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Liu J, Kanno S, Iseki C, Kawakami N, Kakinuma K, Katsuse K, Matsubara S, Ota S, Endo K, Takanami K, Osawa SI, Kawaguchi T, Endo H, Mugikura S, Suzuki K. The grasp reflex in patients with idiopathic normal pressure hydrocephalus. J Neurol 2024; 271:4191-4202. [PMID: 38587636 PMCID: PMC11233324 DOI: 10.1007/s00415-024-12341-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To investigate the prevalence and intensity of grasp reflexes and to examine changes in these reflexes after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). METHODS We enrolled 147 patients with probable iNPH. A standard procedure was used to determine the presence of grasp reflexes, and the intensity of these reflexes was assessed using a four-category classification. Clinical rating scales and their correlation with grasp reflexes were also evaluated. Grasp reflexes were reassessed in 72 patients 1 year after surgery. RESULTS We found that approximately 50.3% of patients with iNPH exhibited a positive grasp reflex. Among these patients, 69% exhibited bilateral positivity, while the remaining patients showed unilateral positivity. Furthermore, the intensity of the grasp reflex was significantly correlated with the severity of gait and with cognitive, urinary, motor, and behavioural symptoms. Surgical interventions led to a reduction (41.7%) or maintenance (30.6%) of the reflex intensity in 72.3% of iNPH patients. The changes in reflex intensity showed significant positive correlations with changes in the number of steps of the Timed Up and Go test and Trail Making Test-A scores but not with changes in total scores on the iNPH Grading Scale. CONCLUSION This retrospective study identified grasp reflexes as a highly prevalent phenomenon in patients with iNPH. These reflexes can assist in evaluating the severity of various symptoms, including cognitive, gait, urinary, motor and emotional symptoms.
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Affiliation(s)
- Junyan Liu
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Shigenori Kanno
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Chifumi Iseki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Nobuko Kawakami
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Kazuo Kakinuma
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Kazuto Katsuse
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Shiho Matsubara
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Shoko Ota
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Keiko Endo
- Department of Rehabilitation, Tohoku University Hospital, Sendai, Japan
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Shin-Ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
- Division of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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Ryoo SW, Anita NZ, Perlman G, Xiong LY, Wu CY, Wood M, Rabin JS, Mitchell J, Swardfager W. Insulin-like growth factor-1 and cognition in normoglycemia, prediabetes, and type 2 diabetes mellitus. Psychoneuroendocrinology 2024; 161:106946. [PMID: 38198904 DOI: 10.1016/j.psyneuen.2023.106946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/23/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The relationship between insulin-like growth factor-1 (IGF-1) and cognition has been studied in healthy individuals, but not extensively with regards to insulin resistance and type 2 diabetes mellitus (T2DM). In this retrospective observational study, we investigated relationships of IGF-1 with memory and executive function across people with normoglycemia, prediabetes, and T2DM. METHODS Data from the Midlife in the United States (MIDUS) study were used. Episodic memory and executive function were assessed using the Brief Test of Adult Cognition by Telephone approximately 21.42 ± 12.10 months prior to measuring IGF-1 levels from a fasting blood sample. Normoglycemia was identified as individuals without a physician diagnosis of diabetes and glycated hemoglobin (HbA1c) ≤5.6%. Prediabetes was identified as those without a physician diagnosis of diabetes and HbA1c between 5.7%-6.4%. T2DM was identified as anyone with a physician diagnosis of diabetes, or HbA1c ≥6.5%, or anyone using an oral hypoglycemic medication. The associations were assessed using linear regressions controlling for age, sex, education, body mass index, C-reactive protein, HbA1c or homeostatic model of insulin resistance, MIDUS wave, exercise, smoking status, sleep quality, alcohol intake, oral hypoglycemic use, and insulin use. RESULTS The study included 1400 participants, which consisted of 583 normoglycemic (48.4% female, mean age 51.0 ± 12.2 years), 512 prediabetes (58.4% female, mean age 57.3 ± 11.8 years), and 305 T2DM participants (53.8% female, mean age 57.6 ± 11.5 years). Peripheral IGF-1 concentrations were lower (F2,1397 = 28.29, p < 0.001) in people with prediabetes or T2DM, vs. normoglycemia. Participants with prediabetes or T2DM had lower episodic memory (F2,1397 = 9.21, p < 0.001) and executive function (F2,1397 = 20.29, p < 0.001) composite z-scores than people with normoglycemia. Higher IGF-1 concentrations were associated with better executive performance in individuals with prediabetes (β = 0.115 [0.028, 0.202], p = 0.010), but not in individuals with normoglycemia or T2DM. An interaction between IGF-1 and sex in predicting executive function was observed in the prediabetes group (β = -0.344, p = 0.042), where the relationship was weaker in females (β = 0.106 [-0.012, 0.224], p = 0.077) than males (β = 0.251 [0.123, 0.380], p < 0.001). No associations were seen between IGF-1 and memory. CONCLUSION The results suggest that peripheral IGF-1 concentrations may be related to executive function, and that the relationship may be sex-specific and dependent on diabetes status.
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Affiliation(s)
- Si Won Ryoo
- Department of Pharmacology and Toxicology- University of Toronto, Medical Sciences Building, 1 King's College Circle Room 4207, Toronto ON M5S 1A8, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada; University Health Network Toronto Rehabilitation Institute - Rumsey Centre Cardiac Rehabilitation, 347 Rumsey Rd, East York ON M4G 2V6, Canada
| | - Natasha Z Anita
- Department of Pharmacology and Toxicology- University of Toronto, Medical Sciences Building, 1 King's College Circle Room 4207, Toronto ON M5S 1A8, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada; University Health Network Toronto Rehabilitation Institute - Rumsey Centre Cardiac Rehabilitation, 347 Rumsey Rd, East York ON M4G 2V6, Canada
| | - George Perlman
- Research Institute of McGill University Health Centre, 1001 Decarie Blvd, Montreal QC H4A 3J1, Canada
| | - Lisa Y Xiong
- Department of Pharmacology and Toxicology- University of Toronto, Medical Sciences Building, 1 King's College Circle Room 4207, Toronto ON M5S 1A8, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada
| | - Che-Yuan Wu
- Department of Pharmacology and Toxicology- University of Toronto, Medical Sciences Building, 1 King's College Circle Room 4207, Toronto ON M5S 1A8, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada
| | - Madeline Wood
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada; Rehabilitation Sciences Institute - University of Toronto, Rehabilitation Sciences Building, 500 University Avenue, Suite 160, Toronto ON M5G 1V7, Canada
| | - Jennifer S Rabin
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada; Rehabilitation Sciences Institute - University of Toronto, Rehabilitation Sciences Building, 500 University Avenue, Suite 160, Toronto ON M5G 1V7, Canada; Division of Neurology, Department of Medicine - University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, Toronto ON M5S 3H2, Canada; Harquail Centre for Neuromodulation, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada
| | - Jane Mitchell
- Department of Pharmacology and Toxicology- University of Toronto, Medical Sciences Building, 1 King's College Circle Room 4207, Toronto ON M5S 1A8, Canada
| | - Walter Swardfager
- Department of Pharmacology and Toxicology- University of Toronto, Medical Sciences Building, 1 King's College Circle Room 4207, Toronto ON M5S 1A8, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada; University Health Network Toronto Rehabilitation Institute - Rumsey Centre Cardiac Rehabilitation, 347 Rumsey Rd, East York ON M4G 2V6, Canada.
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Lee PL, Huang CK, Chen YY, Chang HH, Cheng CH, Lin YC, Lin CL. Enhancing Cognitive Function in Older Adults through Processing Speed Training: Implications for Cognitive Health Awareness. Healthcare (Basel) 2024; 12:532. [PMID: 38470642 PMCID: PMC10930606 DOI: 10.3390/healthcare12050532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/31/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
It may be possible to enhance adults' cognitive health and promote healthy aging through processing speed training using the Useful Field of View (UFOV) related activities and software. This study investigated the impact of utilizing UFOV on processing speed improvement in older adults in response to the growing global attention on cognitive health and aging issues. In this quasi-experimental study, 22 individuals (mean age ± SD = 71.9 ± 4.8) participated in the experimental group, and 20 community-based participants (mean age ± SD = 67.1 ± 4.8) were in the control group. The intervention involved ten sessions of UFOV training, each lasting 60 min, conducted twice a week for the experimental group while the control group engaged in volunteer service activities. Measurements of Counting Back, Fabrica, Double-Decision, and Hawkeye were administered to all participants before and after the intervention. The results showed significant improvements in the experimental group for the four measurements (p ≤ 0.01, 0.05, 0.001, 0.001) and non-significant gains in the control group (p ≥ 0.05) for all. Furthermore, mixed repeated-measures ANOVA analysis, with time 1 pre-test measures as the covariate, revealed significant interaction effects between time and group for all measurement indicators (p = 0.05, 0.01, 0.05) except for Fabrica (p > 0.05). In conclusion, these findings support the effectiveness of UFOV cognitive training interventions in enhancing specific cognitive abilities.
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Affiliation(s)
- Pai-Lin Lee
- Graduate School of Adult Education, National Kaohsiung Normal University, Kaohsiung 80201, Taiwan
| | - Chih-Kun Huang
- Department of Social Work, National Quemoy University, Kinmen 892009, Taiwan;
| | - Yi-Yi Chen
- Wenzao Chinese Language Center, Wenzao Ursuline University of Languages, Kaohsiung 807679, Taiwan;
| | - Hui-Hsiang Chang
- Center for English Language Teaching, Wenzao Ursuline University of Languages, Kaohsiung 807679, Taiwan;
| | - Chun-Hua Cheng
- Occupational Therapy Department, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung 802511, Taiwan;
| | - Yu-Chih Lin
- Division of General Internal Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807377, Taiwan;
| | - Chia-Li Lin
- Department of International Business, Ming Chuan University, Taipei 111, Taiwan;
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Zaksaite T, Loveday C, Edginton T, Spiers HJ, Smith AD. Hydrocephalus: A neuropsychological and theoretical primer. Cortex 2023; 160:67-99. [PMID: 36773394 DOI: 10.1016/j.cortex.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/09/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
Hydrocephalus is a common neurological condition, the hallmark feature of which is an excess in production, or accumulation, of cerebrospinal fluid in the ventricles. Although it is associated with diffuse damage to paraventricular brain areas, patients are broadly typified by a particular pattern of cognitive impairments that include deficits in working memory, attention, and spatial abilities. There have, however, been relatively few neuropsychological accounts of the condition. Moreover, theories of the relationship between aetiology and impairment appear to have emerged in isolation of each other, and proffer fundamentally different accounts. In this primer, we aim to provide a comprehensive and contemporary overview of hydrocephalus for the neuropsychologist, covering cognitive sequelae and theoretical interpretations of their origins. We review clinical and neuropsychological assays of cognitive profiles, along with the few studies that have addressed more integrative behaviours. In particular, we explore the distinction between congenital or early-onset hydrocephalus with a normal-pressure variant that can be acquired later in life. The relationship between these two populations is a singularly interesting one in neuropsychology since it can allow for the examination of typical and atypical developmental trajectories, and their interaction with chronic and acute impairment, within the same broad neurological condition. We reflect on the ramifications of this for our subject and suggest avenues for future research.
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Affiliation(s)
- Tara Zaksaite
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - Catherine Loveday
- School of Social Sciences, University of Westminster, 115 New Cavendish St, London W1W 6UW, UK
| | - Trudi Edginton
- Department of Psychology, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Hugo J Spiers
- Department of Experimental Psychology, Division of Psychology and Language Sciences, University College London, 26 Bedford Way, London, WC1H 0AP, UK
| | - Alastair D Smith
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK; Brain Research and Imaging Centre, University of Plymouth, 7 Derriford Rd, Plymouth, PL6 8BU, UK.
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Zawadka-Kunikowska M, Klawe JJ, Tafil-Klawe M, Bejtka M, Rzepiński Ł, Cieślicka M. Cognitive Function and Postural Control Strategies in Relation to Disease Progression in Patients with Parkinson's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912694. [PMID: 36231994 PMCID: PMC9566250 DOI: 10.3390/ijerph191912694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 06/01/2023]
Abstract
AIM This study assessed the influence of performing an additional cognitive task on center of pressure (COP) displacement in the early and advanced stages of patients with Parkinson's disease (PD) compared to age-matched healthy controls (HCs). METHODS The study included 40 HCs and 62 patients with PD: early PD (n = 38) and advanced PD (n = 24). COP parameters were determined by static posturography during quiet standing with open eyes (ST, single task) and simultaneous performance of a cognitive task (DT, dual task). Cognitive functioning was examined with a Mini Mental State Examination, number-counting-backward test, and number of enunciated words during DT. RESULTS In the advanced-PD group, DT significantly reduced the sway radius (p = 0.009), area of stabilogram (p = 0.034), medio-lateral length (p = 0.027), and velocity (p = 0.033) compared to ST. In HCs, DT showed a significant increase in the sway radius (p = 0.006), total length (p = 0.039), sway velocity (p = 0.037), anterior-posterior length, and sway velocity. Both PD groups showed worse cognitive performance compared to HCs. CONCLUSIONS Both early and advanced patients with PD showed significant delay in cognitive performance associated with executive function compared to the HCs. During additional cognitive tasks, patients with advanced stages of PD may reduce stabilographic parameters in medio-lateral direction, and this is probably an adaptive strategy to restore balance.
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Affiliation(s)
- Monika Zawadka-Kunikowska
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Jacek J. Klawe
- Department of Hygiene, Epidemiology, Ergonomy and Postgraduate Education, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Małgorzata Tafil-Klawe
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Monika Bejtka
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Łukasz Rzepiński
- Department of Neurology, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
- Sanitas-Neurology Outpatient Clinic, Dworcowa 110, 85-010 Bydgoszcz, Poland
| | - Mirosława Cieślicka
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
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Xiao H, Hu F, Ding J, Ye Z. Cognitive Impairment in Idiopathic Normal Pressure Hydrocephalus. Neurosci Bull 2022; 38:1085-1096. [PMID: 35569106 PMCID: PMC9468191 DOI: 10.1007/s12264-022-00873-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/25/2022] [Indexed: 01/03/2023] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a significant cause of the severe cognitive decline in the elderly population. There is no cure for iNPH, but cognitive symptoms can be partially alleviated through cerebrospinal fluid (CSF) diversion. In the early stages of iNPH, cognitive deficits occur primarily in the executive functions and working memory supported by frontostriatal circuits. As the disease progresses, cognition declines continuously and globally, leading to poor quality of life and daily functioning. In this review, we present recent advances in understanding the neurobiological mechanisms of cognitive impairment in iNPH, focusing on (1) abnormal CSF dynamics, (2) dysfunction of frontostriatal and entorhinal-hippocampal circuits and the default mode network, (3) abnormal neuromodulation, and (4) the presence of amyloid-β and tau pathologies.
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Affiliation(s)
- Haoyun Xiao
- Institute of Neuroscience, Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, 200031, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Fan Hu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zheng Ye
- Institute of Neuroscience, Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, 200031, China.
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7
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Kanno S, Ogawa KI, Kikuchi H, Toyoshima M, Abe N, Sato K, Miyazawa K, Oshima R, Ohtomo S, Arai H, Shibuya S, Suzuki K. Reduced default mode network connectivity relative to white matter integrity is associated with poor cognitive outcomes in patients with idiopathic normal pressure hydrocephalus. BMC Neurol 2021; 21:353. [PMID: 34517828 PMCID: PMC8436532 DOI: 10.1186/s12883-021-02389-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate whether default mode network (DMN) connectivity and brain white matter integrity at baseline were associated with severe cognitive impairments at baseline and poor cognitive outcomes after shunt placement in patients with idiopathic normal pressure hydrocephalus (iNPH). METHODS Twenty consecutive patients with iNPH whose symptoms were followed for 6 months after shunt placement and 10 healthy controls (HCs) were enrolled. DMN connectivity and brain white matter integrity at baseline in the patients with iNPH and HCs were detected by using resting-state functional magnetic resonance imaging (MRI) with independent component analysis and diffusion tensor imaging, respectively, and these MRI indexes were compared between the patients with iNPH and HCs. Performance on neuropsychological tests for memory and executive function and on the gait test was assessed in the patients with iNPH at baseline and 6 months after shunt placement. We divided the patients with iNPH into the relatively preserved and reduced DMN connectivity groups using the MRI indexes for DMN connectivity and brain white matter integrity, and the clinical measures were compared between the relatively preserved and reduced DMN connectivity groups. RESULTS Mean DMN connectivity in the iNPH group was significantly lower than that in the HC group and was significantly positively correlated with Rey auditory verbal learning test (RAVLT) immediate recall scores and frontal assessment battery (FAB) scores. Mean fractional anisotropy of the whole-brain white matter skeleton in the iNPH group was significantly lower than that in the HC group. The reduced DMN connectivity group showed significantly worse performance on the RAVLT at baseline and significantly worse improvement in the RAVLT immediate recall and recognition scores and the FAB scores than the preserved DMN connectivity group. Moreover, the RAVLT recognition score highly discriminated patients with relatively preserved DMN connectivity from those with relatively reduced DMN connectivity. CONCLUSIONS Our findings indicated that iNPH patients with reduced DMN connectivity relative to the severity of brain white matter disruption have severe memory deficits at baseline and poorer cognitive outcomes after shunt placement. However, further larger-scale studies are needed to confirm these findings.
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Affiliation(s)
- Shigenori Kanno
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Miyagi, 980-8575, Sendai, Japan. .,Department of Neurology, South Miyagi Medical Center, Shibata, Japan.
| | - Kun-Ichi Ogawa
- Department of Radiology, South Miyagi Medical Center, Shibata, Japan
| | - Hiroaki Kikuchi
- Healthcare Center, South Miyagi Medical Center, Shibata, Japan
| | - Masako Toyoshima
- Department of Rehabilitation, South Miyagi Medical Center, Shibata, Japan
| | - Nobuhito Abe
- Kokoro Research Center, Kyoto University, Kyoto, Japan
| | - Kazushi Sato
- Department of Radiology, South Miyagi Medical Center, Shibata, Japan
| | - Koichi Miyazawa
- Department of Neurology, South Miyagi Medical Center, Shibata, Japan.,Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Ryuji Oshima
- Department of Neurology, South Miyagi Medical Center, Shibata, Japan
| | - Satoru Ohtomo
- Department of Neurosurgery, South Miyagi Medical Center, Shibata, Japan
| | - Hiroaki Arai
- Department of Neurosurgery, South Miyagi Medical Center, Shibata, Japan
| | - Satoshi Shibuya
- Department of Neurology, South Miyagi Medical Center, Shibata, Japan.,Department of Neurology, Moriyama Memorial Hospital, Edogawa, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Miyagi, 980-8575, Sendai, Japan
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Grazzini I, Venezia D, Cuneo GL. The role of diffusion tensor imaging in idiopathic normal pressure hydrocephalus: A literature review. Neuroradiol J 2021; 34:55-69. [PMID: 33263494 PMCID: PMC8041402 DOI: 10.1177/1971400920975153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome that comprises a triad of gait disturbance, dementia and urinary incontinence, associated with ventriculomegaly in the absence of elevated intraventricular cerebrospinal fluid (CSF) pressure. It is important to identify patients with iNPH because some of its clinical features may be reversed by the insertion of a CSF shunt. The diagnosis is based on clinical history, physical examination and brain imaging, especially magnetic resonance imaging (MRI). Recently, some papers have investigated the role of diffusion tensor imaging (DTI) in evaluating white matter alterations in patients with iNPH. DTI analysis in specific anatomical regions seems to be a promising MR biomarker of iNPH and could also be used in the differential diagnosis from other dementias. However, there is a substantial lack of structured reviews on this topic. Thus, we performed a literature search and analyzed the most recent and pivotal articles that investigated the role of DTI in iNPH in order to provide an up-to-date overview of the application of DTI in this setting. We reviewed studies published between January 2000 and June 2020. Thirty-eight studies and four reviews were included. Despite heterogeneity in analysis approaches, the majority of studies reported significant correlations between DTI and clinical symptoms in iNPH patients, as well as different DTI patterns in patients with iNPH compared to those with Alzheimer or Parkinson diseases. It remains to be determined whether DTI could predict the success after CSF shunting.
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Affiliation(s)
- Irene Grazzini
- Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy
| | - Duccio Venezia
- Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy
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Azuma S, Kazui H, Kanemoto H, Suzuki Y, Sato S, Suehiro T, Matsumoto T, Yoshiyama K, Kishima H, Shimosegawa E, Tanaka T, Ikeda M. Cerebral blood flow and Alzheimer's disease-related biomarkers in cerebrospinal fluid in idiopathic normal pressure hydrocephalus. Psychogeriatrics 2019; 19:527-538. [PMID: 30916850 DOI: 10.1111/psyg.12435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/26/2018] [Accepted: 01/13/2019] [Indexed: 11/26/2022]
Abstract
AIM Alzheimer's disease (AD) pathology is highly prevalent in patients with idiopathic normal pressure hydrocephalus (iNPH), and the presence of AD pathology may involve regional cerebral blood flow (rCBF). In this study, we examined the relationship between rCBF and AD-related biomarkers in the cerebrospinal fluid of iNPH patients. METHODS Patients with iNPH (n = 39) were classified into groups with (iNPH/AD+) (n=15) and without (iNPH/AD-) (n=24) high biomarker probability of AD (i.e. combined low amyloid β 42 and high total tau in the cerebrospinal fluid). rCBF was quantified in 17 regions of interest by N-isopropyl-p-[123 I]iodoamphetamine single-photon emission computed tomography with the autoradiography method. We compared rCBF between the iNPH/AD- and iNPH/AD+ groups at baseline using a t-test and then compared changes in rCBF after shunt surgery between the groups using a paired t-test and two-way repeated measures ANOVA. RESULTS At baseline, there were no significant differences in rCBF between the groups in most regions apart from the putamen. After shunt surgery, a significant increase in rCBF in the putamen, amygdala, hippocampus, and parahippocampal gyrus was observed in iNPH/AD- patients. In iNPH/AD+ patients, no significant improvement in rCBF was observed in any region. In repeated measures analysis of variance, a significant group × shunt interaction was observed in the parietal lobe, frontal lobe, posterior cingulate cortex, precuneus, lateral temporal lobe, amygdala, hippocampus, parahippocampal gyrus, and putamen. CONCLUSIONS Improvement in rCBF after shunt surgery in iNPH/AD+ patients may be poorer than that in iNPH AD- patients.
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Affiliation(s)
- Shingo Azuma
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroaki Kazui
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Neuropsychiatry, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Psychiatry, Mizuma Hospital, Kaizuka, Japan.,Cognitive Reserve Research Center, Osaka Kawasaki Rehabilitation University, Kaizuka, Japan
| | - Yukiko Suzuki
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Japan
| | - Shunsuke Sato
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Suehiro
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takuya Matsumoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Eku Shimosegawa
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshihisa Tanaka
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
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10
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Abstract
As the worldwide prevalence of dementia increases, there is a greater and more urgent need for all health care providers to understand how to evaluate and manage cognitive impairment. Many people presenting with a dementing illness have one or more reversible underlying conditions that worsen prognosis and, if treated, can improve cognitive function. This article reviews the major potentially reversible dementias, including the basic workup and management of each condition.
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Affiliation(s)
- Milta O Little
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University Health Center, 1402 South Grand Boulevard Room M238, St Louis, MO 63104, USA.
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11
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Gallagher RM, Marquez J, Osmotherly P. Cognitive and upper limb symptom changes from a tap test in Idiopathic Normal Pressure Hydrocephalus. Clin Neurol Neurosurg 2018; 174:92-96. [PMID: 30219624 DOI: 10.1016/j.clineuro.2018.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 08/19/2018] [Accepted: 09/08/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To determine which cognitive and upper limb assessments can identify change in patients undergoing a Cerebrospinal fluid (CSF) tap test (TT) diagnosed with idiopathic Normal Pressure Hydrocephalus (iNPH). PATIENTS AND METHODS Prospective observational study of 74 iNPH patients undergoing a CSF TT for consideration of a ventricular peritoneal shunt. Patients who were offered surgical intervention were classified as responders. Patients were assessed with a battery of cognitive and upper limb assessments prior to and following a CSF TT. The Timed up and go cognition (TUG-C), Montreal Cognitive assessment (MoCA) and 9-hole peg test were utilised. RESULTS 40 patients were classified responders. Significant differences were identified for responders for the MoCA (0.62 points) and TUG-C (-6.02 s). Only the executive function and orientation sub scores of the MoCA showed significant changes for responders. The 9 hole peg test mean change of 4.33 s for responders was not significant. Non-responder change scores for the MoCA (0.22 points), TUG-C (0.3 s) and 9 hole peg test (2.58 s) were not significant. CONCLUSION The TUG-C has the potential to identify change in patients resulting from a CSF TT. While statistically significant change was found for the MoCA, a mean change of less than 1 point on this scale is unlikely to be clinically relevant. Similarly, the 9 hole peg test cannot be endorsed as an assessment tool for identifying changed performance in iNPH.
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Affiliation(s)
- Ryan M Gallagher
- John Hunter Hospital Physiotherapy Department, Hunter New England Local Health District, Newcastle, Australia; School of Health Sciences, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia.
| | - Jodie Marquez
- School of Health Sciences, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - Peter Osmotherly
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
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12
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Gallagher R, Marquez J, Osmotherly P. Clinimetric Properties and Minimal Clinically Important Differences for a Battery of Gait, Balance, and Cognitive Examinations for the Tap Test in Idiopathic Normal Pressure Hydrocephalus. Neurosurgery 2018; 84:E378-E384. [DOI: 10.1093/neuros/nyy286] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 06/04/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ryan Gallagher
- School of Health Sciences, The University of Newcastle, Australia
- Physiotherapy Department, John Hunter Hospital, Newcastle, Australia
| | - Jodie Marquez
- School of Health Sciences, The University of Newcastle, Australia
| | - Peter Osmotherly
- School of Health Sciences, The University of Newcastle, Australia
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13
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Neuropsychological Assessment in the Differential Diagnosis of Idiopathic Normal Pressure Hydrocephalus. An Important Tool for the Maintenance and Restoration of Neuronal and Neuropsychological Functions. ACTA NEUROCHIRURGICA. SUPPLEMENT 2017. [PMID: 28120085 DOI: 10.1007/978-3-319-39546-3_41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a progressive clinical syndrome that includes gait disturbances, urinary incontinence, and cognitive impairment. iNPH shows similarities to other neurodegenerative disorders, primarily Alzheimer's Disease (AD). Definition of the neuropsychological profile of iNPH and the qualitative analysis of systematic mistakes made in cognitive tests could represent a valid method for systematizing possible specific markers of iNPH dementia and differentiating it from other dementias. To evaluate the role and the efficacy of a neuropsychological protocol, designed at our institution, based on psychometric analysis and qualitative assessment, in the differential diagnosis of iNPH from AD dementia, we prospectively enrolled 12 patients with suspected iNPH, 11 patients with AD, and 10 healthy controls (HC) who underwent neuropsychological assessment. The assessment was done with the Mini Mental State Examination (MMSE), Mental Deterioration Battery (MDB), Frontal Assessment Battery (FAB), and the Deux Barrage Test. Evaluation in the iNPH group was performed before extended lumbar drainage (ELD), 48 h after ELD, and 1 week and 3 months after the insertion of a ventriculoperitoneal shunt (VPS). Statistical analysis demonstrated the cognitive profile of iNPH, which was mainly characterized by executive function and immediate verbal memory impairment compared with AD. Additionally, the neuropsychological markers were different between the two groups. The qualitative analysis of systematic mistakes made on the tests demonstrated differences in cognitive performances between the iNPH, AD, and HC cohorts. Neuropsychological assessment and qualitative evaluation could represent a useful tool for achieving effective management and restoration of functions in patients with iNPH.
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14
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A combined cognitive and gait quantification to identify normal pressure hydrocephalus from its mimics: The Geneva’s protocol. Clin Neurol Neurosurg 2017; 160:5-11. [DOI: 10.1016/j.clineuro.2017.06.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 05/05/2017] [Accepted: 06/04/2017] [Indexed: 11/19/2022]
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15
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Kanno S, Saito M, Kashinoura T, Nishio Y, Iizuka O, Kikuchi H, Takagi M, Iwasaki M, Takahashi S, Mori E. A change in brain white matter after shunt surgery in idiopathic normal pressure hydrocephalus: a tract-based spatial statistics study. Fluids Barriers CNS 2017; 14:1. [PMID: 28132644 PMCID: PMC5278569 DOI: 10.1186/s12987-016-0048-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/20/2016] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to elucidate changes in cerebral white matter after shunt surgery in idiopathic normal pressure hydrocephalus (INPH) using diffusion tensor imaging (DTI). Methods Twenty-eight consecutive INPH patients whose symptoms were followed for 1 year after shunt placement and 10 healthy control (HC) subjects were enrolled. Twenty of the initial 28 INPH patients were shunt-responsive (SR) and the other 8 patients were non-responsive (SNR). The cerebral white matter integrity was detected by assessing fractional anisotropy (FA) and mean diffusivity (MD). The mean hemispheric DTI indices and the ventricular sizes were calculated, and a map of these DTI indices was created for each subject. The DTI maps were analysed to compare preshunt INPH with HC and preshunt INPH with 1 year after shunt placement in each INPH group, using tract-based spatial statistics. We restricted analyses to the left hemisphere because of shunt valve artefacts. Results The ventricles became significantly smaller after shunt placement both in the SR and SNR groups. In addition, there was a significant interaction between clinical improvement after shunt and decrease in ventricular size. Although the hemispheric DTI indices were not significantly changed after shunt placement, there was a significant interaction between clinical improvement and increase in hemispheric MD. Compared with the HC group, FA in the corpus callosum and in the subcortical white matter of the convexity and the occipital cortex was significantly lower in SR at baseline, whereas MD in the periventricular and peri-Sylvian white matter was significantly higher in the SR group. Compared with the pre-operative images, the post-operative FA was only decreased in the corona radiata and only in the SR group. There were no significant regions in which DTI indices were altered after shunt placement in the SNR group. Conclusions Brain white matter regions in which FA was decreased after shunt placement were in the corona radiata between the lateral ventricles and the Sylvian fissures. This finding was observed only in shunt-responsive INPH patients and might reflect the plasticity of the brain for mechanical pressure changes from the cerebrospinal fluid system. Electronic supplementary material The online version of this article (doi:10.1186/s12987-016-0048-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shigenori Kanno
- Department of Neurology, Southmiyagi Medical Center, 38-1, Aza-nishi, Shibata, Miyagi, 989-1253, Japan. .,Department of Behavioural Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Makoto Saito
- Department of Behavioural Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohito Kashinoura
- Department of Behavioural Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiyuki Nishio
- Department of Behavioural Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Osamu Iizuka
- Department of Behavioural Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirokazu Kikuchi
- Department of Behavioural Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahito Takagi
- Department of Behavioural Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shoki Takahashi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Etsuro Mori
- Department of Behavioural Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
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16
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Nassar BR, Lippa CF. Idiopathic Normal Pressure Hydrocephalus: A Review for General Practitioners. Gerontol Geriatr Med 2016; 2:2333721416643702. [PMID: 28138494 PMCID: PMC5119812 DOI: 10.1177/2333721416643702] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/09/2016] [Indexed: 11/15/2022] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurodegenerative disease commonly characterized by a triad of dementia, gait, and urinary disturbance. Advancements in diagnosis and treatment have aided in properly identifying and improving symptoms in patients. However, a large proportion of iNPH patients remain either undiagnosed or misdiagnosed. Using PubMed search engine of keywords "normal pressure hydrocephalus," "diagnosis," "shunt treatment," "biomarkers," "gait disturbances," "cognitive function," "neuropsychology," "imaging," and "pathogenesis," articles were obtained for this review. The majority of the articles were retrieved from the past 10 years. The purpose of this review article is to aid general practitioners in further understanding current findings on the pathogenesis, diagnosis, and treatment of iNPH.
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Affiliation(s)
| | - Carol F. Lippa
- Drexel University, Philadelphia, PA, USA
- Carol F. Lippa, Department of Neurology, College of Medicine, Drexel University, Philadelphia, PA 19102, USA.
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17
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Zawadka-Kunikowska M, Zalewski P, Klawe JJ, Pawlak J, Tafil-Klawe M, Kędziora-Kornatowska K, Newton JL. Age-related changes in cognitive function and postural control in Parkinson's disease. Aging Clin Exp Res 2014; 26:505-10. [PMID: 24691816 DOI: 10.1007/s40520-014-0209-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 02/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS This study objectively analyzed postural instability and cognitive function in patients with Parkinson's disease (PD) and a group of healthy elderly and middle-aged individuals. METHODS The study included ten healthy middle-aged individuals (range 42-57 years), 14 healthy elderly individuals (range 60-90 years) and 15 PD patients (range 58-93 years). Center of pressure (COP) parameters were determined by means of computed static posturography during free standing with open and closed eyes. The level of cognitive functioning was examined with mini mental state examination (MMSE) and counting backwards test (CBT). RESULTS Parkinson's disease patients showed significantly lower MMSE scores compared to healthy middle-aged (p = 0.004) and elderly individuals (p = 0.03). Mean duration of CBT in PD patients was significantly longer than in healthy subjects. COP parameters correlated with age of subjects and cognitive function (MMSE score). No significant differences in any stabilographic parameters were observed between healthy elderly subjects and PD patients. CONCLUSIONS Age is the most significant factor impacting upon the static balance of older individuals during free standing. Compared to middle-aged and elderly individuals without central nervous system impairment, patients with PD present with significant delay in cognitive processes associated with executive function.
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Affiliation(s)
- Monika Zawadka-Kunikowska
- Department of Hygiene and Epidemiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, ul. M. Sklodowskiej-Curie 9, 85-094, Bydgoszcz, Poland,
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18
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Aoki Y, Kazui H, Tanaka T, Ishii R, Wada T, Ikeda S, Hata M, Canuet L, Musha T, Matsuzaki H, Imajo K, Yoshiyama K, Yoshida T, Shimizu Y, Nomura K, Iwase M, Takeda M. EEG and Neuronal Activity Topography analysis can predict effectiveness of shunt operation in idiopathic normal pressure hydrocephalus patients. NEUROIMAGE-CLINICAL 2013; 3:522-30. [PMID: 24273735 PMCID: PMC3830071 DOI: 10.1016/j.nicl.2013.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 09/30/2013] [Accepted: 10/13/2013] [Indexed: 11/19/2022]
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a neuropsychiatric syndrome characterized by gait disturbance, cognitive impairment and urinary incontinence that affect elderly individuals. These symptoms can potentially be reversed by cerebrospinal fluid (CSF) drainage or shunt operation. Prior to shunt operation, drainage of a small amount of CSF or "CSF tapping" is usually performed to ascertain the effect of the operation. Unfortunately, conventional neuroimaging methods such as single photon emission computed tomography (SPECT) and functional magnetic resonance imaging (fMRI), as well as electroencephalogram (EEG) power analysis seem to have failed to detect the effect of CSF tapping on brain function. In this work, we propose the use of Neuronal Activity Topography (NAT) analysis, which calculates normalized power variance (NPV) of EEG waves, to detect cortical functional changes induced by CSF tapping in iNPH. Based on clinical improvement by CSF tapping and shunt operation, we classified 24 iNPH patients into responders (N = 11) and nonresponders (N = 13), and performed both EEG power analysis and NAT analysis. We also assessed correlations between changes in NPV and changes in functional scores on gait and cognition scales before and after CSF tapping. NAT analysis showed that after CSF tapping there was a significant decrease in alpha NPV at the medial frontal cortex (FC) (Fz) in responders, while nonresponders exhibited an increase in alpha NPV at the right dorsolateral prefrontal cortex (DLPFC) (F8). Furthermore, we found correlations between cortical functional changes and clinical symptoms. In particular, delta and alpha NPV changes in the left-dorsal FC (F3) correlated with changes in gait status, while alpha and beta NPV changes in the right anterior prefrontal cortex (PFC) (Fp2) and left DLPFC (F7) as well as alpha NPV changes in the medial FC (Fz) correlated with changes in gait velocity. In addition, alpha NPV changes in the right DLPFC (F8) correlated with changes in WMS-R Mental Control scores in iNPH patients. An additional analysis combining the changes in values of alpha NPV over the left-dorsal FC (∆alpha-F3-NPV) and the medial FC (∆alpha-Fz-NPV) induced by CSF tapping (cut-off value of ∆alpha-F3-NPV + ∆alpha-Fz-NPV = 0), could correctly identified "shunt responders" and "shunt nonresponders" with a positive predictive value of 100% (10/10) and a negative predictive value of 66% (2/3). In contrast, EEG power spectral analysis showed no function related changes in cortical activity at the frontal cortex before and after CSF tapping. These results indicate that the clinical changes in gait and response suppression induced by CSF tapping in iNPH patients manifest as NPV changes, particularly in the alpha band, rather than as EEG power changes. Our findings suggest that NAT analysis can detect CSF tapping-induced functional changes in cortical activity, in a way that no other neuroimaging methods have been able to do so far, and can predict clinical response to shunt operation in patients with iNPH.
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Affiliation(s)
- Yasunori Aoki
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroaki Kazui
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toshihisa Tanaka
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryouhei Ishii
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Corresponding author at: Department of Psychiatry, Osaka University Graduate School of Medicine, D3 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan. Tel.: + 81-6-6879-3051; fax: + 81-6-6879-3059.
| | - Tamiki Wada
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shunichiro Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masahiro Hata
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Leonides Canuet
- UCM-UPM Centre for Biomedical Technology, Department of Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain
| | | | | | - Kaoru Imajo
- Nihon Kohden Corporation, Shinjuku, Tokyo, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuhiko Yoshida
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiro Shimizu
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keiko Nomura
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masao Iwase
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masatoshi Takeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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19
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Malm J, Graff-Radford NR, Ishikawa M, Kristensen B, Leinonen V, Mori E, Owler BK, Tullberg M, Williams MA, Relkin NR. Influence of comorbidities in idiopathic normal pressure hydrocephalus - research and clinical care. A report of the ISHCSF task force on comorbidities in INPH. Fluids Barriers CNS 2013; 10:22. [PMID: 23758953 PMCID: PMC3689166 DOI: 10.1186/2045-8118-10-22] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/28/2013] [Indexed: 01/18/2023] Open
Abstract
Idiopathic normal pressure hydrocephalus (INPH) is a syndrome of ventriculomegaly, gait impairment, cognitive decline and incontinence that occurs in an elderly population prone to many types of comorbidities. Identification of the comorbidities is thus an important part of the clinical management of INPH patients. In 2011, a task force was appointed by the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders (ISHCSF) with the objective to compile an evidence-based expert analysis of what we know and what we need to know regarding comorbidities in INPH. This article is the final report of the task force. The expert panel conducted a comprehensive review of the literature. After weighing the evidence, the various proposals were discussed and the final document was approved by all the task force members and represents a consensus of expert opinions. Recommendations regarding the following topics are given: I. Musculoskeletal conditions; II. Urinary problems; III. Vascular disease including risk factors, Binswanger disease, and white matter hyperintensities; IV. Mild cognitive impairment and Alzheimer disease including biopsies; V. Other dementias (frontotemporal dementia, Lewy body, Parkinson); VI. Psychiatric and behavioral disorders; VII. Brain imaging; VIII. How to investigate and quantify. The task force concluded that comorbidity can be an important predictor of prognosis and post-operative outcome in INPH. Reported differences in outcomes among various INPH cohorts may be partly explained by variation in the rate and types of comorbidities at different hydrocephalus centers. Identification of comorbidities should thus be a central part of the clinical management of INPH where a detailed history, physical examination, and targeted investigations are the basis for diagnosis and grading. Future INPH research should focus on the contribution of comorbidity to overall morbidity, mortality and long-term outcomes.
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Affiliation(s)
- Jan Malm
- Department of Clinical Neuroscience, Umeå University, Umeå, 901 85, Sweden.
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