Poor cognitive outcome in shunt-responsive idiopathic normal pressure hydrocephalus (original) (raw)
Related papers
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.
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.
Archives of Clinical Neuropsychology, 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. Downloaded from c t-Student. d After treatment, only 7 of the 142 patients in TMT-A and in 2 of 83 patients in TMT-B completed the test in the required time.
Annals of Neurology, 2010
To determine the impact of cortical Alzheimer disease pathology on shunt responsiveness in individuals treated for idiopathic normal pressure hydrocephalus (iNPH), 37 patients clinically diagnosed with iNPH participated in a prospective study in which performance on neurologic, psychometric, and gait measures before and 4 months after shunting was correlated with amyloid β plaques, neuritic plaques, and neurofibrillary tangles observed in cortical biopsies obtained during shunt insertion. No complications resulted from biopsy acquisition. Moderate to severe pathology was associated with worse baseline cognitive performance and diminished postoperative improvement on NPH symptom severity scales, gait measures, and cognitive instruments compared to patients lacking pathology. Although idiopathic normal pressure hydrocephalus (iNPH) is considered a reversible cause of cognitive and motor impairment in older adults, estimates of the response rate to shunting vary widely. 1,2 One potential contributor to shunt unresponsiveness is the presence of comorbid neurologic conditions that are common in aging. The role of Alzheimer disease (AD) in patients with iNPH is debated. Whereas some data suggest that comorbid AD contributes to poorer response to shunting in patients with otherwise typical symptoms of iNPH, other evidence indicates that patients who demonstrate typical features of iNPH benefit equally from shunting regardless of the presence of AD pathology.
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.
Alzheimer’s disease pathology and shunt surgery outcome in normal pressure hydrocephalus
PLOS ONE
We aimed to determine whether presence of AD neuropathology predicted cognitive, gait and balance measures in patients with idiopathic normal pressure hydrocephalus (iNPH) after shunt surgery. This is a prospective study of gait and balance measured by Timed Up and Go (TUG) and Tinetti tests, and cognitive function measured by Mini Mental Status Exam (MMSE), before and after shunt surgery in participants 65 years and older with iNPH at the Johns Hopkins University. Random effects models were used and adjusted for confounders. 88 participants were included in the analysis with a median (IQR) time of 104 (57-213) days between surgery and follow-up. 23 (25%) participants had neuritic plaques present (NP+) and were significantly older [76.4 (6.0) years], but were otherwise similar in all demographics and outcome measures, when compared to the group without neuritic plaques (NP-). NP-and NP+ participants equally improved on measures of TUG (β =-3.
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.
Alzheimer's disease comorbidity in normal pressure hydrocephalus: prevalence and shunt response
Journal of Neurology, Neurosurgery & Psychiatry, 2000
The clinical impact of Alzheimer's disease pathology at biopsy was investigated in 56 cognitively impaired patients undergoing shunt surgery for idiopathic normal pressure hydrocephalus (NPH). Cognition was measured by means of the global deterioration scale (GDS), the mini mental status examination (MMSE) and a battery of six psychometric tests. Gait was assessed using objective measurements of velocity and the ambulatory index (AI). The prevalence of cases exhibiting neuritic plaques (positive biopsies) increased in parallel with dementia severity from 18% for patients with GDS 3 to 75% for patients with GDS scores>6. Patients with positive biopsies were more cognitively impaired (higher GDS and lower MMSE scores) as well as more gait impaired (higher AI scores and slower velocities) than patients with negative biopsies. After surgery, gait velocity and AI scores improved significantly and to a comparable degree for patients with and without positive biopsies. Similar proportions of positive and negative biopsy patients also had improved gait as assessed by means of subjective video tape comparisons. There were no significant diVerences between the biopsy groups in the magnitude of postoperative psychometric change or in the proportion of cases exhibiting improved urinary control. Alzheimer's disease pathology is a common source of comorbidity in older patients with idiopathic NPH where it contributes to the clinical impairment associated with this disorder. For patients accurately diagnosed with NPH, concomitant Alzheimer's disease pathology does not strongly influence the clinical response to shunt surgery. (J Neurol Neurosurg Psychiatry 2000;68:778-781)
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.
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 ...