2026 American Academy of Neurology Abstract Website

Objective:

To compare psychiatric outcomes in patients with obstructive versus communicating hydrocephalus.

Background:

Hydrocephalus is a relatively common neurological condition that consists of the accumulation of cerebrospinal fluid (CSF) and presents in different forms, including obstructive and communicating. Prior studies have strongly associated hydrocephalus with various psychiatric disorders, mostly commonly dementia and major depressive disorder (MDD), but the differences in the psychiatric manifestations between the individual types remains underexplored.

Design/Methods:

Using real-world data from the TriNetX U.S. Collaborative Network, we conducted a retrospective cohort study of adult patients with hydrocephalus that was further divided into two cohorts based on hydrocephalus type: obstructive or communicating. Propensity matching (1:1) was used to balance for common demographic information (race, age, gender, etc) and other medical conditions that have known neuropsychiatric sequelae (hypothyroidism, brain neoplasms).

The primary outcome studied was major depressive disorder (MDD) and dementia. Secondary outcomes included unspecified anxiety disorder, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), bipolar disorder, single depressive episode, and schizophrenia. Patients with these disorders prior to their hydrocephalus diagnosis were excluded.

Results:

A total of 83,070 patients were included, with 41,535 patients within each cohort. There were no significant differences between the groups in terms of demographics and neuropsychiatric comorbidities after propensity matching.

Obstructive hydrocephalus was associated with a statistically significant lower incidence of major depressive disorder compared to communicating hydrocephalus (Odds ratio [OR]=0.83, p=<0.01) and dementia (OR=0.74, p=<0.01). Secondary outcomes were significantly lower for obstructive hydrocephalus for unspecified anxiety disorder (OR=0.9, p=<0.01), bipolar disorder (OR=0.86, p=0.029), single episode of depression (OR=0.89, p=<0.01) and schizophrenia (OR=0.8, p=0.042). No significant differences were observed between both groups for GAD, panic disorder, or OCD.

Conclusions:

Communicating hydrocephalus was associated with a higher incidence of psychiatric disorders compared to obstructive hydrocephalus. Healthcare providers may want to consider this increased risk when evaluating hydrocephalus patients.