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      Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus (Third Edition): Endorsed by the Japanese Society of Normal Pressure Hydrocephalus

      1 , 2 , 3 , 4 , 5 , 6 , 7 , 7 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 3 , 1 , 17 , 18 , 19 , 20 , 20 , 21 , 21 , 22 , 23 , 24 , 25 , 8 , 1 , The research committee of idiopathic normal pressure hydrocephalus
      Neurologia medico-chirurgica
      The Japan Neurosurgical Society
      clinical guideline, idiopathic normal pressure hydrocephalus, diagnosis, treatment, management

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          Among the various disorders that manifest with gait disturbance, cognitive impairment, and urinary incontinence in the elderly population, idiopathic normal pressure hydrocephalus (iNPH) is becoming of great importance. The first edition of these guidelines for management of iNPH was published in 2004, and the second edition in 2012, to provide a series of timely, evidence-based recommendations related to iNPH. Since the last edition, clinical awareness of iNPH has risen dramatically, and clinical and basic research efforts on iNPH have increased significantly. This third edition of the guidelines was made to share these ideas with the international community and to promote international research on iNPH. The revision of the guidelines was undertaken by a multidisciplinary expert working group of the Japanese Society of Normal Pressure Hydrocephalus in conjunction with the Japanese Ministry of Health, Labour and Welfare research project. This revision proposes a new classification for NPH. The category of iNPH is clearly distinguished from NPH with congenital/developmental and acquired etiologies. Additionally, the essential role of disproportionately enlarged subarachnoid-space hydrocephalus (DESH) in the imaging diagnosis and decision for further management of iNPH is discussed in this edition. We created an algorithm for diagnosis and decision for shunt management. Diagnosis by biomarkers that distinguish prognosis has been also initiated. Therefore, diagnosis and treatment of iNPH have entered a new phase. We hope that this third edition of the guidelines will help patients, their families, and healthcare professionals involved in treating iNPH.

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          Most cited references284

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              The FAB: A frontal assessment battery at bedside

              To devise a short bedside cognitive and behavioral battery to assess frontal lobe functions. The designed battery consists of six subtests exploring the following: conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy. It takes approximately 10 minutes to administer. The authors studied 42 normal subjects and 121 patients with various degrees of frontal lobe dysfunction (PD, n = 24; multiple system atrophy, n = 6; corticobasal degeneration, n = 21; progressive supranuclear palsy, n = 47; frontotemporal dementia, n = 23). The Frontal Assessment Battery scores correlated with the Mattis Dementia Rating Scale scores (rho = 0.82, p < 0.01) and with the number of criteria (rho = 0.77, p < 0.01) and perseverative errors (rho = 0.68, p < 0.01) of the Wisconsin Card Sorting Test. These variables accounted for 79% of the variance in a stepwise multiple regression, whereas age or Mini-Mental State Examination scores had no significant influence. There was good interrater reliability (kappa = 0.87, p < 0.001), internal consistency (Cronbach's coefficient alpha = 0.78), and discriminant validity (89.1% of cases correctly identified in a discriminant analysis of patients and controls). The Frontal Assessment Battery is easy to administer at bedside and is sensitive to frontal lobe dysfunction.

                Author and article information

                Neurol Med Chir (Tokyo)
                Neurol Med Chir (Tokyo)
                Neurologia medico-chirurgica
                The Japan Neurosurgical Society
                February 2021
                15 January 2021
                : 61
                : 2
                : 63-97
                [1 ] Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
                [2 ] Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Shiga, Japan
                [3 ] Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
                [4 ] Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
                [5 ] Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Kyoto, Japan
                [6 ] Department of Neuropsychiatry, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
                [7 ] Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
                [8 ] Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
                [9 ] Department of Neurosurgery, Division of Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
                [10 ] Department of Neurosurgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Aichi, Japan
                [11 ] Department of Neurosurgery, Chibaken Saiseikai Narashino Hospital, Narashino, Chiba, Japan
                [12 ] Department of Neurosurgery, Noto General Hospital, Nanao, Ishikawa, Japan
                [13 ] Department of Neurosurgery, Kitami Red Cross Hospital, Kitami, Hokkaido, Japan
                [14 ] Department of Neurosurgery, Tokyo Kyosai Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
                [15 ] Department of Functional Brain Imaging Research, National Institute of Radiological Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Chiba, Japan
                [16 ] Department of Neurosurgery, Hokushinkai Megumino Hospital, Eniwa, Hokkaido, Japan
                [17 ] Normal Pressure Hydrocephalus Center, Jifukai Atsuchi Neurosurgical Hospital, Kagoshima, Kagoshima, Japan
                [18 ] Department of Neurosurgery, Kumamoto Takumadai Hospital, Kumamoto, Kumamoto, Japan
                [19 ] Department of Neurosurgery at Tokai University School of Medicine, Isehara, Kanagawa, Japan
                [20 ] Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Iwate, Japan
                [21 ] Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
                [22 ] Nishinomiya Kyoritsu Rehabilitation Hospital, Nishinomiya, Hyogo, Japan
                [23 ] Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata, Yamagata, Japan
                [24 ] Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Osaka, Japan
                [25 ] Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Kyoto, Japan
                Author notes
                Corresponding author: Madoka Nakajima, MD, PhD Department of Neurosurgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8342, Japan e-mail: madoka66@ 123456juntendo.ac.jp
                © 2021 The Japan Neurosurgical Society

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/

                : 17 August 2020
                : 13 October 2020
                Special Topic

                clinical guideline,idiopathic normal pressure hydrocephalus,diagnosis,treatment,management


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