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The HRQoL improves in a number of patients after the placement of a cerebrospinal fluid (CSF) shunt, but long-term follow-up of HRQoL is rare.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Extended follow-up (60\u00a0months) of a prospective cohort study involving 189 patients with iNPH who underwent shunt surgery. Preoperative variables were used to predict favorable HRQoL outcome (improvement or non-deterioration) measured by the 15D instrument 5 years after shunting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of the 189 initially enrolled study participants, 88 had completed 5-year HRQoL follow-up (46%), 64 had died (34%), and 37 (20%) failed to complete the HRQoL follow-up but were alive at the end of the study. After initial post-operative HRQoL improvement, HRQoL deteriorated so that 37\/88 participants (42%) had a favorable HRQoL outcome 5 years after shunting. Multivariate binary logistic regression analysis indicated that younger age (adjusted OR 0.86, 95% CI 0.77\u20130.95;<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.005), lower body mass index (adjusted OR 0.87, 95% CI 0.77\u20130.98;<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) and better Mini-Mental State Examination performance (adjusted OR 1.16, 95% CI 1.01\u20131.32;<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) before surgery predicted favorable 5-year outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This extended follow-up showed that the self-evaluated HRQoL outcome is associated with iNPH patients\u2019 pre-operative cognitive status, overweight and age. The post-operative deterioration may reflect the natural progression of iNPH, but also derive from aging and comorbidities. It indicates a need for long-term follow-up.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00415-021-10477-x","type":"journal-article","created":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T08:02:57Z","timestamp":1614672177000},"page":"3283-3293","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["5-Year health-related quality of life outcome in patients with idiopathic normal pressure hydrocephalus"],"prefix":"10.1007","volume":"268","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8715-1749","authenticated-orcid":false,"given":"A.","family":"Junkkari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1252-0946","authenticated-orcid":false,"given":"H.","family":"Sintonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7094-4432","authenticated-orcid":false,"given":"N.","family":"Danner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. 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