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Abstract
Objective: To assess the complete vascular risk factor (VRF) profile of idiopathic normal pressure hydrocephalus (INPH) using a large sample of representative patients with INPH and population-based controls to determine the extent to which vascular disease influences INPH pathophysiology.
Methods: All patients with INPH who underwent shunting in Sweden in 2008–2010 were compared to age- and sex-matched population-based controls. Inclusion criteria were age 60–85 years and no dementia. The 10 most important VRFs and cerebrovascular and peripheral vascular disease were prospectively assessed using blood samples, clinical examinations, and standardized questionnaires. Assessed VRFs were hypertension, hyperlipidemia, diabetes, obesity, psychosocial factors, smoking habits, diet, alcohol intake, cardiac disease, and physical activity.
Results: In total, 176 patients with INPH and 368 controls participated. Multivariable logistic regression analysis indicated that hyperlipidemia (odds ratio [OR] 2.380; 95% confidence interval [CI] 1.434–3.950), diabetes (OR 2.169; 95% CI 1.195–3.938), obesity (OR 5.428; 95% CI 2.502–11.772), and psychosocial factors (OR 5.343; 95% CI 3.219–8.868) were independently associated with INPH. Hypertension, physical inactivity, and cerebrovascular and peripheral vascular disease were also overrepresented in INPH. Moderate alcohol intake and physical activity were overrepresented among the controls. The population-attributable risk percentage was 24%.
Conclusions: Our findings confirm that patients with INPH have more VRFs and lack the protective factors present in the general population. Almost 25% of cases of INPH may be explained by VRFs. This suggests that INPH may be a subtype of vascular dementia. Targeted interventions against modifiable VRFs are likely to have beneficial effects on INPH.
GLOSSARY
- BMI=
- body mass index;
- CI=
- confidence interval;
- CRasH=
- Comorbidity and Risk Factors Associated With Hydrocephalus;
- CVD=
- cerebrovascular disease;
- INPH=
- idiopathic normal pressure hydrocephalus;
- LVD=
- large vessel disease;
- MMSE=
- Mini-Mental State Examination;
- OR=
- odds ratio;
- PAR%=
- population-attributable risk percent;
- PVD=
- peripheral vascular disease;
- SHQR=
- Swedish Hydrocephalus Quality Registry;
- SPR=
- Swedish population register;
- SVD=
- small vessel disease;
- VaD=
- vascular dementia;
- VaDis=
- vascular disease;
- VRF=
- vascular risk factor
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received February 21, 2016.
- Accepted in final form October 14, 2016.
- © 2017 American Academy of Neurology
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