PONE-D-23-34214Depressive symptoms, functional impairment, and health-related quality of life in idiopathic normal pressure hydrocephalus: a population-based studyPLOS ONE

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Additional Editor Comments:

While the manuscript contains crucial information on iNPH, there is room for enhancement by incorporating the feedback provided by the reviewers.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The study is a population-based investigation on the impact of idiopathic normal pressure hydrocephalus (iNPH) on quality of life, depressive symptoms, and functional disability. Through neurological examinations and brain computed tomography scans of 122 participants, the researchers found that those with iNPH reported higher depression scores and lower functioning status compared to those without iNPH, and their health-related quality of life (HRQoL) was poorer. This study is interesting, but I still have some questions as follows:1. The participants in this study were recruited from a previous cohort study and followed up for two years. The authors should provide detailed inclusion and exclusion criteria for these participants, indicating that they had undergone relevant checks before being included in the study cohort to ensure that they did not have any diseases that could affect the results of this study (for example, whether the participants had excluded the possibility of depressive mood before being included in the study cohort, the authors should elaborate).2. The authors should detail when they assessed depressive symptoms, functional impairment, and/or HRQoL scores in the participants, ensuring that all scales were evaluated at approximately the same time point to exclude possible errors caused by disease progression.3. Although Tables 2 and 3 show different data, there is some duplication in the description of lines 196-199 in the results and lines 212-217. The authors should consider integrating them into one paragraph and more accurately describing the related results. 4. In Table 4, why did the authors select three different models (A, B, C) for logistic regression? The authors should give reasons; the authors should also provide detailed explanations of the differences in their analysis results to facilitate readers' understanding.

Reviewer #2: This study conducted an association analysis of anxiety symptoms, functional status and quality of life among iNPH patients in a population-based sample. In general, the sample size and analysis angle included in this article were acceptable. However, the following aspects need to be further improved by the author:

1. Please clarify the grouping criteria in detail. How to clearly define "iNPH patients" and "unlikely iNPH patients".

2. All participants underwent head imaging, and I recommend supplementating with representative imaging images.

3. The study sample is the population of patients enrolled in 2014 and followed up in 2017. Whether the authors can further follow-up up to 2024 makes the conclusion more convincing.There may be some new discoveries.

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Reviewer #1: No

Reviewer #2: No

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Depressive symptoms, functional impairment, and health-related quality of life in idiopathic normal pressure hydrocephalus: a population-based study

PONE-D-23-34214R1

Dear Dr. Andersson,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Jing A. Zhang, MD, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: The authors have revised and responded well to the issues raised, making the article more logical and the conclusions more convincing. I recommend acceptance of the article for publication.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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