Clinical neurology and neurosurgery · 2026
Impact of frailty on gait outcomes in idiopathic normal pressure hydrocephalus after shunting.
СтатьяНазвание и аннотация: Перевод в очереди
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Kumar Rahul, Pennington Zach, Hamouda Abdelrahman M, Zhu Katherine J, Astudillo Potes Maria D, Shafi Mahnoor, Aubert Cameron, Kendall Nicholas, Bhat Sandesh G, Jusué-Torres Ignacio, Graff-Radford Jonathan, Ramanan Vijay K, Jones David T, Botha Hugo, Cutsforth-Gregory Jeremy K, Cogswell Petrice M, Kaufman Kenton R, Elder Benjamin D
Аннотация
OBJECTIVES: Frailty, reflecting reduced physiological reserve and increased vulnerability to stressors, is common among patients with idiopathic normal pressure hydrocephalus (iNPH). The extent to which frailty influences gait outcomes following ventriculoperitoneal shunting (VPS) remains unclear. This study evaluated the association between frailty and objective gait changes after VPS in patients with iNPH.
METHODS: A single-center database was reviewed for patients who underwent VPS for iNPH with preoperative gait analysis between October 2018 and May 2024. Gait parameters included cadence, velocity, stability ratio, step width, stride length, single and total support. Patients were stratified by the modified 5-item frailty index (mFI) into non-frail (mFI-0), pre-frail (mFI-1), and frail (mFI-2 +). Generalized additive mixed-effects models evaluated time, mFI, and their interaction with patient-specific random effects.
RESULTS: Of the 242 patients that were included, 60 (24.8 %) were classified preoperatively as non-frail, 109 (45 %) were pre-frail, and 73 (30.2 %) were frail, with no difference in age distributions across groups. A total of 844 gait analyses were performed with a median of three per patient and a median latest follow-up time of 12.2 months. Preoperative gait parameters varied significantly across mFI groups. However, the degree of change in gait parameters between preoperative and first postoperative gait assessments did not differ across mFI groups, with most patients exhibiting improvement.
CONCLUSION: Frailty correlated with worse baseline gait performance but did not diminish the likelihood or durability of gait improvement following VPS. These findings suggest that VPS yields meaningful gait benefits in patients with iNPH regardless of frailty status.
METHODS: A single-center database was reviewed for patients who underwent VPS for iNPH with preoperative gait analysis between October 2018 and May 2024. Gait parameters included cadence, velocity, stability ratio, step width, stride length, single and total support. Patients were stratified by the modified 5-item frailty index (mFI) into non-frail (mFI-0), pre-frail (mFI-1), and frail (mFI-2 +). Generalized additive mixed-effects models evaluated time, mFI, and their interaction with patient-specific random effects.
RESULTS: Of the 242 patients that were included, 60 (24.8 %) were classified preoperatively as non-frail, 109 (45 %) were pre-frail, and 73 (30.2 %) were frail, with no difference in age distributions across groups. A total of 844 gait analyses were performed with a median of three per patient and a median latest follow-up time of 12.2 months. Preoperative gait parameters varied significantly across mFI groups. However, the degree of change in gait parameters between preoperative and first postoperative gait assessments did not differ across mFI groups, with most patients exhibiting improvement.
CONCLUSION: Frailty correlated with worse baseline gait performance but did not diminish the likelihood or durability of gait improvement following VPS. These findings suggest that VPS yields meaningful gait benefits in patients with iNPH regardless of frailty status.