Relationship between cognitive profile and neuroradiographic parameters in patients with idiopathic normal pressure hydrocephalus (original) (raw)
Related papers
Profile of cognitive dysfunction and relation with gait disturbance in Normal Pressure Hydrocephalus
Clinical Neurology and Neurosurgery, 2014
Objectives: Although dementia is one of the most relevant symptoms of the idiopathic Normal-Pressure Hydrocephalus (iNPH) syndrome, some doubts remain about the nature of cognitive deficits in this disease. We aimed to determine the neuropsychological profile in iNPH and its relation with ventricular size, white matter vascular lesions (WML) and gait dysfunction. Methods: Seventeen iNPH patients and a control group (n = 14) were assessed with a battery of neuropsychological tests and a timed walk test. We calculated measures of frontal horn, occipital horn and third ventricle sizes and assessed white matter lesion (WML) load with a validated visual scale. Results: Patients differed significantly from controls in all cognitive tests, but did worse on the Rey Complex Figure test. We found no significant correlations between cognitive and imaging results in iNPH. Cognitive function was related to gait in controls, but not in iNPH patients. Conclusions: Patients presented widespread cognitive dysfunction with a predominance of visuo-spatial deficits. Dissociation between gait and cognitive dysfunction in iNPH patients suggests the existence of different pathophysiological mechanisms.
Journal of Neurology, Neurosurgery & Psychiatry, 1994
Measurements of hippocampal formation atrophy using MRI have been useful in distinguishing demented patients with a diagnosis of probable Alzheimer's disease from cognitively normal controls. To determine whether there is a similar relationship between hippocampal size and dementia in elderly patients suspected of normal pressure hydrocephalus (NPH), the authors obtained mini-mental status examination (MMSE) scores and MRI measurements of hippocampal size and CSF volume on 16 elderly patients whose severe ventriculomegaly and unexplained gait impairment made NPH a probable diagnosis. Hippocampal size correlated strongly with MMSE score (r = 0 75, p < 0.001); no significant MMSE correlation was found for ventricular CSF volume or extraventricular/ventricular CSF ratio. It was concluded that hippocampal atrophy is associated with severe cognitive dysfunction in many elderly patients with a diagnosis of NPH. As a hypothesis for further investigation, the detection of such atrophy may help identify cases where the presence of a pathology of Alzheimer's disease complicates the diagnosis of NPH. 1994 57: 590-593 J Neurol Neurosurg Psychiatry J Golomb, M J de Leon, A E George, et al. suspected normal pressure hydrocephalus. with cognitive impairment in elderly patients Hippocampal atrophy correlates with severe http://jnnp.bmj.com/content/57/5/590
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)
DEMENTIA DUE TO NORMAL PRESSURE HYDROCEPHALUS – LITERATURE REVIEW (Atena Editora)
DEMENTIA DUE TO NORMAL PRESSURE HYDROCEPHALUS – LITERATURE REVIEW (Atena Editora), 2023
Introduction: Hydrocephalus is a neurological condition with several causes, where cerebrospinal fluid accumulates abnormally, resulting in serious health risks and high treatment costs. Objective: To review the relationship between normal pressure hydrocephalus and dementia. Result: This condition is classified as a form of dementia and its prevalence increases with age. This occurs mainly due to problems in the circulation of cerebrospinal fluid (CSF), without a significant increase in intracranial pressure. Typical clinical symptoms include walking difficulties, urinary incontinence and dementia, known as Hakim's Triad (PASSOS-NETO CEB, et al., 2022). Conclusion: the disease can be diagnosed prenatally or in neonates using USG, and in older children and adults using CT or MRI (PASSOS-NETO CEB, et al., 2022).
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...
Neurological Research and Practice
Background The aim of this study was to examine in patients with idiopathic and neurodegenerative normal pressure hydrocephalus (NPH) if motor and cognitive performance as well as changes in biomarkers in cerebrospinal fluid (CSF) evolve differently. Methods 41 patients with a typical clinical and MR-/CT-morphological presentation of NPH divided into an Alzheimer-negative (AD–, n = 25) and an Alzheimer-positive (AD+, n = 16) group according to neurodegenerative biomarkers (S100 protein, neuron-specific enolase, β-amyloid 1–42, Tau protein, phospho-Tau, protein-level and CSF pressure) in CSF. Follow-up of cognitive and gait functions before and after a spinal tap of 40–50 ml CSF of up to 49 months. Clinical, motor, neuropsychological and CSF biomarkers were analyzed using a repeated multifactorial analysis of variance (ANOVA) with post-hoc testing. Results Gait and neuropsychological performance and CSF biomarkers evolved differently between the AD− and AD+ patients. In particular, t...
Alzheimer's & Dementia, 2011
Introduction: It has still not been clearly established whether the cognitive deficits of idiopathic normal pressure hydrocephalus (iNPH) are caused by a disturbance in cerebrospinal fluid (CSF) dynamics or an underlying metabolic disturbance. Objective: To identify the possible associations between biochemical markers, the neuroimaging characteristics, and cognitive deficits of patients undergoing investigations for possible iNPH. Methods: A CSF sample obtained during a lumbar puncture from 10 patients with iNPH was analyzed for several biochemical markers (lactate, 8-isoprostane, vascular endothelial growth factor [VEGF], neurofilament heavy protein, glial fibrillary acidic protein, amyloid beta 1-42, and total tau). All patients underwent a battery of neuropsychological testing and imaging as part of their selection process for their suitability for CSF diversion surgical procedure. Volumetric analysis of imaging was carried out measuring the ventricular volume (VV), intracranial volume (ICV), periventricular lucencies, deep white matter hyperintensities, and white matter (WM) volume, as well as their ratios. Results: A significant negative correlation of preoperative symptom duration and total tau levels (R 5 20.841, P 5.002) was found. There was a significant positive correlation (R 5 0.648, P 5.043) between the levels of VEGF and the VV/ICV ratio. There was a significant positive correlation of the levels of glial fibrillary acidic protein and the VV/deep white matter hyperintensities ratio (R 5 0.828, P 5 .006). A significant negative correlation was observed between the levels of neurofilament heavy protein and the VV/ICV ratio (R 5 20.657, P 5.039) and the WM volume (R 5 20.778, P 5.023). Lactate levels were lower for patients performing in the normal range on the Recognition Memory Test for faces. Patients who performed better in the Recognition Memory Test words test had higher ICV volumes. All the patients in this study showed below normal performance when the subcortical function was assessed. Conclusion: The positive correlation of VEGF with the severity of ventriculomegaly may indicate that this is because of the transmantle pressure gradient; this response may not be because of hypoxia but represents an attempt at neuroregeneration. The degree of reactive gliosis correlates inversely with the severity of WM lesions. Neuronal degeneration is negatively correlated with the volume of the WM in these patients. The small association of volumetry and the cognitive profile of these patients may be consistent with a direct biochemical disturbance being responsible for the cognitive deficit observed. Ongoing studies with set protocols for neuropsychological assessment and volumetric analysis are warranted to further elucidate on the preliminary results of the current study.
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.
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.
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.