HD45 - The Estimated Incidence of Normal Pressure Hydrocephalus in Assisted Living and Extended Care Facilities for the Senior Virginia Residents


Executive Summary:
A study of potential risk for Normal Pressure Hydrocephalus (NPH) among the elderly housed in extended care or assisted living facilities within the State of Virginia was completed. In addition, 20,000 brochures describing the symptoms of NPH targeted to our senior citizen population was completed and distributed throughout the state. Medical records from a total of 235 residents within 4 facilities, one extended care and three assisted living were analyzed and queried for risk factors coincident with NPH. Of the 235 residents, 115 (48.9%) were over the age of 85 and were excluded from analysis leaving 147 residents in the study cohort. The three major symptoms, difficulty in walking, dementia and incontinence were identified and classified as to the degree of risk category ranging from no risk (0) to maximum risk (10). 19.5% of residents were associated with a degree of risk of 6 or greater. Residents with all three symptoms of the triad are among the greatest risk for NPH. A total of 8.7% of residents had all three symptoms: gait disturbance, incontinence and dementia. Only 10/147 residents had a brain image (computerized tomography or magnetic resonance) which is necessary to confirm the diagnosis. We conclude, based on symptoms, the estimated incidence of suspected NPH among our senior citizens is high and ranges from 9 to 14% of all admissions. Other medical problems developing over time may overshadow the complications brought on by NPH and it is important that diagnosis and treatment be instituted early. An NPH screen is proposed which can take the form of a one-page query of symptoms specific to Normal Pressure Hydrocephalus. This would include the presence of one or more of the elements of the NPH triad of gait disturbance, incontinence and dementia. Excluding other pathology, the physician can then request a CT scan to determine if ventricles (cavities within the brain) are enlarged and consistent with the diagnosis of NPH. With the combination of symptoms and enlarged ventricle, the patient may be referred to specialists for additional tests to determine if the patient would benefit from surgical treatment leading to an improved quality of life.