認知症疾患医療センターにおける特発性正常圧水頭症診療の現状

The Current Status of Medical Care for Idiopathic Normal-pressure Hydrocephalus in Medical Centers for Dementia in Japan

2013年9月に全国207カ所の認知症疾患医療センターにアンケートを送付し，特発性正常圧水頭症（iNPH）の診療状況を調査した。回収率は48％で，このうち90％の施設でiNPHの診療を行っていた。タップテスト前に脳神経外科に紹介する施設が多かったが，脳神経外科でシャント術の適応なしと判断され，診療上の支障を感じる施設が56%あった。iNPH診療ガイドラインの使用は45％にとどまった。また，近年明らかになったiNPH診療における重要な知見が周知されていない施設もあった。

Abstract

We used a questionnaire to evaluate how patients with idiopathic normal-pressure hydrocephalus (iNPH) are examined in Medical Centers for Dementia (MCDs), which are qualified medical organizations for dementia patients in Japan. Ninety-eight of 205 MCDs responded to our questionnaire. Accordingly, more than 590 patients with iNPH underwent an MCD examination during the period of 1 year. In regards to the Guidelines for Management of iNPH, 40 of the 98 MCDs used neither the first nor second edition of the Guidelines, even though up-to-date information is available in the second edition of the Guidelines. At most MCDs, consultation with iNPH specialists was performed without a cerebrospinal fluid tap test. At more than half of the responding MCDs, doctors felt that the selection of appropriate candidates for shunt surgery differed from those selected by neurosurgeons. Moreover, 73 out of 87 MCDs argued that patients with iNPH should be examined by both dementia specialists and neurosurgeons after shunt surgery. These results suggest that doctors at MCDs should take advantage of up-to-date information and cooperate with iNPH specialists and neurosurgeons.