Normal pressure hydrocephalus diagnostic lumbar puncture tap test: Epworth neuropsychology assessment guideline development.

Abstract

Introduction / Background: Normal Pressure Hydrocephalus is a potentially reversible condition affecting cognition, gait and continence which increases in prevalence with age. Diagnostic lumbar puncture tap tests (LTT) are commonly used to diagnose and inform management. One of the important diagnostic and prognostic indicators is a change in cognitive functioning. To detect change, a standardised cognitive assessment before and after LTT is required. This paper reviews the development of neuropsychology assessment guidelines at Epworth Richmond for this purpose. Methods: Literature review, benchmarking against other hospitals and a review of current Epworth practice was used in the development of the guidelines. Prospective quantitative data on Epworth Clinical Neuropsychologist’s confidence in completing these assessments was collected before and after implementation of the guidelines. Results: New guidelines reflecting the latest evidence and gold standard in assessment and diagnosis of Normal Pressure Hydrocephalus through LTT were developed and implemented. Average clinician confidence prior to the guidelines was 60% which increased to 90% after implementation. Conclusion: A significant improvement in clinician confidence with implementation of an evidence based guideline was observed. Future implications for delivery and review of the guidelines are considered.