Abstract Details

Title Idiopathic Normal Pressure Hydrocephalus Opinions and Practices: A Cross-sectional Survey of Virginia Providers

Topic Movement Disorders

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 16-008

Objective To assess neurologists’ opinions and practices regarding the evaluation of possible/probable iNPH in the state of Virginia to help streamline the care of these patients.

Background Idiopathic normal pressure hydrocephalus (iNPH) is a form of communicating hydrocephalus characterized by gait and/or balance problems, cognitive impairment, and urinary incontinence (Hakim’s triad). The differential diagnosis for iNPH includes conditions across neurological subspecialties including cognitive/behavioral neurology, movement disorders, neuromuscular, and neurosurgery. Thus, the evaluation of these patients is not streamlined.

Design/Methods In an IRB-approved study, 184 attending neurologists and neurology advanced practice providers practicing in the state of Virginia were emailed an anonymous 13-item survey including demographic information, iNPH evaluation practices, and opinion on which provider evaluation is most appropriate to diagnose iNPH (cognitive/behavioral, general neurology, movement disorders, neurosurgery alone, or other).

Results Thirty-nine participants completed the survey (21% response rate). Eighty-one percent were attending physicians with 87% practicing at an academic center and 25% reporting subspecialty training. Sixty-one percent evaluated 0-9 patients, 26% 10-19 patients, 10% 20-29 patients, and 3% over 30 patients per year for a diagnosis of iNPH. Eighty-four percent were likely/very likely to recommend a high-volume lumbar puncture as part of their evaluation. Fifty-five percent were likely/very likely to refer to a subspecialist, most frequently neuropsychology (43%) and movement disorders (39%). Forty-six percent believed movement disorders is the most appropriate subspecialty to diagnose iNPH followed by general (18%), other (18%), cognitive/behavioral (14%), and neurosurgery alone (4%). Eighty-six percent stated they would refer patients to a streamlined iNPH multidisciplinary diagnostic clinic if available.

Conclusions The symptoms of Hakim’s triad span multiple subspecialities, but Virginia providers desire a streamlined approach with a multidisciplinary clinic that includes a movement disorders evaluation. This is appropriate considering gait is the most shunt-responsive iNPH symptom, and movement disorders commonly evaluates neurodegenerative gait disorders that can mimic iNPH.

Authors/Disclosures
Kristina M. Cain, MD PRESENTER	Dr. Cain has nothing to disclose.
Garima Agarwal, MD	Dr. Agarwal has nothing to disclose.
Alissa S. Higinbotham, MD (University of Virginia Medical Center)	Dr. Kasunich has nothing to disclose.

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