Multimodal analysis to predict shunt surgery outcome of 284 patients with suspected idiopathic normal pressure hydrocephalus

Antti J. Luikku, Anette Hall, Ossi Nerg, Anne M. Koivisto, Mikko Hiltunen, Seppo Helisalmi, Sanna-Kaisa Herukka, Anna Sutela, Maria Kojoukhova, Jussi Mattila, Jyrki Lötjönen, Jaana Rummukainen, Irina Alafuzoff, Juha E. Jääskeläinen, Anne M. Remes, Hilkka Soininen, Ville Leinonen

Research output: Contribution to journalArticleScientificpeer-review

17 Citations (Scopus)


Objectives: Optimal selection of idiopathic normal pressure hydrocephalus (iNPH) patients for shunt surgery is challenging. Disease State Index (DSI) is a statistical method that merges multimodal data to assist clinical decision-making. It has previously been shown to be useful in predicting progression in mild cognitive impairment and differentiating Alzheimer's disease (AD) and frontotemporal dementia. In this study, we use the DSI method to predict shunt surgery response for patients with iNPH. Methods: In this retrospective cohort study, a total of 284 patients (230 shunt responders and 54 non-responders) from the Kuopio NPH registry were analyzed with the DSI. Analysis included data from patients' memory disorder assessments, age, clinical symptoms, comorbidities, medications, frontal cortical biopsy, CT/MRI imaging (visual scoring of disproportion between Sylvian and suprasylvian subarachnoid spaces, atrophy of medial temporal lobe, superior medial subarachnoid spaces), APOE genotyping, CSF AD biomarkers, and intracranial pressure. Results: Our analysis showed that shunt responders cannot be differentiated from non-responders reliably even with the large dataset available (AUC?=?0.58). Conclusions: Prediction of the treatment response in iNPH is challenging even with our extensive dataset and refined analysis. Further research of biomarkers and indicators predicting shunt responsiveness is still needed.
Original languageEnglish
Pages (from-to)2311-2319
JournalActa Neurochirurgica
Issue number12
Publication statusPublished - 2016
MoE publication typeA1 Journal article-refereed


  • Idiopathic normal pressure hydrocephalus
  • Shunt response
  • Computer-assisted diagnosis
  • Prognosis
  • Cognitive decline


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