Cognitive Disturbances and Neuropsychological Changes after Surgical Treatment in a Cohort of 185 Patients with Idiopathic Normal Pressure Hydrocephalus (original) (raw)
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Idiopathic Normal Pressure Hydrocephalus: Results of a Prospective Cohort of 236 Shunted Patients
Acta Neurochirurgica Supplementum, 2012
Although idiopathic normal pressure hydrocephalus (iNPH) is considered a treatable dementia, there is still some controversy regarding the cognitive improvement in these patients. The main aims of this study were to analyze baseline cognitive status and to study the neuropsychological changes after surgical treatment in a sample of 185 consecutive iNPH patients. An additional aim was to identify the variables that influenced the cognitive outcome. Specific tests assessing memory, attention, visual scanning, executive functions (EFs), and motor speed were used before and 6 months after shunting. The cognitive domains most affected at baseline were memory, EFs, attention, and psychomotor speed. After shunting, significant differences in the group as a whole were found in all tests except Digits Forward and Trail Making Part B. However, less than 50% of patients showed a significant improvement when analyzed individually. Previous global cognitive status assessed by Mini-Mental State Examination baseline scores was the best predictor for the cognitive outcome.
Characteristics and reversibility of dementia in Normal Pressure Hydrocephalus
Behavioural …, 2007
Studies of the cognitive outcome after shunt insertion for treatment of Normal Pressure Hydrocephalus have reported widely mixed results. We prospectively studied performance of 60 patients with Normal Pressure Hydrocephalus on a comprehensive battery of neuropsychological tests before and after shunt surgery to determine which cognitive functions improve with shunt insertion. We also administered a subset of cognitive tests before and after temporary controlled drainage of cerebrospinal fluid to determine if change on this brief subset of tests after drainage could predict which patients would show cognitive improvement three to six months after shunt insertion. There was a significant improvement in learning, retention, and delayed recall of verbal memory three to six months after surgery (using paired t-tests). The majority (74%) of patients showed significant improvement (by at least one standard deviation) on at least one of the memory tests. Absence of improvement on verbal memory after temporary drainage of cerebrospinal fluid had a high negative predictive value for improvement on memory tests at 3-6 months after surgery (96%; p = 0.0005). Also, the magnitude of improvement from Baseline to Post-Drainage on few specific tests of learning and recall significantly predicted the magnitude of improvement after shunt surgery on the same tests (r 2 = 0.32-0.58; p = 0.04-0.001). Results indicate that testing before and after temporary drainage may be useful in predicting which patients are less likely to improve in memory with shunting.
Poor cognitive outcome in shunt-responsive idiopathic normal pressure hydrocephalus
Neurosurgery, 2013
Idiopathic normal pressure hydrocephalus (iNPH) causes cognitive decline that can be alleviated by shunting, but long-term outcome studies are scarce. To elucidate the long-term cognitive condition of shunt-responsive iNPH patients. The follow-up data (Kuopio University Hospital NPH Registry) of 146 patients diagnosed with iNPH by clinical and radiological examination, 24-hour intraventricular pressure monitoring, frontal cortical biopsy, and response to the shunt were analyzed for signs of dementia. The Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, and specified memory disorder criteria were used. Median follow-up was 4.8 years. At the end of follow-up, 117 (80%) of the 146 iNPH patients had cognitive decline and 67 (46%) had clinical dementia. The most common clinical diagnoses were Alzheimer disease and vascular dementia. In multivariate analysis of the 146 iNPH patients, memory deficit as a first symptom before shunt (odds ratio [OR] 18.3; 95% confidenc...
Cognitive profile of idiopathic normal pressure hydrocephalus
Dementia and geriatric cognitive disorders extra, 2011
Frontal lobe dysfunction is believed to be a primary cognitive symptom in idiopathic normal pressure hydrocephalus (iNPH); however, the neuropsychology of this disorder remains to be fully investigated. The objective of this study was to delineate a comprehensive profile of cognitive dysfunction in iNPH and evaluate the effects of cerebrospinal fluid (CSF) shunt surgery on cognitive dysfunction.
Postshunt Cognitive and Functional Improvement in Idiopathic Normal Pressure Hydrocephalus
Neurosurgery, 2011
BACKGROUND: Improvement in gait after shunt placement has been well documented in idiopathic normal pressure hydrocephalus (iNPH); however, controversy remains regarding the extent and pattern of postsurgical cognitive changes. Conflicting findings may be explained by variability in both test selection and follow-up intervals across studies. Furthermore, most investigations lack a control group, making it difficult to disentangle practice effects from a true treatment effect. OBJECTIVE: To examine postshunt changes in a sample of well-characterized iNPH participants compared with a group of age- and education-matched healthy control subjects. METHODS: We identified 12 participants with iNPH undergoing shunt placement and 9 control participants. All participants were evaluated with comprehensive neuropsychological testing and standardized gait assessment at baseline and were followed up for 6 months. RESULTS: Repeated-measures analysis of variance revealed a significant group- (iNPH ...
Current Journal of Neurology
Background: Normal pressure hydrocephalus (NPH) is a reversible type of dementia, which affects 0.2 to 5.9 percent of elders. It manifests with triad of gait disturbances, urinary incontinence, and cognitive decline. In this study, association between cognitive and neuroradiographic parameters of idiopathic NPH (iNPH) was appraised to find out possible biomarkers for preventive intervention. Methods: In a cross-sectional study, 16 patients with iNPH were evaluated for third and fourth ventricle diameter, diameter of temporal horn of lateral ventricle, Evans index (EI), callosal angle (CA), callosal bowing, and ballooning of frontal horn. The Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG) was used to take cognitive profile. Relation between brain magnetic resonance imaging (MRI) indices and cognitive domains was extracted, using generalized linear model (GLM). Results: Patients with mild callosal bowing had better function in memory (P = 0.050) and language (P = 0.001) than ...
Acta Scientific Medical Sciences, 2020
Normal Pressure Hydrocephalus (NPH) is a neurological disorder characterized by normal or mildly elevated intracranial pressure. Distinguishing NPH from other neurodegenerative disorders such as Alzheimer's disease and vascular dementia is challenging. Therefore, it may be undiagnosed and inappropriately managed. Patients with NPH are treated surgically with placement of a ventriculoperitoneal shunt; subsequently, most of them have shown clinical improvement in gait disturbance, bladder dysfunction, and cognitive functions. The case study within the present report aims to contribute new insights relative to the management and assessment of NPH. The present case additionally helps to inform the relevance of neuropsychological evaluation specific to the cognitive and behavioral sequelae of NPH. The case discussion provides data relative to the intersection of medical and psychological domains that further advance the classification and differentiation of NPH from other medical diseases or cognitive impairments. Further, the implementation of prospective neuropsychological assessments is discussed to help distinguish and inform more succinct diagnoses and appropriate treatment modalities for future providers managing the care of those suffering from NPH or NPH-like symptoms.
Cognitive functions after spinal tap in patients with normal pressure hydrocephalus
Normal pressure hydrocephalus (NPH) is characterised by gait disturbance, urinary incontinence and dementia. Even though dementia is a cardinal symptom of NPH, there is few data available concerning cognitive functioning. The aim of this observational case-control study was to evaluate the use of neuropsychological (NPSY) tests prior and after spinal tap test, which might be helpful for diagnosis, treatment and as a prognostic factor for shunt surgery. 15 patients with NPH and 18 controls
Background: Idiopathic normal pressure hydrocephalus (iNPH) is a progressive syndrome affecting gait, incontinence, and cognition in a significant number of older adults. Still, prospective studies on early development of symptoms are scarce. Aim: To investigate how neuropsychological functions develop before and in already diagnosed iNPH over a two-year period in a population-based material. Method: A sample of 104 participants (median [IQR] 75 [72–80] years old) from the general population underwent CT-imaging and clinical assessment at baseline and follow-up. We used the iNPH symptom scale covering four domains (Neuropsychology, Gait, Balance, Incontinence) and additional tests of executive functions. Morphological signs were rated with the iNPH Radscale. Non-parametric statistics with Bonferroni corrections and a significance-level of p <0.05 were used. Results: Median (IQR) time to follow-up was 25 (23–26) months. Effect size (ES) for individuals who developed iNPH (n = 8) s...
Memory difficulties of the adult patients with shunted hydrocephalus: a clinical research
Turkish Neurosurgery, 2011
AIm: The purpose of this prospective study was to describe memory problems of adult patients with hydrocephalus. mAterIAl and methOds: The research group consisted of healthy adults (control group) and hydrocephlic adults (hydrocephalus group). The hydrocephalus group (n: 19) had no clinical signs or symptoms of increased intracerebral pressure. The control group (n:20) was chosen from healthy adults. Both groups were evaluated by an experienced neuro-psychologist blinded to the groups. The examiner performed a battery of three different neuropsychological tests (Raven Standart Progressive Matrices, RSPM; Rey-Osterrieth Complex Figure Test, RCFT; and Rey Auditory-Verbal Learning Test, AVLT) to all groups. results: Almost all subtest scores of the AVLT and RCFT remained significant after the RSPM scores were controlled. Almost all neuropsychological test results of the hydrocephalus group were significantly worse than control group. COnClusIOn: This prospective study showed that adult patients with hydrocephalus have serious problems in memory function which might be directly caused by the hydrocephalus.