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Hudon C, Belleville S, Belzile F, Landry M, Mulet-Perreault H, Trudel C, Macoir J. Normative Data for the Judgment of Line Orientation Test (Long and Short Forms) in the Quebec-French Population Aged between 50 and 89 Years. Arch Clin Neuropsychol 2023:acad077. [PMID: 37779470 DOI: 10.1093/arclin/acad077] [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] [Accepted: 09/11/2023] [Indexed: 10/03/2023] Open
Abstract
The Judgment of Line Orientation (JLO) Test of Benton assesses visuospatial processing without requiring motor skills. The test is frequently used in geriatric or brain-injured populations. As with other cognitive tests, performance on the JLO test may vary according to age, level of education, sex, and cultural background of individuals. The present study aimed to establish normative data for a short (15 items) and a long (30 items) form of the JLO. The sample for the short and long forms comprised 198 and 260 individuals, respectively, aged 50-89 years. All participants were French-speaking people from the province of Quebec, Canada. Using regression-based norming, the effects of age, years of formal education, and sex on JLO performance were estimated. The normative adjustment of the JLO short and long forms considered the weight of each predictor on test performance. Results indicated that JLO performance was positively associated with years of formal education and male sex, whereas it was negatively associated with age. Accordingly, normative data were generated using Z-scores and adjusted scaled scores derived from the regression equations. To conclude, the present norms will ease the detection of visuospatial impairment in French-Quebec middle-aged and older adults.
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Affiliation(s)
- Carol Hudon
- École de Psychologie, Université Laval, Québec, QC, Canada
- Research Centers CERVO, Québec, QC, Canada
- Research Centers VITAM, Québec, QC, Canada
| | - Sylvie Belleville
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada
| | - Florence Belzile
- École de Psychologie, Université Laval, Québec, QC, Canada
- Research Centers CERVO, Québec, QC, Canada
| | - Mariane Landry
- École de Psychologie, Université Laval, Québec, QC, Canada
- Research Centers CERVO, Québec, QC, Canada
| | - Hannah Mulet-Perreault
- École de Psychologie, Université Laval, Québec, QC, Canada
- Research Centers CERVO, Québec, QC, Canada
| | - Corinne Trudel
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - Joël Macoir
- Research Centers CERVO, Québec, QC, Canada
- Département de Réadaptation, Université Laval, Québec, QC, Canada
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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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3
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Bluett B, Ash E, Farheen A, Fasano A, Krauss JK, Maranzano A, Passaretti M, Tang‐Wai DF, Van Gerpen J, Alonso‐Canovas A, Youn J, Malm J, Martino D. Clinical Features of Idiopathic Normal Pressure Hydrocephalus: Critical Review of Objective Findings. Mov Disord Clin Pract 2023; 10:9-16. [PMID: 36704075 PMCID: PMC9847299 DOI: 10.1002/mdc3.13608] [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: 05/09/2022] [Revised: 09/07/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
Background Idiopathic normal pressure hydrocephalus (iNPH) is characterized by the classic clinical triad of gait, cognitive, and urinary dysfunction, albeit incomplete in a relevant proportion of patients. The clinical findings and evolution of these symptoms have been variably defined in the literature. Objectives To evaluate how the phenomenology has been defined, assessed, and reported, we performed a critical review of the existing literature discussing the phenomenology of iNPH. The review also identified the instrumental tests most frequently used and the evolution of clinical and radiologic findings. Methods The review was divided into 3 sections based on gait, cognitive, and urinary dysfunction. Each section performed a literature search using the terms "idiopathic normal pressure hydrocephalus" (iNPH), with additional search terms used by each section separately. The number of articles screened, duplicates, those meeting the inclusion criteria, and the number of articles excluded were recorded. Findings were subsequently tallied and analyzed. Results A total of 1716 articles with the aforementioned search criteria were identified by the 3 groups. A total of 81 full-text articles were reviewed after the elimination of duplicates, articles that did not discuss phenomenological findings or instrumental testing of participants with iNPH prior to surgery, and articles with fewer than 10 participants. Conclusions "Wide-based gait" was the most common gait dysfunction identified. Cognitive testing varied significantly across articles, and ultimately a specific cognitive profile was not identified. Urodynamic testing found detrusor overactivity and "overactive bladder" as the most common symptom of urinary dysfunction.
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Affiliation(s)
- Brent Bluett
- Central California Movement DisordersPismo BeachCaliforniaUSA
| | - Elissa Ash
- Department of Neurology, Faculty of MedicineTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Amtul Farheen
- Department of NeurologyLebanon VA Medical CenterLebanonPennsylvaniaUSA
- Department of NeurologyPenn State Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's DiseaseMorton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
- Howard Cohen Normal Pressure Hydrocephalus ProgramUniversity Health Network, Toronto Western HospitalTorontoOntarioCanada
- Department of Medicine, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | | | - Alessio Maranzano
- Department of NeurologyIstituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico)MilanItaly
- Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
| | | | - David F. Tang‐Wai
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
- Howard Cohen Normal Pressure Hydrocephalus ProgramUniversity Health Network, Toronto Western HospitalTorontoOntarioCanada
- Department of Medicine, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- University Health Network Memory ClinicToronto Western HospitalTorontoOntarioCanada
| | - Jay Van Gerpen
- Department of NeurologyUniversity of Alabama at BirminghamHuntsvilleAlabamaUSA
| | - Araceli Alonso‐Canovas
- Movement Disorders Unit. Neurology DepartmentHospital Universitario Ramón y CajalMadridSpain
| | - Jinyoung Youn
- Department of NeurologySamsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Jan Malm
- Department of Clinical NeuroscienceUmeå UniversityUmeåSweden
| | - Davide Martino
- Department of Clinical Neurosciences and Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
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4
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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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Motor skills, cognitive impairment, and quality of life in normal pressure hydrocephalus: early effects of shunt placement. Acta Neurochir (Wien) 2022; 164:1765-1775. [PMID: 35212797 PMCID: PMC9233626 DOI: 10.1007/s00701-022-05149-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/24/2022] [Indexed: 11/24/2022]
Abstract
Background Traditionally, clinical findings of normal pressure hydrocephalus are mainly characterized by the Hakim triad. The aim of this study is to evaluate the performance of patients suffering from idiopathic normal pressure hydrocephalus (iNPH) in a more holistic manner regarding motor skills, cognitive impairment, and quality of life. Methods In total, 30 individuals diagnosed with iNPH as well as a reference group with another 30 individuals were included. The iNPH patients and the reference group were age, educational, and morbidity matched. A standardized test battery for psychomotor skills, gait, neuropsychological abilities as well as questionnaires for quality of life was applied. The iNPH group was tested prior to surgery, at 6 weeks, and 3 months postoperatively. The reference group was tested once. Results Patients showed a significant improved performance in various items of the test battery during the first 3 months postoperatively. This included neuropsychological evaluation, motor skills including gait and upper motor function as well as the quality of life of the patients. Compared to reference individuals, neuropsychological aspects and quality of life of iNPH patients improved in some parts nearly to normal values. Conclusion Our findings underline that shunt surgery does not only improve the symptoms in iNPH patients but also ameliorates the quality of life to a great extent close to those of age and comorbidity matched reference individuals. This data enables an optimized counseling of iNPH patients regarding the expectable outcome after shunt surgery especially regarding cognitive performance, motor skills as well as life quality.
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6
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There is more to NPH than lower body Parkinsonism. Acta Neurochir (Wien) 2021; 163:2673-2674. [PMID: 34241678 PMCID: PMC8437831 DOI: 10.1007/s00701-021-04904-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022]
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7
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Büyükgök D, Özdemir Ö, Ünal TC, Barlas O. When to Assess: Cognitive Impact of Ventriculoperitoneal Shunt Operation in Elderly Adults with Normal Pressure Hydrocephalus. World Neurosurg 2021; 154:e302-e312. [PMID: 34246822 DOI: 10.1016/j.wneu.2021.07.015] [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: 02/18/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Normal pressure hydrocephalus (NPH) has clinical manifestations with different cognitive difficulties. Despite the intense interest, the change in cognitive functions after ventriculoperitoneal shunt (VPS) treatment varies widely. The aims of this study were to monitor the effect of NPH on cognition in elderly and the progress of cognitive abilities after VPS surgery. METHODS Patients diagnosed with idiopathic NPH (iNPH) who had ventriculomegaly with narrow callosal angle and/or periventricular signal changes not attributable to ischemic changes were included in study. All patients (n = 30) underwent comprehensive neuropsychological assessment and received programmable VPS. After VPS placement, 2 consecutive examinations were performed at approximately 6-month intervals. RESULTS At the baseline evaluation, patients with iNPH displayed poorer performance in executive functions (EFs) compared with the matched control group (n = 30). Among those patients, significant improvement was observed in semantic fluency (M = 13.94; standard deviation, 4.95) and clock drawing (M = 3.67; standard deviation, 1.57) at the second follow-up evaluation (P = 0.015 and P = 0.024, respectively). The other prominent finding was in memory process: patients with iNPH showed improvement in delayed recall (P = 0.011), recognition (P = 0.033), and learning scores (P = 0.041) at the second follow-up compared with evaluation before VPS placement. CONCLUSIONS iNPH seems to have a detrimental effect predominantly on EFs. As EFs become corrupted, decline occurs in learning and recall processes of memory. VPS provides an improvement of cognitive deterioration; however, efficacy of this treatment on cognitive abilities is shows in a longer period compared with other iNPH symptoms.
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Affiliation(s)
- Deniz Büyükgök
- Department of Psychiatry, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Ömer Özdemir
- Department of Neurosurgery, Faculty of Medicine, Gaziosmanpasa Education and Research Hospital, Istanbul, Turkey
| | - Tuğrul Cem Ünal
- Department of Neurosurgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Orhan Barlas
- Department of Neurosurgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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8
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Gasser AI, Descloux V, von Siebenthal A, Cordonier N, Rossier P, Zumbach S. Benton judgment of line orientation test: Examination of four short forms. Clin Neuropsychol 2019; 34:580-590. [PMID: 31076008 DOI: 10.1080/13854046.2019.1611927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: This multicenter retrospective study aimed at examining the clinical accuracy of four 15-item versions (Woodard's O and E; Quall's Q and S) of the original 30-item Benton judgment of line orientation test in a mixed clinical sample of 260 patients. It is a test frequently used as a measure of visuospatial processing. It has the advantage of requiring minimal motor skills, while a major weakness is the lengthy administration time.Method: An archival search was conducted within four in- and out-patient clinics. The frequency and magnitude of score differences were calculated to examine the equivalence of the short forms. We then checked the clinical accuracy of the short forms concerning classification of impaired, borderline, and non-impaired performance, according to NEURONORMA norms. After that, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficients to assess the classification outcome of the short versions compared to the long version, when using a dichotomous classification (impaired versus intact performance).Results: When applying NEURONORMA norms, specificity (99.1%), PPV (93.1%), and kappa coefficient (0.87) were highest for version E. NPV (99.4%) and sensitivity (95.5%) were highest for version S, but the PPV of this version was relatively low (67.7%).Conclusions: We suggest use of version E when a short test is needed, as specificity, kappa coefficient, and PPV are highest for this version, while maintaining a high NPV (97.8%). However, future research should develop new normative data for these short 15-item versions.
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Affiliation(s)
- Anne-Isabelle Gasser
- Réseau fribourgeois de santé mentale, Marsens, Switzerland.,Neuropsychology Unit, Clinique Valmont, Glion, Switzerland
| | - Virginie Descloux
- Neuropsychology Unit, Hopital Fribourgeois Site Billens, Billens, Switzerland
| | - Aline von Siebenthal
- Réseau fribourgeois de santé mentale, Marsens, Switzerland.,Neuropsychology Unit, Hopital Fribourgeois Site Billens, Billens, Switzerland
| | - Natacha Cordonier
- Neuropsychology Unit, Hopital Fribourgeois Site Billens, Billens, Switzerland
| | - Philippe Rossier
- Neuropsychology Unit, Hopital Fribourgeois Site Billens, Billens, Switzerland
| | - Serge Zumbach
- Réseau fribourgeois de santé mentale, Marsens, Switzerland.,Department of Medicine, University of Fribourg, Fribourg, Switzerland
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9
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McGovern RA, Nelp TB, Kelly KM, Chan AK, Mazzoni P, Sheth SA, Honig LS, Teich AF, McKhann GM. Predicting Cognitive Improvement in Normal Pressure Hydrocephalus Patients Using Preoperative Neuropsychological Testing and Cerebrospinal Fluid Biomarkers. Neurosurgery 2019; 85:E662-E669. [DOI: 10.1093/neuros/nyz102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 03/01/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Though it is well known that normal pressure hydrocephalus (NPH) patients can cognitively improve after ventriculoperitoneal shunting (VPS), one of the major dilemmas in NPH is the ability to prospectively predict which patients will improve.
OBJECTIVE
To prospectively assess preoperative predictors of postshunt cognitive improvement.
METHODS
This was a prospective observational cohort including 52 consecutive patients with approximately 1-yr follow-up. Patients underwent neuropsychological testing at baseline, postlumbar drainage, and postshunt. Cerebrospinal fluid (CSF) biomarkers and cortical biopsies were also collected to examine their relationship with postshunt cognitive improvement.
RESULTS
Rey Auditory Verbal Learning Test-L (RAVLT-L) was the only neuropsychological test to demonstrate statistically significant improvement both postlumbar drain and postshunt. Improvement on the RAVLT-L postlumbar drain predicted improvement on the RAVLT-L postshunt. Patients with biopsies demonstrating Aβ+ Tau+ had lower ventricular CSF Aβ42 and higher lumbar CSF pTau compared to Aβ– Tau– patients. A receiver operating curve analysis using lumbar pTau predicted Aβ+ Tau+ biopsy status but was not related to neuropsychological test outcome.
CONCLUSION
The RAVLT can be a useful preoperative predictor of postoperative cognitive improvement, and thus, we recommend using the RAVLT to evaluate NPH patients. CSF biomarkers could not be related to neuropsychological test outcome. Future research in a larger patient sample will help determine the prospective utility of CSF biomarkers in the evaluation of NPH patients.
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Affiliation(s)
- Robert A McGovern
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Taylor B Nelp
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Kathleen M Kelly
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Andrew K Chan
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Pietro Mazzoni
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
- Department of Neurology, Columbia University Medical Center, New York, New York
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Lawrence S Honig
- Department of Neurology, Columbia University Medical Center, New York, New York
| | - Andrew F Teich
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
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10
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Song J, Kim OY. Galanin's implications for post-stroke improvement. Anat Cell Biol 2016; 49:223-230. [PMID: 28127496 PMCID: PMC5266107 DOI: 10.5115/acb.2016.49.4.223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/16/2016] [Accepted: 12/08/2016] [Indexed: 02/07/2023] Open
Abstract
Stroke leads to a variety of pathophysiological conditions such as ischemic infarct, cerebral inflammation, neuronal damage, cognitive decline, and depression. Many endeavors have been tried to find the therapeutic solutions to attenuate severe neuropathogenesis after stroke. Several studies have reported that a decrease in the neuropeptide regulator ‘galanin’ is associated with neuronal loss, learning and memory dysfunctions, and depression following a stroke. The present review summarized recent evidences on the function and the therapeutic potential of galanin in post-ischemic stroke to provide a further understanding of galanin's role. Hence, we suggest that galanin needs to be considered as a therapeutic factor in the alleviation of post-stroke pathologies.
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Affiliation(s)
- Juhyun Song
- Department of Biomedical Sciences, Center for Creative Biomedical Scientists at Chonnam National University, Gwangju, Korea.; Human Life Research Center, Dong-A University, Busan, Korea
| | - Oh Yoen Kim
- Human Life Research Center, Dong-A University, Busan, Korea.; Department of Food Science and Nutrition, Dong-A University, Brain Busan 21, Busan, Korea
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11
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Peterson KA, Savulich G, Jackson D, Killikelly C, Pickard JD, Sahakian BJ. The effect of shunt surgery on neuropsychological performance in normal pressure hydrocephalus: a systematic review and meta-analysis. J Neurol 2016; 263:1669-77. [PMID: 27017344 PMCID: PMC4971036 DOI: 10.1007/s00415-016-8097-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 11/25/2022]
Abstract
We conducted a systematic review of the literature and used meta-analytic techniques to evaluate the impact of shunt surgery on neuropsychological performance in patients with normal pressure hydrocephalus (NPH). Twenty-three studies with 1059 patients were identified for review using PubMed, Web of Science, Google scholar and manual searching. Inclusion criteria were prospective, within-subject investigations of cognitive outcome using neuropsychological assessment before and after shunt surgery in patients with NPH. There were statistically significant effects of shunt surgery on cognition (Mini-Mental State Examination; MMSE), learning and memory (Rey Auditory Verbal Learning Test; RAVLT, total and delayed subtests), executive function (backwards digit span, phonemic verbal fluency, trail making test B) and psychomotor speed (trail making test A) all in the direction of improvement following shunt surgery, but with considerable heterogeneity across all measures. A more detailed examination of the data suggested robust evidence for improved MMSE, RAVLT total, RAVLT delayed, phonemic verbal fluency and trail making test A only. Meta-regressions revealed no statistically significant effect of age, sex or follow-up interval on improvement in the MMSE. Our results suggest that shunt surgery is most sensitive for improving global cognition, learning and memory and psychomotor speed in patients with NPH.
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Affiliation(s)
- Katie A Peterson
- Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Level 4 Box 189, Cambridge, CB2 0QQ, UK.
| | - George Savulich
- Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Level 4 Box 189, Cambridge, CB2 0QQ, UK
| | - Dan Jackson
- MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge, UK
| | - Clare Killikelly
- Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Level 4 Box 189, Cambridge, CB2 0QQ, UK
| | - John D Pickard
- Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Barbara J Sahakian
- Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Level 4 Box 189, Cambridge, CB2 0QQ, UK
- MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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12
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Barreda-Gómez G, Lombardero L, Giralt MT, Manuel I, Rodríguez-Puertas R. Effects of galanin subchronic treatment on memory and muscarinic receptors. Neuroscience 2015; 293:23-34. [PMID: 25732139 DOI: 10.1016/j.neuroscience.2015.02.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/13/2015] [Accepted: 02/20/2015] [Indexed: 11/28/2022]
Abstract
The cholinergic pathways, which originate in the basal forebrain and are responsible for the control of different cognitive processes including learning and memory, are also regulated by some neuropeptides. One of these neuropeptides, galanin (GAL), is involved in both neurotrophic and neuroprotective actions. The present study has evaluated in rats the effects on cognition induced by a subchronic treatment with GAL by analyzing the passive avoidance response, and the modulation of muscarinic cholinergic receptor densities and activities. [(3)H]-N-methyl-scopolamine, [(3)H]-oxotremorine, and [(3)H]-pirenzepine were used to quantify the density of muscarinic receptors (MRs) and the stimulation of the binding of guanosine 5'-(γ-[(35)S]thio)triphosphate by the muscarinic agonist, carbachol, to determine their functionality. Some cognitive deficits that were induced by the administration of artificial cerebrospinal fluid (aCSF) (i.c.v. aCSF 2 μl/min, once a day for 6 days) were not observed in the animals also treated with GAL (i.c.v. 1.5 mmol in aCSF, 2 μl/min, once a day for 6 days). GAL modulates the changes in M1 and M2 MR densities observed in the rats treated with aCSF, and also increased their activity mediated by G(i/o) proteins in specific areas of the dorsal and ventral hippocampus. The subchronic administration of the vehicle was also accompanied by an increased number of positive fibers and cells for GAL around the cortical tract of the cannula used, but that was not the case in GAL-treated rats. In addition, the increase of GAL receptor density in the ventral hippocampus and entorhinal cortex in the aCSF group was avoided when GAL was administered. The number of acetylcholinesterase (AChE)-positive neurons was decreased in the nucleus basalis of Meynert of both GAL- and aCSF-treated animals. In summary, GAL improves memory-related abilities probably through the modulation of MR density and/or efficacy in hippocampal areas.
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Affiliation(s)
- G Barreda-Gómez
- Department of Pharmacology, Faculty of Medicine and Odontology, University of the Basque Country (UPV/EHU), E-48940 Leioa, Vizcaya, Spain
| | - L Lombardero
- Department of Pharmacology, Faculty of Medicine and Odontology, University of the Basque Country (UPV/EHU), E-48940 Leioa, Vizcaya, Spain
| | - M T Giralt
- Department of Pharmacology, Faculty of Medicine and Odontology, University of the Basque Country (UPV/EHU), E-48940 Leioa, Vizcaya, Spain
| | - I Manuel
- Department of Pharmacology, Faculty of Medicine and Odontology, University of the Basque Country (UPV/EHU), E-48940 Leioa, Vizcaya, Spain
| | - R Rodríguez-Puertas
- Department of Pharmacology, Faculty of Medicine and Odontology, University of the Basque Country (UPV/EHU), E-48940 Leioa, Vizcaya, Spain.
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13
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Behrens A, Eklund A, Elgh E, Smith C, Williams MA, Malm J. A computerized neuropsychological test battery designed for idiopathic normal pressure hydrocephalus. Fluids Barriers CNS 2014; 11:22. [PMID: 25279138 PMCID: PMC4181752 DOI: 10.1186/2045-8118-11-22] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/23/2014] [Indexed: 11/12/2022] Open
Abstract
Background A tool for standardized and repeated neuropsychological assessments in patients with idiopathic normal pressure hydrocephalus (INPH) is needed. The objective of this study was to develop a computerized neuropsychological test battery designed for INPH and to evaluate its reliability, validity and patient’s ability to complete the tests. Methods Based on a structured review of the literature on neuropsychological testing in INPH, the eight tests most sensitive to the INPH cognitive profile were implemented in a computerized format. The Geriatric Depression Scale (GDS) was also included. Tests were presented on a touch-screen monitor, with animated instructions and speaker sound. The battery was evaluated with the following cohorts: A. Test-retest reliability, 44 healthy elderly; B. Validity against standard pen and pencil testing, 28 patients with various cognitive impairments; C. Ability to complete test battery, defined as completion of at least seven of the eight tests, 40 investigated for INPH. Results A. All except the figure copy test showed good test-retest reliability, r = 0.67-0.90; B. A high correlation was seen between conventional and computerized tests (r = 0.66-0.85) except for delayed recognition and figure copy task; C. Seventy-eight percent completed the computerized battery; Patients diagnosed with INPH (n = 26) performed worse on all tests, including depression score, compared to healthy controls. Conclusions A new computerized neuropsychological test battery designed for patients with communicating hydrocephalus and INPH was introduced. Its reliability, validity for general cognitive impairment and completion rate for INPH was promising. After exclusion of the figure copy task, the battery is ready for clinical evaluation and as a next step we suggest validation for INPH and a comparison before and after shunt surgery. Trial registration ClinicalTrials.org NCT01265251.
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Affiliation(s)
- Anders Behrens
- Blekinge Centre of Competence, Blekinge Hospital Karlskrona, Karlskrona, Sweden ; Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Anders Eklund
- Centre for Biomedical Engineering and Physics, Umeå University, Umeå, Sweden ; Department of Radiation Science, Umeå University, Umeå, Sweden
| | - Eva Elgh
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
| | - Cynthia Smith
- The Sandra and Malcolm Berman Brain & Spine Institute, Sinai Hospital of Baltimore, Baltimore, MD, USA ; Division of Neuropsychology, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Michael A Williams
- The Sandra and Malcolm Berman Brain & Spine Institute, Sinai Hospital of Baltimore, Baltimore, MD, USA ; Adult Hydrocephalus Center, Sinai Hospital of Baltimore, Baltimore, MD, USA ; Department of Neurology, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Jan Malm
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
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14
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Cognitive, biochemical, and imaging profile of patients suffering from idiopathic normal pressure hydrocephalus. Alzheimers Dement 2011; 7:501-8. [PMID: 21757406 DOI: 10.1016/j.jalz.2011.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Revised: 12/20/2010] [Accepted: 01/26/2011] [Indexed: 11/22/2022]
Abstract
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 = -0.841, P = .002) was found. There was a significant positive correlation (R = 0.648, P = .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 = 0.828, P = .006). A significant negative correlation was observed between the levels of neurofilament heavy protein and the VV/ICV ratio (R = -0.657, P = .039) and the WM volume (R = -0.778, P = .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.
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15
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Devito EE, Pickard JD, Salmond CH, Iddon JL, Loveday C, Sahakian BJ. The neuropsychology of normal pressure hydrocephalus (NPH). Br J Neurosurg 2009; 19:217-24. [PMID: 16455521 DOI: 10.1080/02688690500201838] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Normal pressure hydrocephalus (NPH) accounts for one of the few known forms of reversible dementia. Varied aetiology and clinical presentation contribute to difficulties with early or differential diagnoses, and delayed surgical treatment may be less efficacious. Clinical neuropsychology provides a means of determining a cognitive profile for NPH, assisting in differential diagnosis, tracking the disorder's progression and assessing the efficacy of treatment. This article will review possible applications of clinical neuropsychology and propose a clinical assessment protocol for NPH.
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Affiliation(s)
- E E Devito
- Department of Neurosurgery, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK.
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16
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Woodworth GF, McGirt MJ, Williams MA, Rigamonti D. CEREBROSPINAL FLUID DRAINAGE AND DYNAMICS IN THE DIAGNOSIS OF NORMAL PRESSURE HYDROCEPHALUS. Neurosurgery 2009; 64:919-25; discussion 925-6. [PMID: 19404152 DOI: 10.1227/01.neu.0000341902.44760.10] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
INTRODUCTION
Because of the difficulty in distinguishing idiopathic normal pressure hydrocephalus (INPH) from other neurodegenerative conditions unrelated to cerebrospinal fluid (CSF) dynamics, response to CSF shunting remains highly variable. We examined the utility of CSF drainage and CSF pressure (Pcsf) dynamics in predicting response to CSF shunting for patients with INPH.
METHODS
Fifty-one consecutive INPH patients underwent continuous lumbar Pcsf monitoring for 48 hours followed by 72 hours of slow CSF drainage before ventriculoperitoneal shunting. Response to CSF drainage and B-wave characteristics were assessed via multivariate proportional-hazards regression analysis.
RESULTS
Improvement in 1, 2, or all 3 INPH symptoms was observed in 35 (69%), 28 (55%), and 11 (22%) patients, respectively, after CSF shunt implantation by 12 months after surgery. A positive response to CSF drainage was found to be an independent predictor of shunt responsiveness (relative risk, 0.30; 95% confidence interval, 0.09–0.98; P = 0.05). There was no difference in Pcsf wave characteristics between the shunt-responsive and -nonresponsive groups, regardless of whether 1-, 2-, or 3-symptom improvement was used to define response to CSF shunting.
CONCLUSION
In this study of 51 INPH patients who underwent Pcsf monitoring with waveform analysis and CSF drainage followed by shunt surgery, there was no correlation between specific Pcsf wave characteristics and objective symptomatic improvement after shunt placement. Pcsf monitoring with B-wave analysis contributes little to the diagnostic dilemma with INPH patients. Clinical response to continuous CSF drainage over a 72-hour period suggests a high likelihood of shunt responsiveness.
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Affiliation(s)
| | - Matthew J. McGirt
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Michael A. Williams
- Adult Hydrocephalus Program, and Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniele Rigamonti
- Department of Neurosurgery, and Adult Hydrocephalus Program, The Johns Hopkins Hospital, Baltimore, Maryland
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Walther T, Albrecht D, Becker M, Schubert M, Kouznetsova E, Wiesner B, Maul B, Schliebs R, Grecksch G, Furkert J, Sterner-Kock A, Schultheiss HP, Becker A, Siems WE. Improved learning and memory in aged mice deficient in amyloid beta-degrading neutral endopeptidase. PLoS One 2009; 4:e4590. [PMID: 19240795 PMCID: PMC2643003 DOI: 10.1371/journal.pone.0004590] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2008] [Accepted: 01/17/2009] [Indexed: 12/03/2022] Open
Abstract
Background Neutral endopeptidase, also known as neprilysin and abbreviated NEP, is considered to be one of the key enzymes in initial human amyloid-β (Aβ) degradation. The aim of our study was to explore the impact of NEP deficiency on the initial development of dementia-like symptoms in mice. Methodology/Principal Findings We found that while endogenous Aβ concentrations were elevated in the brains of NEP-knockout mice at all investigated age groups, immunohistochemical analysis using monoclonal antibodies did not detect any Aβ deposits even in old NEP knockout mice. Surprisingly, tests of learning and memory revealed that the ability to learn was not reduced in old NEP-deficient mice but instead had significantly improved, and sustained learning and memory in the aged mice was congruent with improved long-term potentiation (LTP) in brain slices of the hippocampus and lateral amygdala. Our data suggests a beneficial effect of pharmacological inhibition of cerebral NEP on learning and memory in mice due to the accumulation of peptides other than Aβ degradable by NEP. By conducting degradation studies and peptide measurements in the brain of both genotypes, we identified two neuropeptide candidates, glucagon-like peptide 1 and galanin, as first potential candidates to be involved in the improved learning in aged NEP-deficient mice. Conclusions/Significance Thus, the existence of peptides targeted by NEP that improve learning and memory in older individuals may represent a promising avenue for the treatment of neurodegenerative diseases.
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Affiliation(s)
- Thomas Walther
- Department of Cardiology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
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Hellström P, Edsbagge M, Blomsterwall E, Archer T, Tisell M, Tullberg M, Wikkelsø C. NEUROPSYCHOLOGICAL EFFECTS OF SHUNT TREATMENT IN IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS. Neurosurgery 2008; 63:527-35; discussion 535-6. [DOI: 10.1227/01.neu.0000325258.16934.bb] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
OBJECTIVE
To prospectively evaluate the effects of shunting on the neuropsychological performance of patients with idiopathic normal pressure hydrocephalus (INPH), to compare their performance with that of healthy individuals, and to estimate the predictive utility of putatively important factors.
METHODS
A consecutive series of 47 patients with INPH underwent neurological, radiological, and neuropsychological examinations before and 3 months after shunt surgery. The same neuropsychological tests, measuring simple and target reaction times, dexterity, memory and learning, working memory, and aspects of executive functioning, were also administered to 159 healthy individuals.
RESULTS
Performance on all neuropsychological tests, except Simple Reaction Time and Digit Span, significantly improved after surgery, with more severe functional deficits showing greatest improvement. Age, education, duration, vascular comorbidity, sex, and onset symptom all failed to predict the neuropsychological effects of treatment. Despite improvement 3 months after shunt surgery, INPH patients were still outperformed by healthy individuals.
CONCLUSION
Most of the wide range of neuropsychological functions that are affected by INPH are markedly improved by shunt treatment, but not completely restored.
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Affiliation(s)
- Per Hellström
- Institute of Neuroscience and Physiology, Göteborg University, Gothenburg, Sweden
| | - Mikael Edsbagge
- Institute of Neuroscience and Physiology, Göteborg University, Gothenburg, Sweden
| | | | - Trevor Archer
- Department of Psychology, Göteborg University, Gothenburg, Sweden
| | - Magnus Tisell
- Department of Neurosurgery, The National Hospital, Rikshospitalet, Oslo, Norway
| | - Mats Tullberg
- Institute of Neuroscience and Physiology, Göteborg University, Gothenburg, Sweden
| | - Carsten Wikkelsø
- Institute of Neuroscience and Physiology, Göteborg University, Gothenburg, Sweden
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Hellström P, Edsbagge M, Archer T, Tisell M, Tullberg M, Wikkelsø C. THE NEUROPSYCHOLOGY OF PATIENTS WITH CLINICALLY DIAGNOSED IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS. Neurosurgery 2007; 61:1219-26; discussion 1227-8. [DOI: 10.1227/01.neu.0000306100.83882.81] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Per Hellström
- Institute of Neuroscience and Physiology, Göteborg University, Göteborg, Sweden
| | - Mikael Edsbagge
- Institute of Neuroscience and Physiology, Göteborg University, Göteborg, Sweden
| | - Trevor Archer
- Department of Psychology, Göteborg University, Göteborg, Sweden
| | - Magnus Tisell
- Department of Neurosurgery, The National Hospital, Rikshospitalet, Oslo, Norway
| | - Mats Tullberg
- Institute of Neuroscience and Physiology, Göteborg University, Göteborg, Sweden
| | - Carsten Wikkelsø
- Institute of Neuroscience and Physiology, Göteborg University, Göteborg, Sweden
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del Mar Matarín M, Pueyo R, Poca MA, Falcón C, Mataró M, Bargalló N, Sahuquillo J, Junqué C. Post-surgical changes in brain metabolism detected by magnetic resonance spectroscopy in normal pressure hydrocephalus: results of a pilot study. J Neurol Neurosurg Psychiatry 2007; 78:760-3. [PMID: 17299021 PMCID: PMC2117662 DOI: 10.1136/jnnp.2006.088450] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Adult normal pressure hydrocephalus (NPH) is one of the few potentially treatable causes of dementia. Some morphological and functional abnormalities attributed to hydrocephalus improve following treatment. OBJECTIVES We focused on analysis of changes in cerebral metabolites using proton magnetic resonance spectroscopy (1H-MRS) after NPH treatment, and its clinical and cognitive correlation. METHODS 1H-MRS, neuropsychological and clinical status examinations were performed before and 6 months after shunting in 12 adults with idiopathic NPH. We obtained N-acetyl-aspartate (NAA), choline (Cho), myoinositol (MI) and creatine (Cr) values. RESULTS After surgery, NAA/Cr was significantly increased. Moreover, NAA/Cr values were related to cognitive deterioration. CONCLUSION MRS could be a marker of neuronal dysfunction in NPH.
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21
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Byrd C. Normal pressure hydrocephalus: dementia's hidden cause. Nurse Pract 2006; 31:28-9, 31-5; quiz 36-7. [PMID: 16862055 DOI: 10.1097/00006205-200607000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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22
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Miyoshi N, Kazui H, Ogino A, Ishikawa M, Miyake H, Tokunaga H, Ikejiri Y, Takeda M. Association between cognitive impairment and gait disturbance in patients with idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Disord 2005; 20:71-6. [PMID: 15908748 DOI: 10.1159/000085858] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2005] [Indexed: 11/19/2022] Open
Abstract
We compared the scores of the Frontal Assessment Battery (FAB), initial fluency subtest, category fluency subtest and subtests of the Mini-Mental State Examination (MMSE) between patients with idiopathic normal pressure hydrocephalus (iNPH) and age-, sex- and MMSE-matched patients with Alzheimer's disease (AD). In patients with iNPH, the time and number of steps required to go and come back a 10-meter distance were measured (Walking test) and the associations between the scores of the cognitive tests and the performance of the Walking test were evaluated. The scores of the FAB and initial fluency subtest in patients with iNPH were significantly lower than those in patients with AD. The scores of the FAB, initial fluency subtest and serial 7 subtest of the MMSE significantly correlated with the two scores of the Walking test in patients with iNPH. The present results indicate that frontal lobe functions were impaired in patients with iNPH and that cognitive impairment was closely associated with gait disturbance in patients with iNPH.
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Affiliation(s)
- Noriko Miyoshi
- Psychiatry and Behavioral Science, Osaka University Graduate School of Medicine, Osaka, Japan
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