The diagnosis and management of Normal Pressure Hydrocephalus (NPH) often rely on semi-quantitative methods, posing challenges in selecting patients for ventriculo-peritoneal shunt implantation. We evaluated a combined protocol using the Lumbar Infusion Test (LIT) and complex gait analysis to enhance diagnostic accuracy and predict therapeutic outcomes in NPH patients.
A cohort of 30 patients (21 males, 9 females; mean age: 74.7 ± 4.3 years) underwent the LIT to asses the resistance to cerebrospinal fluid outflow (RCSFO). Gait analysis, including the Diers 4D formetric scanner and traditional 20-meter walking test, was performed before and after LIT, which included the draining of 50 ml CSF at the end of the procedure.
Both RCSFO and improvement in walking speed post-procedures showed significant odds ratios in identifying shunt-selected patients: (OR = 1.34, 95% CI: 1.07-1.83, p = 0.029) and (OR = 1.14, 95% CI: 1.2-1.33, p = 0.041), respectively.
The combined ROC curve for a predictive model assessing the need for shunt implantation based on improvement in walking and RCSF value yielded the highest AUC (0.886), surpassing that of any individual parameter alone.
Our study highlights the potential of combining LIT with gait analysis for improved NPH diagnosis and therapeutic decision-making.