The Dynamic Gait Index in Evaluating Patients with Normal Pressure Hydrocephalus for Cerebrospinal Fluid Diversion

Authors

Srinivas Chivukula, Department of Neurological Surgery, University of California Los Angeles, Los Angeles, California, USA. Electronic address: schivukula@mednet.ucla.edu.
Zachary J. Tempel, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Nathan T. Zwagerman, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
W Christopher Newman, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Samuel S. Shin, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Ching-Jen Chen, Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Paul A. Gardner, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Eric M. McDade, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Andrew F. Ducruet, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.Follow

Document Type

Article

Abstract

BACKGROUND: Diagnosing normal pressure hydrocephalus (NPH) remains challenging. Most clinical tests currently used to evaluate suspected NPH patients for shunt surgery are invasive, require inpatient admission, and are not without complications. An objective, noninvasive, and low-cost alternative would be ideal. METHODS: A retrospective review was performed of prospectively collected dynamic gait index (DGI) scores, obtained at baseline and on every day of a 3- to 5-day lumbar cerebrospinal fluid (CSF) drainage trial on patients with suspected NPH at our institution. RESULTS: Between 2003 and 2014, 170 patients were suspected to have primary NPH (166, 97.6%) or secondary NPH (4, 2.4%). Using responsiveness to lumbar CSF drainage and subsequent shunting as the reference standard, we found that a baseline DGI ≥ 7 was found to have significant ability in selecting patients for permanent CSF diverting shunt surgery: sensitivity of 84.2% (95% confidence interval [95% CI]: 75.6%-90.2%), specificity of 80.6% (95% CI 70.0%-88.0%), and diagnostic odds ratio of 22.1 (95% CI 9.9-49.3). CONCLUSIONS: A baseline DGI ≥ 7 appears to provide an objective, low-cost, noninvasive measure to select patients with suspected NPH for a positive response to CSF diversion with high sensitivity, specificity and diagnostic odds ratio.

Keywords

Dementia, Gait, Normal pressure hydrocephalus, Surgery

Medical Subject Headings

Adult; Aged; Aged, 80 and over; Cerebrospinal Fluid Shunts; Dementia (etiology, prevention & control); Female; Gait; Humans; Hydrocephalus, Normal Pressure (complications, physiopathology, surgery); Male; Middle Aged; Odds Ratio; Predictive Value of Tests; ROC Curve; Retrospective Studies; Sensitivity and Specificity

Publication Date

12-1-2015

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

84

Issue

6

First Page

1871

Last Page

6

PubMed ID

26320865

Digital Object Identifier (DOI)

10.1016/j.wneu.2015.08.021

Recommended Citation

Chivukula, Srinivas; Tempel, Zachary J.; Zwagerman, Nathan T.; Newman, W Christopher; Shin, Samuel S.; Chen, Ching-Jen; Gardner, Paul A.; McDade, Eric M.; and Ducruet, Andrew F., "The Dynamic Gait Index in Evaluating Patients with Normal Pressure Hydrocephalus for Cerebrospinal Fluid Diversion" (2015). Translational Neuroscience. 2176.
https://scholar.barrowneuro.org/neurobiology/2176