{
  "abstract": "Long-term functional independence after shunt surgery for idiopathic normal pressure hydrocephalus varies widely, particularly in older patients with multiple comorbidities. We aimed to develop and prospectively validate a frailty-integrated prognostic prediction tool to support patient selection and preoperative decision-making. A retrospective cohort of 82 patients with idiopathic normal pressure hydrocephalus who underwent shunt surgery between 2005 and 2014 was used to develop a weighted idiopathic normal pressure hydrocephalus–specific frailty index based on multivariable logistic regression. The index incorporated neurological and non-neurological comorbidities, including dementia, cancer, depression, and movement disorders. The weighted idiopathic normal pressure hydrocephalus–specific frailty index was combined with preoperative modified Rankin Scale scores to estimate the probability of achieving functional independence (modified Rankin Scale ≤2) at 1, 2, and mid- to long-term follow-up (up to 4 years). Prospective validation was performed in an independent cohort of 30 patients treated between 2018 and 2023. The weighted idiopathic normal pressure hydrocephalus–specific frailty index demonstrated improved predictive performance, particularly for mid- to long-term outcomes (2-4 years), compared with conventional frailty indices, with higher correlation coefficients and lower Akaike Information Criterion values. Predicted probabilities of long-term independence declined stepwise with increasing frailty burden. In the validation cohort, predicted and observed outcomes showed good agreement, with adequate calibration confirmed by the Hosmer–Lemeshow test. This frailty-integrated prognostic prediction tool provides individualized estimates of long-term postoperative independence, particularly in the context of frailty and comorbidity burden. By incorporating comorbidity burden into preoperative assessment, the tool supports patient selection and shared decision-making and may facilitate realistic counseling and long-term care planning in older patients.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Stroke Medicine and Neurosurgery, Japanese Red Cross Kitami Hospital and Okhotsk Stroke Medical Center, Kitami, Hokkaido, Japan",
    "Department of Neurosurgery, Dohtoh Neurosurgery Hospital, Kitami, Hokkaido, Japan",
    "Information Design and Communication Course, Kitami Institute of Technology, Kitami, Hokkaido, Japan",
    "Department of Neurosurgery, Nagoya City University Graduate School of Medical Science, Nagoya, Aichi, Japan",
    "Department of Neurosurgery, Nayoro General Hospital, Nayoro, Hokkaido, Japan",
    "Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Teruo KIMURA"
    },
    {
      "affs": [
        2
      ],
      "name": "Atsushi NAKAGAKI"
    },
    {
      "affs": [
        0
      ],
      "name": "Takahiro SANADA"
    },
    {
      "affs": [
        0
      ],
      "name": "Hirotaka SATO"
    },
    {
      "affs": [
        0
      ],
      "name": "Seiya FUJIKAWA"
    },
    {
      "affs": [
        0
      ],
      "name": "Yujiro MATSUSHIMA"
    },
    {
      "affs": [
        0
      ],
      "name": "Anna ARAKI"
    },
    {
      "affs": [
        3
      ],
      "name": "Shigeki YAMADA"
    },
    {
      "affs": [
        4
      ],
      "name": "Kazuhiro SAKO"
    },
    {
      "affs": [
        5
      ],
      "name": "Manabu KINOSHITA"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bx0ygezkxbmqa.bib",
  "cited_by": 0,
  "doi": "10.2176/jns-nmc.2026-0066",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13731978/",
  "id": "bx0ygezkxbmqa",
  "issns": [
    "0470-8105",
    "1349-8029"
  ],
  "landing_url": "https://doi.org/10.2176/jns-nmc.2026-0066",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2728|Cerebrospinal fluid and hydrocephalus"
    ]
  ],
  "openalex": "W7196955262",
  "pdf_url": "https://www.jstage.jst.go.jp/article/nmc/advpub/0/advpub_2026-0066/_pdf",
  "pmcid": "PMC13731978",
  "pmid": "42572281",
  "published": "2026-08-07",
  "publisher": "Japan Neurosurgical Society",
  "ris": "https://research.draconitic.com/paper/bx0ygezkxbmqa.ris",
  "sources": [
    {
      "first_seen": "2026-11-08T12:22:03Z",
      "native_id": "PMC13731978",
      "source": "pmc",
      "url": "https://doi.org/10.2176/jns-nmc.2026-0066"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Cerebrospinal fluid and hydrocephalus",
      "subfield": "neurology"
    }
  ],
  "title": "A Frailty-integrated Prognostic Prediction Tool for Long-term Outcomes after Shunt Surgery in Idiopathic Normal Pressure Hydrocephalus: Development and Prospective Validation",
  "title_text": "A Frailty-integrated Prognostic Prediction Tool for Long-term Outcomes after Shunt Surgery in Idiopathic Normal Pressure Hydrocephalus: Development and Prospective Validation",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:22:03Z",
  "url": "https://research.draconitic.com/paper/bx0ygezkxbmqa",
  "venue": "Neurologia medico-chirurgica",
  "versions": []
}