PROBABILISTIC DIAGNOSIS OF NORMAL-PRESSURE HYDROCEPHALUS AND OTHER TREATABLE CEREBRAL-LESIONS IN DEMENTIA

Clinical profiles of dementia patients, differing with respect to age, presence of gait abnormalities and urinary incontinence are discussed . Epidemiological data, subjective probabilities and clinical reasonin g are used to predict a treatable cerebral lesion, i.e., an intracrani al space occupying lesion or normal pressure hydrocephalus (NPH). Our calculations help in distinguishing clinically between demented patien ts who are, and who are not likely to benefit from computed tomography (CT) investigation for treatable lesions and, eventually, from cerebr ospinal fluid shunting for NPH. Utility calculations show that shuntin g can be recommended only for a patient with the full triad of symptom s of NPH, and CT evidence of NPH, when no other prognostic information is available. Future clinical research should address the long-term p rognosis of (treated) NPH patients, and the mortality of shunting, bec ause these two factors arc critical to the shunting decision.