{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T11:06:28Z","timestamp":1781089588843,"version":"3.54.1"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Idiopathic normal pressure hydrocephalus (iNPH) is an underdiagnosed, progressive, and disabling condition. Early treatment is associated with better outcomes and improved quality of life. In this paper, the authors aimed to identify features associated with patients with iNPH using natural language processing (NLP) to characterize this cohort, with the intention to later target the development of artificial intelligence\u2013driven tools for early detection.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The electronic health records of patients with shunt-responsive iNPH were retrospectively reviewed using an NLP algorithm. Participants were selected from a prospectively maintained single-center database of patients undergoing CSF diversion for probable iNPH (March 2008\u2013July 2020).<\/jats:p>\n<jats:p>Analysis was conducted on preoperative health records including clinic letters, referrals, and radiology reports accessed through CogStack. Clinical features were extracted from these records as SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) concepts using a named entity recognition machine learning model.<\/jats:p>\n<jats:p>In the first phase, a base model was generated using unsupervised training on 1 million electronic health records and supervised training with 500 double-annotated documents. The model was fine-tuned to improve accuracy using 300 records from patients with iNPH double annotated by two blinded assessors. Thematic analysis of the concepts identified by the machine learning algorithm was performed, and the frequency and timing of terms were analyzed to describe this patient group.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>In total, 293 eligible patients responsive to CSF diversion were identified. The median age at CSF diversion was 75 years, with a male predominance (69% male). The algorithm performed with a high degree of precision and recall (F1 score 0.92).<\/jats:p>\n<jats:p>Thematic analysis revealed the most frequently documented symptoms related to mobility, cognitive impairment, and falls or balance. The most frequent comorbidities were related to cardiovascular and hematological problems.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>This model demonstrates accurate, automated recognition of iNPH features from medical records. Opportunities for translation include detecting patients with undiagnosed iNPH from primary care records, with the aim to ultimately improve outcomes for these patients through artificial intelligence\u2013driven early detection of iNPH and prompt treatment.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.9.jns221095","type":"journal-article","created":{"date-parts":[[2022,11,18]],"date-time":"2022-11-18T12:13:43Z","timestamp":1668773623000},"page":"1731-1739","source":"Crossref","is-referenced-by-count":7,"title":["Characterization of patients with idiopathic normal pressure hydrocephalus using natural language processing within an electronic healthcare record system"],"prefix":"10.3171","volume":"138","author":[{"given":"Jonathan P.","family":"Funnell","sequence":"first","affiliation":[{"name":"Wellcome\/EPSRC Centre for Interventional and Surgical Sciences, University College London;"},{"name":"National Hospital for Neurology and Neurosurgery, London;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kawsar","family":"Noor","sequence":"additional","affiliation":[{"name":"Institute for Health Informatics, University College London;"},{"name":"NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danyal Z.","family":"Khan","sequence":"additional","affiliation":[{"name":"Wellcome\/EPSRC Centre for Interventional and Surgical Sciences, University College London;"},{"name":"National Hospital for Neurology and Neurosurgery, London;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"D\u2019Antona","sequence":"additional","affiliation":[{"name":"National Hospital for Neurology and Neurosurgery, London;"},{"name":"UCL Queen Square Institute of Neurology, University College London;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J. B.","family":"Dobson","sequence":"additional","affiliation":[{"name":"Institute for Health Informatics, University College London;"},{"name":"NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London;"},{"name":"Health Data Research UK London, University College London;"},{"name":"NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King\u2019s College London;"},{"name":"Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King\u2019s College London;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.","family":"Hanrahan","sequence":"additional","affiliation":[{"name":"Wellcome\/EPSRC Centre for Interventional and Surgical Sciences, University College London;"},{"name":"National Hospital for Neurology and Neurosurgery, London;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Hepworth","sequence":"additional","affiliation":[{"name":"B. Braun Medical Ltd., Sheffield, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanor M.","family":"Moncur","sequence":"additional","affiliation":[{"name":"National Hospital for Neurology and Neurosurgery, London;"},{"name":"UCL Queen Square Institute of Neurology, University College London;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin M.","family":"Thomas","sequence":"additional","affiliation":[{"name":"B. Braun Medical AB, Danderyd, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis","family":"Thorne","sequence":"additional","affiliation":[{"name":"National Hospital for Neurology and Neurosurgery, London;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence D.","family":"Watkins","sequence":"additional","affiliation":[{"name":"National Hospital for Neurology and Neurosurgery, London;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon C.","family":"Williams","sequence":"additional","affiliation":[{"name":"Wellcome\/EPSRC Centre for Interventional and Surgical Sciences, University College London;"},{"name":"National Hospital for Neurology and Neurosurgery, London;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai Keong","family":"Wong","sequence":"additional","affiliation":[{"name":"NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London;"},{"name":"Health Data Research UK London, University College London;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed K.","family":"Toma","sequence":"additional","affiliation":[{"name":"National Hospital for Neurology and Neurosurgery, London;"},{"name":"NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London;"},{"name":"UCL Queen Square Institute of Neurology, University College London;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani J.","family":"Marcus","sequence":"additional","affiliation":[{"name":"Wellcome\/EPSRC Centre for Interventional and Surgical Sciences, University College London;"},{"name":"National Hospital for Neurology and Neurosurgery, London;"},{"name":"NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London;"},{"name":"UCL Queen Square Institute of Neurology, University College London;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Neurol Clin Pract","first-page":"375","article-title":"Diagnosis and management of idiopathic normal-pressure hydrocephalus","volume":"3","author":"Williams MA","year":"2013","unstructured":"Williams MA, Relkin NR. 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