A Screening Protocol for Idiopathic Normal Pressure Hydrocephalus: Reducing Underdiagnosis, Relieving the Economic Burden for the Health Systems, while Improving the Quality of Life of our Patients.

Abstract

Background: Idiopathic Normal Pressure Hydrocephalus (iNPH) is a common condition affecting the elderly. Numerous investigations highlight that its period-prevalence could be underestimated, as well as the economic burden of the missed treatments. The objective of the present investigation is to determine if a cohort of radiolocally suspected iNPH patients presents the clinical landmarks of this condition, and to estimate the economic burden of these potentially missed diagnoses.

Methods: We recorded age, sex, reason to access emergency rooms (ER) of our community hospitals, values of Evans' Index, Callosal Angle, presence of DESH and obvious ventricular enlargement. We telephoned the patients who presented at least two radiological signs of iNPH and administered the iNPHGs, to assess the severity of signs and symptoms linked to iNPH, to understand if a strong radiologic suspect had a clinical correlation.

Results: Among the 308 brain CT scans of a week, a total of 21 agreed to be enrolled in the present investigation. When administering iNPHGs questionnaire to radiological suspected iNPH, 17/21 patients (80.1%) scored ≥1 in at least two of the three iNPHGS subscale. The scores of the three subscales were strongly associated to each other. The estimated monthly and yearly health-related costs may be EUR 4'799'440 and 57.59 million of Euros respectively.

Conclusions: There is an association between the radiologic features of iNPH and the scores of iNPHGs. The period-prevalence could be 5.51%, implying high healthcare costs, with significant societal impact, and reduced quality of life in patients suffering from undiagnosed iNPH.