Vascular risk factors for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

Hanlin Cai; Feng Yang; Hui Gao; Keru Huang; Linyuan Qin; Ruihan Wang; Yi Liu; Liangxue Zhou; Zilong Hao; Dong Zhou; Qin Chen

doi:10.3389/fneur.2023.1220473

Vascular risk factors for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

Front Neurol. 2023 Aug 10:14:1220473. doi: 10.3389/fneur.2023.1220473. eCollection 2023.

Authors

Hanlin Cai^#¹, Feng Yang^#¹, Hui Gao¹, Keru Huang², Linyuan Qin¹, Ruihan Wang¹, Yi Liu², Liangxue Zhou², Zilong Hao¹, Dong Zhou¹, Qin Chen¹

Affiliations

¹ Department of Neurology, West China Hospital of Sichuan University, Chengdu, China.
² Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China.

^# Contributed equally.

Abstract

Objective: Idiopathic normal-pressure hydrocephalus (iNPH) is a treatable cause of dementia; however, its etiology and pathogenesis remain poorly understood. The objective of this study was to investigate the prevalence and impact of vascular risk factors in patients with iNPH compared to a control cohort to better understand the potential mechanisms and preventive measures.

Methods: We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library (from inception to December 20, 2022) for studies reporting vascular risk factors for the development of iNPH. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using random-effects models.

Results: After screening 1,462 articles, 11 case-control studies comprising 1,048 patients with iNPH and 79,668 cognitively unimpaired controls were included in the meta-analysis. Our data showed that hypertension (N = 991, OR = 2.30, 95% CI 1.64 to 3.23, I²= 64.0%), diabetes mellitus (DM) (N = 985, OR = 3.12, 95% CI 2.29 to 4.27, I²= 44.0%), coronary heart disease (CHD; N = 880, OR = 2.34, 95% CI 1.33 to 4.12, I²= 83.1%), and peripheral vascular disease (N = 172, OR = 2.77, 95% CI 1.50 to 5.13, I²= 0.0%) increased the risk for iNPH, while overweight was a possible factor (N = 225, OR = 2.01, 95% CI 1.34 to 3.04, I²= 0.0%) based on the sensitivity analysis. Smoking and alcohol consumption were not associated with iNPH.

Conclusions: Our study suggested that hypertension, DM, CHD, peripheral vascular disease, and overweight were associated with iNPH. These factors might be involved in the pathophysiological mechanisms promoting iNPH. These findings require further investigation in future studies.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, CRD42022383004.

Keywords: diabetes mellitus; hypertension; idiopathic normal pressure hydrocephalus; meta-analysis; vascular risk factors.

Publication types

Systematic Review

Grants and funding

This work was supported by the STI2030-Major Projects Youth Scientist Program (No. 2022ZD0213600), National Natural Science Foundation of China (No. 82071203), Natural Science Foundation of Sichuan (No. 2022NSFSC1325), Chengdu Science and Technology Bureau Program (2019-YF09-00215-SN), and Young Scientists Fund (No. 82201608).