This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal

Onset of Gait Abnormality Before Dementia Predicts Good Surgical Outcome

Neill R. Graff-Radford, MB, BCh, MRCP(UK); John C. Godersky, MD

Arch Neurol. 1986;43(9):940-942.

Abstract
• In 1977, Fisher reported that in patients with possible normal-pressure hydrocephalus (NPH), if the gait abnormality preceded dementia, surgery usually had a favorable outcome and vice versa. We studied this finding in 21 patients shunted for possible NPH. By evaluating serial videotapes of gait, neuropsychological tests, and Katz index ratings, preoperatively and at approximately two months and six months postoperatively, we judged 16 patients improved. In the improved group, the families reported that the gait abnormality preceded the dementia in 11 patients and occurred at the same time in five. In the unimproved group, dementia was noted first in three patients, gait abnormality first in one patient, and gait abnormality and dementia at the same time in one patient. Using Fisher's exact test, we compared the improved and unimproved groups for gait abnormality or dementia onset first and found a significant difference. We conclude that the history of gait abnormality occurring before or after dementia in patients with possible NPH is an important prognostic factor for surgical outcome.

Author Affiliations
From the Department of Neurology (Dr Graff-Radford), Division of Behavioral Neurology, and the Department of Surgery (Dr Godersky), Division of Neurosurgery, University of Iowa College of Medicine, Iowa City.

Footnotes
Accepted for publication June 7, 1986.

Reprint requests to Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 (Dr Graff-Radford).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Idiopathic normal pressure hydrocephalus: increased supplementary motor activity accounts for improvement after CSF drainage
Lenfeldt et al.
Brain 2008;131:2904-2912.
ABSTRACT | FULL TEXT  

Idiopathic normal pressure hydrocephalus
Malm and Eklund
PN 2006;6:14-27.
FULL TEXT  

Brain energy metabolism and intracranial pressure in idiopathic adult hydrocephalus syndrome
Agren-Wilsson et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:1088-1093.
ABSTRACT | FULL TEXT  

Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson's disease
Stolze et al.
J. Neurol. Neurosurg. Psychiatry 2001;70:289-297.
ABSTRACT | FULL TEXT  

Systematic Review of Clinical Prediction Rules for Neuroimaging in the Evaluation of Dementia
Gifford et al.
Arch Intern Med 2000;160:2855-2862.
ABSTRACT | FULL TEXT  

Normal Pressure Hydrocephalus: New Concepts on Etiology and Diagnosis
Bradley
Am. J. Neuroradiol. 2000;21:1586-1590.
FULL TEXT  

The Predictive Value of Cerebrospinal Fluid Dynamic Tests in Patients With the Idiopathic Adult Hydrocephalus Syndrome
Malm et al.
Arch Neurol 1995;52:783-789.
ABSTRACT  

Frequency of Idiopathic Normal Pressure Hydrocephalus
Casmiro et al.
Arch Neurol 1989;46:608-608.
ABSTRACT  

A partial recovery following delayed surgical treatment of normal pressure hydrocephalus
Mashiah et al.
Clin Rehabil 1987;1:315-317.
ABSTRACT