and urinary incontinence (U) showed signs of improvement in the early postoperative stage, while dementia (D) and mRS score began to gradually improve from 6 months postoperatively. Patient's fall frequency tended to become higher until 6 months postoperatively than the preoperative rate. In group A, symptom improvement was comparatively maintained until 4 years postoperatively, while in group B, all symptoms and mRS tended to gradually deteriorate beginning at 3 years postoperatively.