Abstract：
OBJECTIVE: The objective of this study was to describe the demographic characteristics of patients with idiopathic normal pressure hydrocephalus (iNPH) through an analysis of 3000 consecutive, surgically treated Swedish patients and a systematic review of the literature.
METHODS: Data on age, sex, comorbidities, diagnostic delay, initial symptoms, and severity of symptoms at diagnosis were extracted from the Swedish Hydrocephalus Quality Registry. In addition, a systematic PRISMA-based review of the literature published from database inception until August 2019 was performed using the PubMed, Cochrane, and Scopus databases on the basis of two concepts: normal pressure hydrocephalus and demography and their association with related terms. Of 1020 unique articles, 16 were eligible for study inclusion and were assessed for quality using the Newcastle-Ottawa Scale. Mean and weighted mean values were calculated.
UNASSIGNED: The mean patient age at the time of surgery was 74.4 years, 79% of patients were in their 70s, and 60% of the patients were men. Almost 50% of the patients had symptoms from four main domains (i.e., balance, gait, cognition, and urinary dysfunction) at disease onset. Patients aged < 60 years (2%) reported more headaches and fewer balance problems than those aged ≥ 60. Women were more impaired in function than men at the time of diagnosis. Dementia (Mini-Mental State Examination score < 25) was found in 47% of the patients. Men had more diabetes, heart disease, hypertension, and stroke than women, and comorbidity correlated with increased impairment. The incidence of surgery for iNPH was 20%-40% of the disease incidence according to survey and operation-based studies.
CONCLUSIONS: Most iNPH patients undergo surgery in their 70s. Those aged < 60 years show slightly different symptomatology and probably present with a specific disease entity, indicating that the lower age limit for iNPH should be 60 years. iNPH patients have severe impairment preceded by a long diagnostic delay. Even though the included study designs differed, the systematic review showed that the disorder has a very low treatment incidence. The importance of diagnosing and treating iNPH is further emphasized by the fact that iNPH may account for a considerable part of all cases of dementia.
METHODS: Data on age, sex, comorbidities, diagnostic delay, initial symptoms, and severity of symptoms at diagnosis were extracted from the Swedish Hydrocephalus Quality Registry. In addition, a systematic PRISMA-based review of the literature published from database inception until August 2019 was performed using the PubMed, Cochrane, and Scopus databases on the basis of two concepts: normal pressure hydrocephalus and demography and their association with related terms. Of 1020 unique articles, 16 were eligible for study inclusion and were assessed for quality using the Newcastle-Ottawa Scale. Mean and weighted mean values were calculated.
UNASSIGNED: The mean patient age at the time of surgery was 74.4 years, 79% of patients were in their 70s, and 60% of the patients were men. Almost 50% of the patients had symptoms from four main domains (i.e., balance, gait, cognition, and urinary dysfunction) at disease onset. Patients aged < 60 years (2%) reported more headaches and fewer balance problems than those aged ≥ 60. Women were more impaired in function than men at the time of diagnosis. Dementia (Mini-Mental State Examination score < 25) was found in 47% of the patients. Men had more diabetes, heart disease, hypertension, and stroke than women, and comorbidity correlated with increased impairment. The incidence of surgery for iNPH was 20%-40% of the disease incidence according to survey and operation-based studies.
CONCLUSIONS: Most iNPH patients undergo surgery in their 70s. Those aged < 60 years show slightly different symptomatology and probably present with a specific disease entity, indicating that the lower age limit for iNPH should be 60 years. iNPH patients have severe impairment preceded by a long diagnostic delay. Even though the included study designs differed, the systematic review showed that the disorder has a very low treatment incidence. The importance of diagnosing and treating iNPH is further emphasized by the fact that iNPH may account for a considerable part of all cases of dementia.
摘要：
目的：这项研究的目的是描述特发性正常压力脑积水（iNPH）患者的人口统计学特征，通过对3000例连续，经手术治疗的瑞典患者和文献的系统综述。
方法：年龄数据，性别,合并症,诊断延迟,最初的症状,和诊断时症状的严重程度从瑞典脑积水质量登记处提取。此外,使用PubMed对从数据库开始到2019年8月发布的文献进行了基于PRISMA的系统审查，科克伦,和Scopus数据库基于两个概念：常压性脑积水和人口学及其与相关术语的关联。在1020篇独特文章中，16人符合纳入研究的条件，并使用纽卡斯尔-渥太华量表进行了质量评估。计算平均值和加权平均值。
未经证实：手术时患者的平均年龄为74.4岁，79%的病人在70多岁,60%的患者是男性。几乎50%的患者有来自四个主要领域的症状(即，balance,步态,认知，和泌尿功能障碍）在疾病发作时。年龄<60岁（2%）的患者比年龄≥60岁的患者报告更多的头痛和更少的平衡问题。在诊断时，女性的功能受损程度高于男性。在47%的患者中发现痴呆(简易精神状态检查评分<25)。男性有更多的糖尿病，心脏病,高血压,和中风比女性，合并症与损伤增加相关。根据调查和基于手术的研究，iNPH的手术发生率为疾病发生率的20％-40％。
结论：大多数iNPH患者在70多岁时接受手术。年龄<60岁的患者表现出轻微不同的症状，可能存在特定的疾病实体，表明iNPH的年龄下限应为60岁。iNPH患者有严重的损伤，之前有很长的诊断延迟。即使包含的研究设计不同，系统评价显示，该疾病的治疗发生率很低。诊断和治疗iNPH的重要性进一步通过以下事实得到强调:iNPH可占所有痴呆病例的相当一部分。
方法：年龄数据，性别,合并症,诊断延迟,最初的症状,和诊断时症状的严重程度从瑞典脑积水质量登记处提取。此外,使用PubMed对从数据库开始到2019年8月发布的文献进行了基于PRISMA的系统审查，科克伦,和Scopus数据库基于两个概念：常压性脑积水和人口学及其与相关术语的关联。在1020篇独特文章中，16人符合纳入研究的条件，并使用纽卡斯尔-渥太华量表进行了质量评估。计算平均值和加权平均值。
未经证实：手术时患者的平均年龄为74.4岁，79%的病人在70多岁,60%的患者是男性。几乎50%的患者有来自四个主要领域的症状(即，balance,步态,认知，和泌尿功能障碍）在疾病发作时。年龄<60岁（2%）的患者比年龄≥60岁的患者报告更多的头痛和更少的平衡问题。在诊断时，女性的功能受损程度高于男性。在47%的患者中发现痴呆(简易精神状态检查评分<25)。男性有更多的糖尿病，心脏病,高血压,和中风比女性，合并症与损伤增加相关。根据调查和基于手术的研究，iNPH的手术发生率为疾病发生率的20％-40％。
结论：大多数iNPH患者在70多岁时接受手术。年龄<60岁的患者表现出轻微不同的症状，可能存在特定的疾病实体，表明iNPH的年龄下限应为60岁。iNPH患者有严重的损伤，之前有很长的诊断延迟。即使包含的研究设计不同，系统评价显示，该疾病的治疗发生率很低。诊断和治疗iNPH的重要性进一步通过以下事实得到强调:iNPH可占所有痴呆病例的相当一部分。
