{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T00:51:18Z","timestamp":1771635078671,"version":"3.50.1"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Vascular risk factors (VRFs) may act synergistically, and clinical decision support tools (CDSTs) have been developed that present vascular risk as a summarized score. Because VRFs are a major issue in patients with idiopathic normal pressure hydrocephalus (INPH), a CDST may be useful in the diagnostic workup. The objective was to compare 4 CDSTs to determine which one most accurately predicts short-term outcome and 10-year mortality after CSF shunt surgery in INPH patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>One-hundred forty INPH patients who underwent CSF shunt surgery were included. For each patient, 4 CDST scores (Systematic Coronary Risk Evaluation\u2013Older Persons [SCORE-OP], Framingham Risk Score [FRS], Revised Framingham Stroke Risk Profile, and Kiefer\u2019s Comorbidity Index [KCI]) were estimated. Short-term outcome (3 months after CSF shunt surgery) was defined on the basis of improvements in gait, Mini-Mental State Examination score, and modified Rankin Scale score. The 10-year mortality rate after surgery was noted. The CDSTs were compared by using Cox regression analysis, receiver operating characteristic curve analysis, and the chi-square test.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>For 3 CDSTs, increased score was associated with increased risk of 10-year mortality. A 1-point increase in the FRS indicated a 2% higher risk of death within 10 years (HR 1.02, 95% CI 1.003\u20131.035, p = 0.021); SCORE-OP, 5% (HR 1.05, 95% CI 1.019\u20131.087, p = 0.002); and KCI, 12% (HR 1.12, 95% CI 1.03\u20131.219, p = 0.008). FRS predicted short-term outcome of surgery (p = 0.024). When the cutoff value was set to 32.5%, the positive predictive value was 80% and the negative predictive value was 48% (p = 0.012).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The authors recommend using FRS to predict short-term outcome and 10-year risk of mortality in INPH patients. The study indicated that extensive treatment of the risk factors of INPH may decrease risk of mortality.<\/jats:p>\n<jats:p>Clinical trial registration no.: NCT01850914 (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/ClinicalTrials.gov\/\">ClinicalTrials.gov<\/jats:ext-link>)<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.4.jns22125","type":"journal-article","created":{"date-parts":[[2022,7,8]],"date-time":"2022-07-08T19:27:16Z","timestamp":1657308436000},"page":"476-482","source":"Crossref","is-referenced-by-count":4,"title":["Vascular risk profiles for predicting outcome and long-term mortality in patients with idiopathic normal pressure hydrocephalus: comparison of clinical decision support tools"],"prefix":"10.3171","volume":"138","author":[{"given":"Sanna A.","family":"Eklund","sequence":"first","affiliation":[{"name":"Department of Clinical Science, Neurosciences, Ume\u00e5 University, Ume\u00e5, Sweden;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanna","family":"Israelsson","sequence":"additional","affiliation":[{"name":"Department of Health, Medicine and Caring Sciences, Link\u00f6ping University, Link\u00f6ping, Sweden; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Carlberg","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Malm","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Neurosciences, Ume\u00e5 University, Ume\u00e5, Sweden;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Fluids Barriers CNS","first-page":"22","article-title":"Influence of comorbidities in idiopathic normal pressure hydrocephalus - research and clinical care. A report of the ISHCSF task force on comorbidities in INPH","volume":"10","author":"Malm J","year":"2013","unstructured":"Malm J, Graff-Radford NR, Ishikawa M,  Influence of comorbidities in idiopathic normal pressure hydrocephalus - research and clinical care. A report of the ISHCSF task force on comorbidities in INPH. Fluids Barriers CNS. 2013;10(1):22."},{"issue":"6","key":"b2","series-title":"Neurology","first-page":"577","article-title":"Vascular risk factors in INPH: a prospective case-control study (the INPH-CRasH study)","volume":"88","author":"Israelsson H","year":"2017","unstructured":"Israelsson H, Carlberg B, Wikkels\u00f6 C,  Vascular risk factors in INPH: a prospective case-control study (the INPH-CRasH study). Neurology. 2017;88(6):577\u2013585.28062721"},{"key":"b3","series-title":"World Neurosurg","first-page":"e624","article-title":"Incidence, comorbidities, and mortality in idiopathic normal pressure hydrocephalus","volume":"112","author":"Pyykk\u00f6 OT","year":"2018","unstructured":"Pyykk\u00f6 OT, Nerg O, Niskasaari HM,  Incidence, comorbidities, and mortality in idiopathic normal pressure hydrocephalus. World Neurosurg. 2018;112:e624\u2013e631.29374607"},{"issue":"2","key":"b4","series-title":"J Neurosurg","first-page":"221","article-title":"Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease","volume":"90","author":"Boon AJ","year":"1999","unstructured":"Boon AJ, Tans JT, Delwel EJ,  Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease. J Neurosurg. 1999;90(2):221\u2013226."},{"issue":"1","key":"b5","series-title":"J Neurol","first-page":"178","article-title":"Long-term effects of complications and vascular comorbidity in idiopathic normal pressure hydrocephalus: a quality registry study","volume":"265","author":"Andr\u00e9n K","year":"2018","unstructured":"Andr\u00e9n K, Wikkels\u00f6 C, Sundstr\u00f6m N,  Long-term effects of complications and vascular comorbidity in idiopathic normal pressure hydrocephalus: a quality registry study. J Neurol. 2018;265(1):178\u2013186.29188384"},{"issue":"8","key":"b6","series-title":"Arch Neurol","first-page":"783","article-title":"The predictive value of cerebrospinal fluid dynamic tests in patients with the idiopathic adult hydrocephalus syndrome","volume":"52","author":"Malm J","year":"1995","unstructured":"Malm J, Kristensen B, Karlsson T, Fagerlund M, Elfverson J, Ekstedt J. The predictive value of cerebrospinal fluid dynamic tests in patients with the idiopathic adult hydrocephalus syndrome. Arch Neurol. 1995;52(8):783\u2013789.7639630"},{"issue":"3","key":"b7","series-title":"J Neurol","first-page":"640","article-title":"Survival in treated idiopathic normal pressure hydrocephalus","volume":"267","author":"Andr\u00e9n K","year":"2020","unstructured":"Andr\u00e9n K, Wikkels\u00f8 C, Sundstr\u00f6m N,  Survival in treated idiopathic normal pressure hydrocephalus. J Neurol. 2020;267(3):640\u2013648.31713102"},{"issue":"2","key":"b8","series-title":"J Nucl Cardiol","first-page":"207","article-title":"Synergistic effect of coronary artery disease risk factors on long-term survival in patients with normal exercise SPECT studies","volume":"18","author":"Supariwala A","year":"2011","unstructured":"Supariwala A, Uretsky S, Singh P,  Synergistic effect of coronary artery disease risk factors on long-term survival in patients with normal exercise SPECT studies. J Nucl Cardiol. 2011;18(2):207\u2013214.217.21184207"},{"issue":"29","key":"b9","series-title":"Eur Heart J","first-page":"2315","article-title":"2016 European Guidelines on cardiovascular disease prevention in clinical practice","volume":"37","author":"Piepoli MF","year":"2016","unstructured":"Piepoli MF, Hoes AW, Agewall S,  2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37(29):2315\u20132381.27222591"},{"issue":"10","key":"b10","series-title":"Eur J Prev Cardiol","first-page":"1093","article-title":"Cardiovascular risk estimation in older persons: SCORE O.P","volume":"23","author":"Cooney MT","year":"2016","unstructured":"Cooney MT, Selmer R, Lindman A,  Cardiovascular risk estimation in older persons: SCORE O.P. Eur J Prev Cardiol. 2016;23(10):1093\u20131103."},{"issue":"18","key":"b11","series-title":"Circulation","first-page":"1837","article-title":"Prediction of coronary heart disease using risk factor categories","volume":"97","author":"Wilson PW","year":"1998","unstructured":"Wilson PW, D\u2019Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837\u20131847.9603539"},{"issue":"12","key":"b12","series-title":"Circulation","first-page":"1145","article-title":"Revised Framingham Stroke Risk Profile to reflect temporal trends","volume":"135","author":"Dufouil C","year":"2017","unstructured":"Dufouil C, Beiser A, McLure LA,  Revised Framingham Stroke Risk Profile to reflect temporal trends. Circulation. 2017;135(12):1145\u20131159.28159800"},{"key":"b13","first-page":"364","article-title":"Outcome predictors for normal-pressure hydrocephalus. Acta Neurochir Suppl","volume":"96","author":"Kiefer M","year":"2006","unstructured":"Kiefer M, Eymann R, Steudel WI. Outcome predictors for normal-pressure hydrocephalus. Acta Neurochir Suppl. 2006;96:364\u2013367.16671486"},{"issue":"4","key":"b14","series-title":"Neurosurg Focus","first-page":"E8","article-title":"Risk factors, comorbidities, quality of life, and complications after surgery in idiopathic normal pressure hydrocephalus: review of the INPH-CRasH study","volume":"49","author":"Israelsson H","year":"2020","unstructured":"Israelsson H, Larsson J, Eklund A, Malm J. Risk factors, comorbidities, quality of life, and complications after surgery in idiopathic normal pressure hydrocephalus: review of the INPH-CRasH study. Neurosurg Focus. 2020;49(4):E8.33002861"},{"issue":"2","key":"b15","series-title":"Neurosurgery","first-page":"161","article-title":"Symptoms of depression are common in patients with idiopathic normal pressure hydrocephalus: the INPH-CRasH Study","volume":"78","author":"Israelsson H","year":"2016","unstructured":"Israelsson H, Allard P, Eklund A, Malm J. Symptoms of depression are common in patients with idiopathic normal pressure hydrocephalus: the INPH-CRasH Study. Neurosurgery. 2016;78(2):161\u2013168.26528670"},{"issue":"1","key":"b16","series-title":"Neurosurgery","first-page":"122","article-title":"Falls and fear of falling in shunted idiopathic normal pressure hydrocephalus\u2014the Idiopathic Normal Pressure Hydrocephalus Comorbidity and Risk Factors Associated With Hydrocephalus Study","volume":"89","author":"Larsson J","year":"2021","unstructured":"Larsson J, Israelsson H, Eklund A, Lundin-Olsson L, Malm J. Falls and fear of falling in shunted idiopathic normal pressure hydrocephalus\u2014the Idiopathic Normal Pressure Hydrocephalus Comorbidity and Risk Factors Associated With Hydrocephalus Study. Neurosurgery. 2021;89(1):122\u2013128.33830219"},{"issue":"3)(suppl","key":"b17","series-title":"Neurosurgery","first-page":"S4","article-title":"Diagnosing idiopathic normal-pressure hydrocephalus","volume":"57","author":"Relkin N","year":"2005","unstructured":"Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57(3)(suppl):S4\u2013S16.ii\u2013v.16160425"},{"issue":"7","key":"b18","series-title":"Circulation","first-page":"542","article-title":"Comparison of conventional lipoprotein tests and apolipoproteins in the prediction of cardiovascular disease","volume":"140","author":"Welsh C","year":"2019","unstructured":"Welsh C, Celis-Morales CA, Brown R,  Comparison of conventional lipoprotein tests and apolipoproteins in the prediction of cardiovascular disease. Circulation. 2019;140(7):542\u2013552.31216866"},{"issue":"50","key":"b19","series-title":"Medicine (Baltimore)","first-page":"e8387","article-title":"Correlation study of Framingham risk score and vascular dementia: An observational study","volume":"96","author":"Li SS","year":"2017","unstructured":"Li SS, Zheng J, Mei B, Wang HY, Zheng M, Zheng K. Correlation study of Framingham risk score and vascular dementia: An observational study. Medicine (Baltimore). 2017;96(50):e8387.29390252"},{"issue":"1","key":"b20","series-title":"BMC Med","first-page":"109","article-title":"Performance of the Framingham risk models and pooled cohort equations for predicting 10-year risk of cardiovascular disease: a systematic review and meta-analysis","volume":"17","author":"Damen JA","year":"2019","unstructured":"Damen JA, Pajouheshnia R, Heus P,  Performance of the Framingham risk models and pooled cohort equations for predicting 10-year risk of cardiovascular disease: a systematic review and meta-analysis. BMC Med. 2019;17(1):109.31189462"},{"issue":"29","key":"b21","series-title":"Eur Heart J","first-page":"2259","article-title":"Limitations of the SCORE-guided European guidelines on cardiovascular disease prevention","volume":"38","author":"Mortensen MB","year":"2017","unstructured":"Mortensen MB, Falk E. Limitations of the SCORE-guided European guidelines on cardiovascular disease prevention. Eur Heart J. 2017;38(29):2259\u20132263.27941016"},{"issue":"4","key":"b22","series-title":"Neurology","first-page":"576","article-title":"Three-year survival and functional outcome of patients with idiopathic adult hydrocephalus syndrome","volume":"55","author":"Malm J","year":"2000","unstructured":"Malm J, Kristensen B, Stegmayr B, Fagerlund M, Koskinen LO. Three-year survival and functional outcome of patients with idiopathic adult hydrocephalus syndrome. Neurology. 2000;55(4):576\u2013578.10953197"},{"issue":"9298","key":"b23","series-title":"Lancet","first-page":"2026","article-title":"High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study","volume":"358","author":"Walldius G","year":"2001","unstructured":"Walldius G, Jungner I, Holme I, Aastveit AH, Kolar W, Steiner E. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet. 2001;358(9298):2026\u20132033.11755609"},{"issue":"16","key":"b24","series-title":"Neurology","first-page":"1449","article-title":"Prevalence of idiopathic normal-pressure hydrocephalus","volume":"82","author":"Jaraj D","year":"2014","unstructured":"Jaraj D, Rabiei K, Marlow T, Jensen C, Skoog I, Wikkels\u00f8 C. Prevalence of idiopathic normal-pressure hydrocephalus. Neurology. 2014;22;82(16):1449\u20131154.24682964"},{"key":"b25","series-title":"Pract Neurol","first-page":"14","article-title":"Idiopathic normal pressure hydrocephalus","volume":"6","author":"Malm J","year":"2006","unstructured":"Malm J, Eklund A. Idiopathic normal pressure hydrocephalus. Pract Neurol. 2006;6:14\u201327."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/138\/2\/article-p476.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/138\/2\/article-p476.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/138\/2\/article-p476.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T13:11:45Z","timestamp":1732194705000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/138\/2\/article-p476.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,1]]},"references-count":25,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2022.4.jns22125","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,1]]}}}