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He Y, Wang Z, Zuo M, Zhang S, Li W, Chen S, Yuan Y, Yang Y, Liu Y. The impact of neurocognitive and psychiatric disorders on the risk of idiopathic normal pressure hydrocephalus: A bidirectional Mendelian randomization study. Brain Behav 2024; 14:e3532. [PMID: 38779749 PMCID: PMC11112403 DOI: 10.1002/brb3.3532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Neurocognitive and psychiatric disorders have been proved that they can comorbid more often with idiopathic normal pressure hydrocephalus (iNPH) than general population. However, the potential causal association between these disorders and iNPH has not been assessed. Thus, our study aims to investigate the causal relationship between them based on a bidirectional Mendelian randomization (MR) analysis. METHODS Random effects of the inverse variance weighted (IVW) method were conducted to obtain the causal association among the neurocognitive disorders, psychiatric disorders, and iNPH. Genome-wide association studies (GWAS) of 12 neurocognitive and psychiatric disorders were downloaded via the OpenGWAS database, GWAS Catalog, and Psychiatric Genomics Consortium, whereas GWAS data of iNPH were obtained from the FinnGen consortium round 9 release, with 767 cases and 375,610 controls of European ancestry. We also conducted the sensitivity analysis in these significant causal inferences using weighted median model, Cochrane's Q test, MR-Egger regression, MR Pleiotropy Residual Sum and Outlier detect and the leave-one-out analysis. RESULTS For most of the neurocognitive and psychiatric disorders, no causal association was established between them and iNPH. We have found that iNPH (odds ratio [OR] = 1.030, 95% confidence interval [CI]: 1.011-1.048, p = .001) is associated with increased risk for schizophrenia, which failed in validation of sensitivity analysis. Notably, genetically predicted Parkinson's disease (PD) is associated with increased risk of iNPH (OR = 1.256, 95% CI: 1.045-1.511, p = .015). CONCLUSION Our study has revealed the potential causal effect in which PD associated with an increased risk of iNPH. Further study is warranted to investigate the association between PD and iNPH and the potential underlying mechanism.
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Affiliation(s)
- Yuze He
- Department of NeurosurgeryWest China HospitalSichuan UniversityChengduChina
| | - Zhihao Wang
- Department of NeurosurgeryWest China HospitalSichuan UniversityChengduChina
| | - Mingrong Zuo
- Department of Pediatric NeurosurgeryWest China Women's and Children's Hospital, Sichuan University West China Second University HospitalChengduChina
| | - Shuxin Zhang
- Department of Critical Care MedicineWest China HospitalSichuan UniversityChengduChina
| | - Wenhao Li
- Department of NeurosurgeryWest China HospitalSichuan UniversityChengduChina
| | - Siliang Chen
- Department of NeurosurgeryWest China HospitalSichuan UniversityChengduChina
| | - Yunbo Yuan
- Department of NeurosurgeryWest China HospitalSichuan UniversityChengduChina
| | - Yuan Yang
- Department of NeurosurgeryWest China HospitalSichuan UniversityChengduChina
| | - Yanhui Liu
- Department of NeurosurgeryWest China HospitalSichuan UniversityChengduChina
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Mendes GADS, Hayashi CY, Vilela GHF, Kido L, Teixeira MJ, Pinto FCG. Comparison of Noninvasive Measurements of Intracranial with Tap Test Results in Patients with Idiopathic Normal Pressure Hydrocephalus. Neuropsychiatr Dis Treat 2023; 19:1127-1143. [PMID: 37193548 PMCID: PMC10182791 DOI: 10.2147/ndt.s402358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/17/2023] [Indexed: 05/18/2023] Open
Abstract
Background Normal pressure hydrocephalus is a disease directly related to the change in intracranial compliance and consequent repercussions in the brain parenchyma. Invasive monitoring of such parameters proves to be reliable especially for prognosis in neurocritical patients; however, it is not applicable in an outpatient service setting. The present study describes the comparison between the tap test results and the parameters obtained with a non-invasive sensor for monitoring intracranial compliance in patients with suspected NPH. Methods Twenty-eight patients were evaluated before and after lumbar puncture of 50mL of CSF (the tap test), comprising clinical assessment, magnetic resonance imaging, physical therapy assessment using the Timed Up and Go test, Dynamic Gait Index, BERG test, neuropsychological assessment, and recording of non-invasive intracranial compliance data using the Brain4care® device in three different positions (lying, sitting, and standing) for 5 min each. The tap test results were compared to the Time to Peak and P2/P1 ratio parameters obtained by the device. Results The group that had a positive Tap test result presented a median P2/P1 ratio greater than 1.0, suggesting a change in intracranial compliance. In addition, there was also a significant difference between patients with positive, negative, and inconclusive results, especially in the lying position. Conclusion A non-invasive intracranial compliance device when used with the patient lying down and standing up obtained parameters that suggest correspondence with the result of the tap test.
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Affiliation(s)
- Gabriel André da Silva Mendes
- Physiotherapy Nucleous, Hospital of the State Public Servant of São Paulo, São Paulo City, São Paulo State, Brazil
- Brain Hydrodynamics Group, Department of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo City, São Paulo State, Brazil
- Correspondence: Gabriel André da Silva Mendes, Email
| | - Cintya Yukie Hayashi
- Brain Hydrodynamics Group, Department of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo City, São Paulo State, Brazil
- Braincare Desenvolvimento e Inovação Tecnológica S.A, São Carlos City, São Paulo State, Brazil
| | | | - Lissa Kido
- Braincare Desenvolvimento e Inovação Tecnológica S.A, São Carlos City, São Paulo State, Brazil
| | - Manoel Jacobsen Teixeira
- Brain Hydrodynamics Group, Department of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo City, São Paulo State, Brazil
| | - Fernando Campos Gomes Pinto
- Brain Hydrodynamics Group, Department of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo City, São Paulo State, Brazil
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Langheinrich T, Chen C, Thomas O. Update on the Cognitive Presentations of iNPH for Clinicians. Front Neurol 2022; 13:894617. [PMID: 35937049 PMCID: PMC9350547 DOI: 10.3389/fneur.2022.894617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022] Open
Abstract
This mini-review focuses on cognitive impairment in iNPH. This symptom is one of the characteristic triad of symptoms in a condition long considered to be the only treatable dementia. We present an update on recent developments in clinical, neuropsychological, neuroimaging and biomarker aspects. Significant advances in our understanding have been made, notably regarding biomarkers, but iNPH remains a difficult diagnosis. Stronger evidence for permanent surgical treatment is emerging but selection for treatment remains challenging, particularly with regards to cognitive presentations. Encouragingly, there has been increasing interest in iNPH, but more research is required to better define the underlying pathology and delineate it from overlapping conditions, in order to inform best practise for the clinician managing the cognitively impaired patient. In the meantime, we strongly encourage a multidisciplinary approach and a structured service pathway to maximise patient benefit.
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Affiliation(s)
- Tobias Langheinrich
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
- *Correspondence: Tobias Langheinrich
| | - Cliff Chen
- Department of Neuropsychology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Owen Thomas
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom
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Nakajima M, Yamada S, Miyajima M, Kawamura K, Akiba C, Kazui H, Mori E, Ishikawa M. Tap Test Can Predict Cognitive Improvement in Patients With iNPH-Results From the Multicenter Prospective Studies SINPHONI-1 and -2. Front Neurol 2021; 12:769216. [PMID: 34795635 PMCID: PMC8593336 DOI: 10.3389/fneur.2021.769216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: We analyzed the predictive value of the tap test (TT) on the outcome of cerebrospinal fluid (CSF) shunting in patients with idiopathic normal pressure hydrocephalus (iNPH) and cognitive impairment up to 12 months postoperatively. Methods: We analyzed the data of two prospective multicenter studies on ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS) use in iNPH patients. We selected patients with Mini-Mental State Examination (MMSE) scores ≤ 26 points as study subjects. We used a multivariate logistic regression model to obtain the optimal threshold of MMSE scores after TT to predict the score improvement at 12 months following shunting and that helped to control for confounding factors such as age and MMSE scores before TT. We used logistic regression models to identify variables with age-adjusted odds ratio (A-OR) and multivariate-adjusted OR (M-OR). Results: For an improvement of ≥3 points in the MMSE score cutoff 7 days following TT in VPS and LPS cohort studies, the MMSE scores improved by 6 points after 12 months. The VPS cohort had sensitivity, specificity, and area under the curve (AUC) of 69.2, 73.7, and 0.771%, respectively; however, for the LPS cohort, they were 86.2, 90.9, and 0.906%, respectively. For MMSE scores that improved by ≥3 points in patients after the TT, the possibility of an improvement by 6 points at 12 months following CSF shunt had A-OR 7.77 and M-OR 6.3 times for the VPS, and A-OR 62.3 and M-OR 59.6 times for the LPS cohort. Conclusion: CSF shunting contributes to improved cognitive function in iNPH patients. Furthermore, MMSE score evaluation at the TT can sensitively predict improvement in postoperative MMSE scores following LPS intervention. Clinical Trial Registration: SINPHONI-1 (ClinicalTrials.gov, no. NCT00221091), first posted: September 22, 2005. SINPHONI-2 [University Hospital Medical Information Network (UMIN) Clinical Trials no. UMIN000002730], the posted: February 1, 2010.
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Affiliation(s)
- Madoka Nakajima
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shigeki Yamada
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Kaito Kawamura
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Chihiro Akiba
- Department of Neurosurgery, Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroaki Kazui
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Japan
| | - Masatsune Ishikawa
- Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan
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Valsecchi N, Mantovani P, Piserchia VA, Giannini G, Cevoli S, Aspide R, Oppi F, Milletti D, Cortelli P, Elder BD, Palandri G. The Role of Simultaneous Medical Conditions in Idiopathic Normal Pressure Hydrocephalus. World Neurosurg 2021; 157:e29-e39. [PMID: 34562629 DOI: 10.1016/j.wneu.2021.09.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is a chronic neurologic syndrome that affects the elderly population in a context of concomitant medical conditions. The aim of this study was to understand the significance of comorbidities using 4 validated and specific clinical scores: Cumulative Illness Rating Scale (CIRS), American Society of Anesthesiologists (ASA) score, Comorbidity Index (CMI), and Charlson Comorbidity Index (CCI). METHODS From 2015 until 2019, the Bologna PRO-Hydro multidisciplinary team selected 63 patients for shunt surgery. All comorbidity scores were collected during preoperative anesthesia evaluation. Positive shunt response was defined as an improvement in overall disability (assessed with modified Rankin Scale [mRS]), in risk of fall (assessed with Tinetti Permormance Orientated Mobility Assessment, Tinetti) and in INPH specific symptoms (assessed with INPH Grading Scale, INPHGS). RESULTS Patients with elevated values of CIRS had worse performance in gait and balance at Tinetti scale, both before (P = 0.039) and after surgery (P = 0.005); patients with high values of CMI had inferior values of Tinetti at baseline (P = 0.027) and higher mRS after surgery (P = 0.009); ASA 2 patients had better postoperative Tinetti scores than ASA 3 patients (P = 0.027). A positive or negative shunt response was not significantly correlated with patients' preoperative comorbidity scores. CONCLUSIONS Patients with multiple comorbidities have a worse preoperative condition compared to patients with less concomitant diseases, and the proposed comorbidity scores, CIRS in particular, are useful clinical tools for the anesthesiologist. Comorbidities, though, do not impact overall postoperative outcome.
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Affiliation(s)
- Nicola Valsecchi
- Ophthalmology Unit, DIMES, Alma Mater Studiorum University of Bologna and S. Orsola-Malpighi Teaching Hospital, Bologna, Italy.
| | - Paolo Mantovani
- UOC Neurochirurgia, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Vito Antonio Piserchia
- UOC Anestesia e rianimazione Ospedale Bellaria, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; Clinica Neurologica Metropolitana NEUROMET, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sabina Cevoli
- Clinica Neurologica Metropolitana NEUROMET, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raffaele Aspide
- UOC Anestesia e rianimazione Ospedale Bellaria, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federico Oppi
- UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia
| | - David Milletti
- UOSI Medicina Riabilitativa Intensiva, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giorgio Palandri
- UOC Neurochirurgia, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Kamohara C, Nakajima M, Kawamura K, Akiba C, Ogino I, Xu H, Karagiozov K, Arai H, Miyajima M. Neuropsychological tests are useful for predicting comorbidities of idiopathic normal pressure hydrocephalus. Acta Neurol Scand 2020; 142:623-631. [PMID: 32619270 PMCID: PMC7689708 DOI: 10.1111/ane.13306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/14/2020] [Accepted: 06/24/2020] [Indexed: 01/12/2023]
Abstract
Objectives Comorbidities of idiopathic normal pressure hydrocephalus (iNPH), such as Alzheimer's disease (AD) and Parkinson's spectrum (PS) disorder, can affect the long‐term prognosis of cerebrospinal fluid (CSF) shunting. Therefore, it is important to be able to predict comorbidities in the early stage of the disease. This study aimed to predict the comorbidities of iNPH using neuropsychological tests and cognitive performance evaluation. Materials & Methods Forty‐nine patients with possible iNPH were divided into three groups: iNPH without AD or PS comorbidity (group‐1), iNPH with AD comorbidity (group‐2), and iNPH with PS comorbidity (group‐3), according to CSF biomarkers such as phosphorylated tau and dopamine transporter imaging. Scores on the new EU‐iNPH‐scale, which is based on 4 neuropsychological tests (Rey Auditory Verbal Learning Test, Grooved Pegboard test, Stroop colour‐naming test and interference test), were compared for each group. In addition, the scores before and 12 months after CSF shunting for each group were compared. Results EU‐iNPH‐scale using 4 neuropsychological tests could distinguish group‐1 from group‐2 or group‐3 by area under the curve values of 0.787 and 0.851, respectively. Patients in group‐1 showed a remarkable increase in memory and learning ability after surgery. Group‐2 performed significantly poorer than group‐1 patients on memory testing, but otherwise showed improvements in most of the neuropsychological tests. Group‐3 performed significantly worse than group‐1 patients—especially on Stroop tests—but showed post‐surgery improvement on only the Stroop colour‐naming test. Conclusions The 4 neuropsychological tests of the EU‐iNPH‐scale can help predict iNPH comorbidities and evaluate the prognosis of CSF shunting.
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Affiliation(s)
| | | | - Kaito Kawamura
- Department of Neurosurgery Juntendo University Tokyo Japan
| | - Chihiro Akiba
- Department of Neurosurgery Juntendo Tokyo Koto Geriatric Medical Center Tokyo Japan
| | - Ikuko Ogino
- Department of Neurosurgery Juntendo University Tokyo Japan
| | - Hanbing Xu
- Department of Neurosurgery Juntendo University Tokyo Japan
| | | | - Hajime Arai
- Department of Neurosurgery Juntendo University Tokyo Japan
| | - Masakazu Miyajima
- Department of Neurosurgery Juntendo Tokyo Koto Geriatric Medical Center Tokyo Japan
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