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Brandt E, Koivisto A, Pereira P, Mustanoja E, Auvinen P, Saari T, Lehtola JM, Hannonen S, Rusanen M, Leinonen V, Scheperjans F, Kärkkäinen V. Gut Microbiome Changes in Patients With Idiopathic Normal Pressure Hydrocephalus. Alzheimer Dis Assoc Disord 2024; 38:133-139. [PMID: 38602449 PMCID: PMC11132091 DOI: 10.1097/wad.0000000000000613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/20/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The gut microbiome is a complex system within the human gastrointestinal tract. The bacteria play a significant role in human health, and some can promote inflammation and pathologic processes through chemical interactions or metabolites. Gut microbiome dysbiosis has been linked to some neurological and other diseases. Here we aimed to examine microbiome differences between patients with a progressive neurological disorder, idiopathic normal pressure hydrocephalus (iNPH), compared with healthy controls (CO). METHODS We recruited 37 neurologically healthy CO and 10 patients with shunted iNPH. We evaluated these participants' cognition using the CERAD-NB test battery and CDR test, and collected a variety of information, including about dietary habits and health. We also collected fecal samples, which were subjected to 16S amplicon sequencing to analyze differences in gut microbiome composition. RESULTS We found that the iNPH group exhibited significantly different abundances of 10 bacterial genera compared with the CO group. The Escherichia/Shigella and Anaeromassilibacillus genera were most remarkably increased. Other increased genera were Butyrivibrio , Duncaniella , and an unidentified genus. The decreased genera were Agathobaculum , Paramuribaculum , Catenibacterium , and 2 unidentified genera. CONCLUSIONS Here we report the first identified microbiome differences in iNPH patients compared with healthy controls.
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Affiliation(s)
- Emilia Brandt
- Departments of Neurology
- NeuroCenter, Kuopio University Hospital, Kuopio
| | - Anne Koivisto
- NeuroCenter, Kuopio University Hospital, Kuopio
- Department of Neurosciences, Faculty of Medicine
- Department of Geriatrics, Helsinki University Hospital Helsinki
| | | | - Ella Mustanoja
- Institute of Biotechnology, University of Helsinki, Helsinki Institute of Life Sciences
| | - Petri Auvinen
- Institute of Biotechnology, University of Helsinki, Helsinki Institute of Life Sciences
| | - Toni Saari
- Institute of Biotechnology, University of Helsinki, Helsinki Institute of Life Sciences
| | - Juha-Matti Lehtola
- Departments of Neurology
- Department of Psychiatry, Turku University Hospital, Turku, Finland
| | - Sanna Hannonen
- Departments of Neurology
- NeuroCenter, Kuopio University Hospital, Kuopio
| | - Minna Rusanen
- Departments of Neurology
- NeuroCenter, Kuopio University Hospital, Kuopio
| | - Ville Leinonen
- Neurosurgery, Institute of Clinical Medicine, School of Medicine, University of Eastern Finland
- NeuroCenter, Kuopio University Hospital, Kuopio
| | - Filip Scheperjans
- Clinicum, University of Helsinki
- Neurology, Helsinki University Hospital, Helsinki
| | - Virve Kärkkäinen
- Neurosurgery, Institute of Clinical Medicine, School of Medicine, University of Eastern Finland
- NeuroCenter, Kuopio University Hospital, Kuopio
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Tseng PH, Huang WT, Wang JH, Huang BR, Huang HY, Tsai ST. Cerebrospinal fluid shunt surgery reduces the risk of developing dementia and Alzheimer's disease in patients with idiopathic normal pressure hydrocephalus: a nationwide population-based propensity-weighted cohort study. Fluids Barriers CNS 2024; 21:16. [PMID: 38355601 PMCID: PMC10868070 DOI: 10.1186/s12987-024-00517-9] [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: 11/26/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Patients with idiopathic normal-pressure hydrocephalus (iNPH) are predisposed to developing dementing disorders. Cerebrospinal fluid (CSF) shunt implantation is a treatment used to improve the motor and cognitive disabilities of these patients; however, its effect on the risk of developing dementing disorders remains unclear. We conducted a population-based propensity-weighted cohort study to investigate whether CSF shunt surgery may reduce the risk of subsequently developing dementia, Alzheimer's disease (AD), and vascular dementia in iNPH patients. METHODS Patients aged ≥ 60 years who were diagnosed with iNPH (n = 2053) between January 2001 and June 2018 were identified from the Taiwan National Health Insurance Research Database. Various demographic characteristics (age, sex, and monthly income) and clinical data (incidence year, comorbidities, and Charlson comorbidity index) were collected and divided into the shunt surgery group (SSG) and the non-shunt surgery group (NSSG). Stabilized inverse probability of treatment weighting by using the propensity score was performed to achieve a balanced distribution of confounders across the two study groups. The cumulative incidence rate and risk of dementing disorders were estimated during a 16-year follow-up period. RESULTS After weighting, the data of 375.0 patients in SSG and 1677.4 patients in NSSG were analyzed. Kaplan-Meier curve analysis indicated that the cumulative incidence rate of AD (p = 0.009), but not dementia (p = 0.241) and vascular dementia (p = 0.761), in SSG was significantly lower than that in NSSG over the 16-year follow-up period. Cox proportional hazards regression analysis revealed that SSG had a reduced hazard ratio (HR) for developing AD [HR (95% CI) 0.17 (0.04-0.69)], but not for dementia [HR (95% CI) 0.83 (0.61-1.12)] and vascular dementia [HR (95% CI) 1.18 (0.44-3.16)], compared with NSSG. Further Fine-Gray hazard regression analysis with death as a competing event demonstrated that SSG had a reduced subdistribution HR (sHR) for developing dementia [sHR (95% CI) 0.74 (0.55-0.99)] and AD [sHR (95% CI) 0.15 (0.04-0.61)], but not for vascular dementia [sHR (95% CI) 1.07 (0.40-2.86)]. CONCLUSION CSF shunt surgery is associated with reduced risks of the subsequent development of dementia and AD in iNPH patients. Our findings may provide valuable information for assessing the benefit-to-risk profile of CSF shunt surgery.
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Affiliation(s)
- Pao-Hui Tseng
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970, Taiwan
| | - Wan-Ting Huang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec 3, Zhongyang Road, Hualien, 970, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec 3, Zhongyang Road, Hualien, 970, Taiwan
| | - Bor-Ren Huang
- Department of Neurosurgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, 427, Taiwan
- School of Medicine, Tzu Chi University, Hualien, 970, Taiwan
| | - Hsin-Yi Huang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec 3, Zhongyang Road, Hualien, 970, Taiwan.
| | - Sheng-Tzung Tsai
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan.
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, 970, Taiwan.
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Greenberg ABW, Mehta NH, Mekbib KY, Kiziltug E, Smith HR, Hyman BT, Chan D, Curry Jr. WT, Arnold SE, Frosch MP, Duy PQ, Kahle KT. Cases of familial idiopathic normal pressure hydrocephalus implicate genetic factors in disease pathogenesis. Cereb Cortex 2023; 33:11400-11407. [PMID: 37814356 PMCID: PMC10690850 DOI: 10.1093/cercor/bhad374] [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: 08/07/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/11/2023] Open
Abstract
Idiopathic normal pressure hydrocephalus is a disorder of unknown pathophysiology whose diagnosis is paradoxically made by a positive response to its proposed treatment with cerebrospinal fluid diversion. There are currently no idiopathic normal pressure hydrocephalus disease genes or biomarkers. A systematic analysis of familial idiopathic normal pressure hydrocephalus could aid in clinical diagnosis, prognosis, and treatment stratification, and elucidate disease patho-etiology. In this 2-part analysis, we review literature-based evidence for inheritance of idiopathic normal pressure hydrocephalus in 22 pedigrees, and then present a novel case series of 8 familial idiopathic normal pressure hydrocephalus patients. For the case series, demographics, familial history, pre- and post-operative symptoms, and cortical pathology were collected. All novel familial idiopathic normal pressure hydrocephalus patients exhibited improvement following shunt treatment and absence of neurodegenerative cortical pathology (amyloid-beta and hyperphosphorylated tau), in contrast to many sporadic cases of idiopathic normal pressure hydrocephalus with variable clinical responses. Analysis of the 30 total familial idiopathic normal pressure hydrocephalus cases reported herein is highly suggestive of an autosomal dominant mechanism of inheritance. This largest-ever presentation of multiply affected idiopathic normal pressure hydrocephalus pedigrees provides strong evidence for Mendelian inheritance and autosomal dominant transmission of an idiopathic normal pressure hydrocephalus trait in a subset of patients that positively respond to shunting and lack neurodegenerative pathology. Genomic investigation of these families may identify the first bona fide idiopathic normal pressure hydrocephalus disease gene.
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Affiliation(s)
- Ana B W Greenberg
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Neel H Mehta
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Kedous Y Mekbib
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, United States
| | - Emre Kiziltug
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, United States
| | - Hannah R Smith
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Bradley T Hyman
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Diane Chan
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - William T Curry Jr.
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Steven E Arnold
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Matthew P Frosch
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Phan Q Duy
- Department of Neurosurgery, University of Virginia, Charlottesville, VA 22903, United States
| | - Kristopher T Kahle
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, United States
- Harvard Center for Hydrocephalus and Neurodevelopmental Disorders, Massachusetts General Hospital, Boston, MA 02114, United States
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Serafin P, Zaremba M, Sulejczak D, Kleczkowska P. Air Pollution: A Silent Key Driver of Dementia. Biomedicines 2023; 11:biomedicines11051477. [PMID: 37239148 DOI: 10.3390/biomedicines11051477] [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: 04/27/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
In 2017, the Lancet Commission on Dementia Prevention, Intervention, and Care included air pollution in its list of potential risk factors for dementia; in 2018, the Lancet Commission on Pollution concluded that the evidence for a causal relationship between fine particulate matter (PM) and dementia is encouraging. However, few interventions exist to delay or prevent the onset of dementia. Air quality data are becoming increasingly available, and the science underlying the associated health effects is also evolving rapidly. Recent interest in this area has led to the publication of population-based cohort studies, but these studies have used different approaches to identify cases of dementia. The purpose of this article is to review recent evidence describing the association between exposure to air pollution and dementia with special emphasis on fine particulate matter of 2.5 microns or less. We also summarize here the proposed detailed mechanisms by which air pollutants reach the brain and activate the innate immune response. In addition, the article also provides a short overview of existing limitations in the treatment of dementia.
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Affiliation(s)
- Pawel Serafin
- Military Institute of Hygiene and Epidemiology, 01-163 Warsaw, Poland
| | - Malgorzata Zaremba
- Military Institute of Hygiene and Epidemiology, 01-163 Warsaw, Poland
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research (CBP), Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Dorota Sulejczak
- Department of Experimental Pharmacology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland
| | - Patrycja Kleczkowska
- Military Institute of Hygiene and Epidemiology, 01-163 Warsaw, Poland
- Maria Sklodowska-Curie, Medical Academy in Warsaw, Solidarnosci 12 Str., 03-411 Warsaw, Poland
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5
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Chernyaeva L, Ratti G, Teirilä L, Fudo S, Rankka U, Pelkonen A, Korhonen P, Leskinen K, Keskitalo S, Salokas K, Gkolfinopoulou C, Crompton KE, Javanainen M, Happonen L, Varjosalo M, Malm T, Leinonen V, Chroni A, Saavalainen P, Meri S, Kajander T, Wollman AJ, Nissilä E, Haapasalo K. Reduced binding of apoE4 to complement factor H promotes amyloid-β oligomerization and neuroinflammation. EMBO Rep 2023:e56467. [PMID: 37155564 DOI: 10.15252/embr.202256467] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023] Open
Abstract
The APOE4 variant of apolipoprotein E (apoE) is the most prevalent genetic risk allele associated with late-onset Alzheimer's disease (AD). ApoE interacts with complement regulator factor H (FH), but the role of this interaction in AD pathogenesis is unknown. Here we elucidate the mechanism by which isoform-specific binding of apoE to FH alters Aβ1-42-mediated neurotoxicity and clearance. Flow cytometry and transcriptomic analysis reveal that apoE and FH reduce binding of Aβ1-42 to complement receptor 3 (CR3) and subsequent phagocytosis by microglia which alters expression of genes involved in AD. Moreover, FH forms complement-resistant oligomers with apoE/Aβ1-42 complexes and the formation of these complexes is isoform specific with apoE2 and apoE3 showing higher affinity to FH than apoE4. These FH/apoE complexes reduce Aβ1-42 oligomerization and toxicity, and colocalize with complement activator C1q deposited on Aβ plaques in the brain. These findings provide an important mechanistic insight into AD pathogenesis and explain how the strongest genetic risk factor for AD predisposes for neuroinflammation in the early stages of the disease pathology.
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Affiliation(s)
- Larisa Chernyaeva
- Department of Bacteriology and Immunology, Medicum and Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Laura Teirilä
- Department of Bacteriology and Immunology, Medicum and Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Satoshi Fudo
- Department of Bacteriology and Immunology, Medicum and Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Uni Rankka
- Department of Bacteriology and Immunology, Medicum and Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anssi Pelkonen
- A.I. Virtanen Institute for Molecular Sciences, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Paula Korhonen
- A.I. Virtanen Institute for Molecular Sciences, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Katarzyna Leskinen
- Department of Bacteriology and Immunology, Medicum and Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Salla Keskitalo
- Institute of Biotechnology, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Kari Salokas
- Institute of Biotechnology, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Christina Gkolfinopoulou
- Institute of Biosciences and Applications, National Center for Scientific Research "Demokritos", Athens, Greece
| | | | - Matti Javanainen
- Institute of Biotechnology, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Lotta Happonen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Markku Varjosalo
- Institute of Biotechnology, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Tarja Malm
- A.I. Virtanen Institute for Molecular Sciences, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland and Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Angeliki Chroni
- Institute of Biosciences and Applications, National Center for Scientific Research "Demokritos", Athens, Greece
| | - Päivi Saavalainen
- Department of Bacteriology and Immunology, Medicum and Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Seppo Meri
- Department of Bacteriology and Immunology, Medicum and Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Humanitas University, Milano, Italy
| | - Tommi Kajander
- Institute of Biotechnology, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Adam Jm Wollman
- Biosciences Institute, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Eija Nissilä
- Department of Bacteriology and Immunology, Medicum and Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Karita Haapasalo
- Department of Bacteriology and Immunology, Medicum and Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Paolini S, Severino R, Ciavarro M, Missori P, Cardarelli G, Mancarella C. Balloon-Assisted Corpus Callosotomy. Reducing the Impact of Transcallosal Approaches. Oper Neurosurg (Hagerstown) 2023; 24:e155-e159. [PMID: 36701680 DOI: 10.1227/ons.0000000000000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 09/12/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The interhemispheric transcallosal approach is widely used to remove intraventricular lesions. Corpus callosotomy gives immediate access to the ventricular chambers but is invasive in nature. Loss of callosal fibers, although normally tolerate, may cause disturbances ranging from a classical disconnection syndrome up to minor neuropsychological changes. OBJECTIVE To open an operative window in the corpus callosum through separation rather than disconnection of the white matter fibers. METHODS In 7 patients undergoing the interhemispheric transcallosal approach for intraventricular lesions, lying around or below the foramen of Monro, a stoma was created within the corpus callosum by using a 4F Fogarty catheter. The series included 3 colloid of the third ventricle, 2 thalamic cavernomas, 1 subependymoma, and 1 ependymoma of the foramen of Monro. We illustrate the technique and the clinico-radiological outcome, focusing on the size of callosotomy as seen on postoperative MRI. RESULTS The balloon-assisted corpus callosotomy provided a circular, smooth-walled access to the ventricular chambers, which allowed uncomplicated removal of the lesions. On postoperative MRI, the size of the callosotomy shrinked compared with surgery (2.8-6.4 mm at follow-up vs 6-9 mm as measured intraoperatively). No signs of disconnection syndrome or new permanent deficits were observed in this series. CONCLUSION The balloon-assisted technique produces a small callosotomy, without clinical consequences, showing a self-closing trend on postoperative MRI. This technique is a rewarding tool to reduce the impact of callosotomy while keeping the advantages of microsurgical interhemispheric approaches.
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Affiliation(s)
- Sergio Paolini
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Rocco Severino
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
| | - Marco Ciavarro
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
| | - Paolo Missori
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Giovanni Cardarelli
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
| | - Cristina Mancarella
- Department of Neurosurgery, Neuromed Institute, IRCCS, Sapienza University of Rome, Pozzilli, Isernia, Italy
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de Guilhem de Lataillade A, Boutoleau-Bretonnière C, Aguilar-Garcia J, Pallardy A, Bigot-Corbel E, Roualdes V, Leroy J, Damier P, Pouclet-Courtemanche H. Idiopathic normal pressure hydrocephalus and frontotemporal dementia: an unexpected association. Brain Commun 2022; 4:fcac319. [PMID: 36751501 PMCID: PMC9897186 DOI: 10.1093/braincomms/fcac319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/20/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Idiopathic normal pressure hydrocephalus has a complex multifactorial pathogenesis and is associated with Alzheimer's disease in many patients. To date, it is not well known if a similar association exists with behavioural variant of frontotemporal lobar degeneration. In a first step, we compare the prevalence of idiopathic normal pressure hydrocephalus in two groups of patients, one with behavioural variant of frontotemporal lobar degeneration (n = 69) and the other with Alzheimer's disease (n = 178). In the second step, we describe more precisely the phenotype of patients with the association of idiopathic normal pressure hydrocephalus and behavioural variant of frontotemporal lobar degeneration. Firstly, we report that the prevalence of idiopathic normal pressure hydrocephalus was far higher in the group of patients with behavioural variant of frontotemporal lobar degeneration than in the group of patients with Alzheimer's disease (7.25% and 1.1%, respectively, P = 0.02). Secondly, we show that patients with the double diagnosis share common clinical and para-clinical features of both idiopathic normal pressure hydrocephalus and behavioural variant of frontotemporal lobar degeneration patients, including CSF shunting efficacy in real-life experience. Overall, our results suggest a link between these two conditions and should encourage neurologists to look for idiopathic normal pressure hydrocephalus in their behavioural variant of frontotemporal lobar degeneration patients in the event of gait disturbances; the benefit/risk balance could indeed be in favour of shunt surgery for selected patients with this newly described entity.
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Affiliation(s)
- Adrien de Guilhem de Lataillade
- Centre d'investigations cliniques, INSERM 1413, CHU Nantes, 44093 Nantes, France,Department of Neurology, CHU Nantes, 44093 Nantes, France,Nantes University, 44093 Nantes, France
| | - Claire Boutoleau-Bretonnière
- Centre d'investigations cliniques, INSERM 1413, CHU Nantes, 44093 Nantes, France,Department of Memory Resource and Research Centre, CHU Nantes, 44093 Nantes, France,Department of Neurology, CHU Nantes, 44093 Nantes, France
| | | | | | - Edith Bigot-Corbel
- Laboratory of Biochemistry, CHU Nantes, 44093 Nantes, France,Nantes University, 44093 Nantes, France
| | | | - Julie Leroy
- Department of Neurology, CHU Nantes, 44093 Nantes, France
| | | | - Hélène Pouclet-Courtemanche
- Correspondence to: Hélène Pouclet-Courtemanche CMRR, CHU de Nantes, Hôpital Laennec, bd Jacques Monod 44093 Nantes cedex 1, France E-mail:
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Computer-based Eye-tracking Analysis of King-Devick Test Differentiates Persons With Idiopathic Normal Pressure Hydrocephalus From Cognitively Unimpaired. Alzheimer Dis Assoc Disord 2022; 36:340-346. [PMID: 36219131 PMCID: PMC9698082 DOI: 10.1097/wad.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/12/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Functional defects in eye movements and reduced reading speed in neurodegenerative diseases represent a potential new biomarker to support clinical diagnosis. We investigated whether computer-based eye-tracking (ET) analysis of the King-Devick (KD) test differentiates persons with idiopathic normal pressure hydrocephalus (iNPH) from cognitively unimpaired [control (CO)] and persons with Alzheimer's disease (AD). METHODS We recruited 68 participants (37 CO, 10 iNPH, and 21 AD) who underwent neurological examination, the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological test battery (CERAD-NB), and a Clinical Dementia Rating interview. The KD reading test was performed using computer-based ET. We analyzed the total time used for the reading test, number of errors, durations of fixation and saccade, and saccade amplitudes. RESULTS The iNPH group significantly differed from the CO group in the KD test mean total time (CO 69.3 s, iNPH 87.3 s; P ≤0.009) and eye-tracking recording of the mean saccade amplitude (CO 3.6 degree, iNPH 3.2 degree; P ≤0.001). The AD group significantly differed from the CO group in each tested parameter. No significant differences were detected between the iNPH and AD groups. CONCLUSION For the first time, we demonstrated altered reading ability and saccade amplitudes in patients with iNPH.
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Illies T, Eckert B, Kehler U. What Radiologists Should Know About Normal Pressure Hydrocephalus. ROFO-FORTSCHR RONTG 2021; 193:1197-1206. [PMID: 34530457 DOI: 10.1055/a-1425-8065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Normal pressure hydrocephalus is a disease in elderly patients and one of the most common causes of treatable dementia. It occurs frequently with microangiopathy and Alzheimer's disease, so that differential diagnosis plays an important role. This is crucially determined by imaging findings. Therapy consists of cerebrospinal fluid drainage through a shunt, which should be performed as early as possible to improve the chances of success. METHOD This report is based on a summary of the relevant literature that has been reviewed in PubMed with reference to epidemiology, symptoms, pathophysiology, diagnostics, and therapy. The results were supplemented by the joint guidelines of the German Society of Neurology and the German Society of Neurosurgery. RESULTS AND CONCLUSION The understanding of the pathophysiologic changes leading to normal pressure hydrocephalus has expanded significantly in recent years to include concepts explaining relevant comorbidities. Diagnosis is based on radiological and clinical indicators, although accurate differentiation with respect to comorbidities is not always possible. A high response rate to treatment can be achieved by good patient selection. Positive prognostic markers for therapeutic success include Disproportionately Enlarged Subarachnoid Space Hydrocephalus (DESH), short disease duration, predominant gait disturbance, and few comorbidities. KEY POINTS · Normal pressure hydrocephalus mainly affects patients older than 65 years of age with high comorbidity rate for microangiopathy and Alzheimer's disease. · Radiologic findings play an important role in the diagnosis and follow-up after shunting. · The earlier a shunt is placed, the better the outcome. CITATION FORMAT · Illies T, Eckert B, Kehler U. What Radiologists Should Know About Normal Pressure Hydrocephalus. Fortschr Röntgenstr 2021; 193: 1197 - 1206.
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Affiliation(s)
- Till Illies
- Fachbereich Neuroradiologie, Asklepios Klinik Altona, Hamburg, Germany
| | - Bernd Eckert
- Fachbereich Neuroradiologie, Asklepios Klinik Altona, Hamburg, Germany
| | - Uwe Kehler
- Abt. f. Neurochirurgie, Asklepios Klinik Altona, Hamburg, Germany
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Nerg O, Junkkari A, Hallikainen I, Rauramaa T, Luikku A, Hiltunen M, Jääskeläinen JE, Leinonen V, Hänninen T, Koivisto A. The CERAD Neuropsychological Battery in Patients with Idiopathic Normal Pressure Hydrocephalus Compared with Normal Population and Patients with Mild Alzheimer's Disease. J Alzheimers Dis 2021; 81:1117-1130. [PMID: 33896842 DOI: 10.3233/jad-201363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The usefulness of CERAD Neuropsychological Battery for describing the cognitive impairment in idiopathic normal pressure hydrocephalus (iNPH) is unknown. OBJECTIVE To compare the cognitive profile of patients with iNPH to patients with mild Alzheimer's disease (AD) and age-matched cognitively healthy individuals by using the CERAD-NB. METHODS We studied CERAD-NB subtest results, including the Mini-Mental State Examination (MMSE), between 199 patients with probable iNPH, 236 patients with mild AD, and 309 people with normal cognition, using age, education, and gender adjusted multivariate linear regression model. In addition, the effects of AD-related brain pathology detected in frontal cortical brain biopsies in iNPH patients' cognitive profiles were examined. RESULTS The iNPH patients performed worse than cognitively healthy people in all CERAD-NB subtests. Despite similar performances in the MMSE, AD patients outperformed iNPH patients in Verbal Fluency (p = 0.016) and Clock Drawing (p < 0.001) tests. However, iNPH patients outperformed AD patients in the Boston Naming Test and Word List Recall and Recognition (p < 0.001). AD-related pathology in brain biopsies did not correlate with the CERAD-NB results. CONCLUSION At the time of the iNPH diagnosis, cognitive performances differed from cognitively healthy people in all CERAD-NB subtests. When the iNPH and AD patients' results were compared, the iNPH patients performed worse in Verbal Fluency and Clock Drawing tests while the AD group had more pronounced episodic memory dysfunctions. This study demonstrates significant differences in the CERAD-NB subtests between cognitive profiles of iNPH and AD patients. These differences are not captured by the MMSE alone.
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Affiliation(s)
- Ossi Nerg
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Unit of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti Junkkari
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Unit of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ilona Hallikainen
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Rauramaa
- Unit of Pathology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Antti Luikku
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Unit of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Unit of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Unit of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tuomo Hänninen
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Anne Koivisto
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Unit of Neurosciences, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Geriatrics / Internal Medicine and Rehabilitation, Helsinki University Hospital, Helsinki, Finland
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11
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Libard S, Walter J, Alafuzoff I. In vivo Characterization of Biochemical Variants of Amyloid-β in Subjects with Idiopathic Normal Pressure Hydrocephalus and Alzheimer's Disease Neuropathological Change. J Alzheimers Dis 2021; 80:1003-1012. [PMID: 33612546 PMCID: PMC8150506 DOI: 10.3233/jad-201469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Stepwise occurrence of biochemically modified amyloid-β (Aβ) in the brain of subjects with Alzheimer’s disease (AD) has been suggested to be of significance for cognitive impairment. Our previous reports have shown that Aβ is observed in 63% of all subjects with idiopathic normal pressure hydrocephalus (iNPH) suggesting that the majority of iNPH subjects with Aβ are indeed also suffering from AD. Objective: We assessed the occurrence of biochemically modified Aβ variants, in vivo, in subjects with iNPH and in a cohort of postmortem brain samples from patients with dementia. Methods: We assessed Aβ proteins in 127 diagnostic brain biopsies obtained from subjects with iNPH and in a cohort of subjects with dementia by means of immunohistochemistry. Results: The pyroglutamylated Aβ (pyAβ) precedes the aggregation of phosphorylated Aβ (pAβ) during the AD neuropathological change progression; moreover, these modified variants of Aβ correlate with hyperphosphorylated tau in the frontal cortical area of human brain. Our results confirm the existence of the suggested biochemical stages of Aβ aggregation that might be of significance for neurodegeneration leading to cognitive impairment. Conclusion: The observation that both pyAβ and pAβ are seen in vivo in iNPH subjects is intriguing. It has been reported that most of the iNPH subjects with Aβ in the brain biopsy indeed develop AD with time. Based on our current and previous results, it is clinically merited to obtain a diagnostic biopsy from a subject with iNPH. When Aβ is observed in the biopsy, the biochemical characterization is of interest.
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Affiliation(s)
- Sylwia Libard
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Jochen Walter
- Department of Neurology, University of Bonn, Bonn, Germany
| | - Irina Alafuzoff
- Department of Pathology, Uppsala University Hospital, Uppsala, Sweden
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12
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Kambara A, Kajimoto Y, Yagi R, Ikeda N, Furuse M, Nonoguchi N, Kawabata S, Kuroiwa T, Kuroda K, Tsuji S, Saura R, Wanibuchi M. Long-Term Prognosis of Cognitive Function in Patients With Idiopathic Normal Pressure Hydrocephalus After Shunt Surgery. Front Aging Neurosci 2021; 12:617150. [PMID: 33551791 PMCID: PMC7854532 DOI: 10.3389/fnagi.2020.617150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022] Open
Abstract
The long-term prognosis of cognitive function in patients with idiopathic normal pressure hydrocephalus (iNPH) remains unclear. This study aimed to determine the long-term prognosis of cognitive function in patients with iNPH, as well as the factors related to it. It included 48 patients with iNPH who were treated with cerebrospinal fluid shunting between January 2015 and December 2017 at Osaka Medical College Hospital, with follow-up evaluation of their cognitive function for >2 years. Cognitive function was measured using the Mini-Mental State Examination (MMSE) preoperatively and at 3 months, 1 and 2 years post-operatively. The mean MMSE score (22.4 ± 5.4 preoperatively) improved at 3 months [23.8 ± 5.0 (p = 0.0002)] and 1 year [23.7 ± 4.8 (p = 0.004)] post-operatively. At 2 years post-operatively, they were able to maintain their preoperative level (22.6 ± 5.3). The patients were classified in to the cognitive decline group [11 (23%) patients; a decrease in the MMSE score by ≥ 2 points 2 years after surgery] and the maintenance/improvement group [37 (77%) patients]. Univariate and receiver operating characteristic analyses were performed for the two groups to identify factors associated with cognitive prognosis. In both groups, the patients who were younger (p = 0.009) or had milder symptoms (p = 0.035) had a better long-term prognosis of cognitive function. The cutoffs for age and disease severity (idiopathic normal-pressure hydrocephalus grading scale; INPHGS) were 78 years (area under the curve = 0.77) and 5 points (area under the curve = 0.71), respectively. In conclusion, most patients (77%) were able to improve and maintain cognitive function for at least 2 years after surgery. The fact that disease severity and age are associated with cognitive prognosis suggests that early iNPH intervention is desirable to improve cognitive prognosis.
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Affiliation(s)
- Akihiro Kambara
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan
| | | | - Ryokichi Yagi
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan
| | - Naokado Ikeda
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan
| | - Motomasa Furuse
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan
| | | | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan
| | - Toshihiko Kuroiwa
- Department of Neurosurgery, Tesseikai Neurosurgery Hospital, Shijonawate, Japan
| | - Kenji Kuroda
- Clinical Department of Rehabilitation, Osaka Medical College, Takatsuki, Japan
| | - Shohei Tsuji
- Clinical Department of Rehabilitation, Osaka Medical College, Takatsuki, Japan
| | - Ryuichi Saura
- Department of Physical and Rehabilitation Medicine, Osaka Medical College, Takatsuki, Japan
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13
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Luikku AJ, Hall A, Nerg O, Koivisto AM, Hiltunen M, Helisalmi S, Herukka SK, Junkkari A, Sutela A, Kojoukhova M, Korhonen V, Mattila J, Lötjönen J, Rummukainen J, Alafuzoff I, Jääskeläinen JE, Remes AM, Solomon A, Kivipelto M, Soininen H, Rauramaa T, Leinonen V. Predicting Development of Alzheimer's Disease in Patients with Shunted Idiopathic Normal Pressure Hydrocephalus. J Alzheimers Dis 2020; 71:1233-1243. [PMID: 31498122 DOI: 10.3233/jad-190334] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) patients often develop Alzheimer's disease (AD) related brain pathology. Disease State Index (DSI) is a method to combine data from various sources for differential diagnosis and progression of neurodegenerative disorders. OBJECTIVE To apply DSI to predict clinical AD in shunted iNPH-patients in a defined population. METHODS 335 shunted iNPH-patients (median 74 years) were followed until death (n = 185) or 6/2015 (n = 150). DSI model (including symptom profile, onset age of NPH symptoms, atrophy of medial temporal lobe in CT/MRI, cortical brain biopsy finding, and APOE genotype) was applied. Performance of DSI model was evaluated with receiver operating characteristic (ROC) curve analysis. RESULTS A total of 70 (21%) patients developed clinical AD during median follow-up of 5.3 years. DSI-model predicted clinical AD with moderate effectiveness (AUC = 0.75). Significant factors were cortical biopsy (0.69), clinical symptoms (0.66), and medial temporal lobe atrophy (0.66). CONCLUSION We found increased occurrence of clinical AD in previously shunted iNPH patients as compared with general population. DSI supported the prediction of AD. Cortical biopsy during shunt insertion seems indicated for earlier diagnosis of comorbid AD.
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Affiliation(s)
- Antti J Luikku
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Anette Hall
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ossi Nerg
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter Kuopio University Hospital, Kuopio, Finland
| | - Anne M Koivisto
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter Kuopio University Hospital, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter Kuopio University Hospital, Kuopio, Finland.,Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Seppo Helisalmi
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter Kuopio University Hospital, Kuopio, Finland
| | - Antti Junkkari
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Anna Sutela
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Maria Kojoukhova
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Ville Korhonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | | | | | - Jaana Rummukainen
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland.,Department of Pathology, University of Eastern Finland, Kuopio, Finland
| | - Irina Alafuzoff
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University and Departmentof Pathology and Cytology, Uppsala University Hospital, Uppsala, Sweden
| | - Juha E Jääskeläinen
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Alina Solomon
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Miia Kivipelto
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Rauramaa
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland.,Department of Pathology, University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland.,Research Unit of Clinical Neuroscience, Neurosurgery, University of Oulu, Oulu, Finland
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14
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Fasano A, Espay AJ, Tang-Wai DF, Wikkelsö C, Krauss JK. Gaps, Controversies, and Proposed Roadmap for Research in Normal Pressure Hydrocephalus. Mov Disord 2020; 35:1945-1954. [PMID: 32959936 DOI: 10.1002/mds.28251] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/09/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022] Open
Abstract
Idiopathic normal pressure hydrocephalus is considered common but remains underinvestigated. There are no uniformly accepted diagnostic criteria and therapeutic guidelines. We summarize the accumulated evidence regarding the definition, pathophysiology, diagnosis, and treatment of idiopathic normal pressure hydrocephalus, highlighting the many gaps and controversies, including diagnostic challenges, the frequent association with neurodegeneration and vascular disease, and the many unknowns regarding patient selection and outcome predictors. A roadmap to fill these gaps and solve the controversies around this condition is also proposed. More evidence is required with respect to diagnostic criteria, the value of ancillary testing, prospective population-based studies and novel trial designs. Furthermore, a need exists to develop new advanced options in shunt technology. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada.,Howard Cohen Normal Pressure Hydrocephalus Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - David F Tang-Wai
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,Howard Cohen Normal Pressure Hydrocephalus Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.,University Health Network Memory Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Carsten Wikkelsö
- Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
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15
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Manniche C, Hejl AM, Hasselbalch SG, Simonsen AH. Cerebrospinal Fluid Biomarkers in Idiopathic Normal Pressure Hydrocephalus versus Alzheimer's Disease and Subcortical Ischemic Vascular Disease: A Systematic Review. J Alzheimers Dis 2020; 68:267-279. [PMID: 30741681 DOI: 10.3233/jad-180816] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The diagnostic workup of idiopathic normal pressure hydrocephalus (iNPH) can be challenging due to an overlap in symptoms and neuroimaging features with other disorders. Despite a growing interest, a cerebrospinal fluid (CSF) biomarker profile in iNPH has not yet been identified. OBJECTIVE To determine the CSF biomarkers with the greatest evidence for differentiating iNPH from the most common differential diagnoses, Alzheimer's disease (AD) and subcortical ischemic vascular disease (SIVD). METHODS A systematic literature search was conducted in PubMed to identify relevant articles up to July 2018 using the following MESH-terms: "Cerebrospinal fluid", "diagnos*", "hydrocephalus, normal pressure". Relevant data were extracted to assess the risk of bias in the included studies. RESULTS Twenty-five studies including 664 patients with iNPH, 502 with AD, 57 with SIVD, 81 with other disorders, and 338 healthy controls (HC) were included. They investigated the diagnostic value of 92 CSF biomarkers. Most evidence existed for amyloid-β 42 (Aβ42), phosphorylated tau (p-tau), and total tau (t-tau) in iNPH versus AD and HC: Aβ42 did not differ between iNPH and AD, but was lower than in HC subjects. T-tau and p-tau were lower in iNPH versus AD on a level comparable to HC subjects. There was moderate or limited evidence for 62 and 88 biomarkers, respectively. Several plausible biases characterize the literature including small sample sizes and inconsistent diagnostic criteria. CONCLUSION T-tau and p-tau may differentiate iNPH from AD and Aβ42 from HC. A combination of these biomarkers may improve the diagnostic accuracy in iNPH.
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Affiliation(s)
- Christina Manniche
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen OE, Denmark
| | - Anne-Mette Hejl
- Department of Neurology, Bispebjerg Hospital, Copenhagen NV, Denmark
| | - Steen Gregers Hasselbalch
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen OE, Denmark
| | - Anja Hviid Simonsen
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen OE, Denmark
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16
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Onder H. Progressive Supranuclear Palsy: A Crucial Co-occurrence in Normal Pressure Hydrocephalus or an Etiology of Hydrocephalic Presentation? INDIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1055/s-0040-1708080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractCo-occurrences of neurodegenerative diseases in normal pressure hydrocephalus (NPH) is a remarkable topic of discussion, which has been mentioned in recent studies and it was also emphasized by the International Society for Hydrocephalus and Cerebrospinal Fluid Disorder. In this report, I illustrate two remarkable cases which were initially diagnosed with idiopathic normal pressure hydrocephalus (iNPH) and ventriculoperitoneal (VP) shunt surgery was performed, which yielded significant improvement in the clinic of both patients in the short-term period. However, in the long-term follow-up, both of them deteriorated, and re-evaluation of the neurological examination and neuroimaging data yielded the full clinical picture of progressive supranuclear palsy (PSP). Via the illustration of these cases and related literature data, I rediscuss some related hypotheses about the co-occurrence of these two conditions of hydrocephalus and PSP. I also suggest some distinct discussions to be clarified in future studies.
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Affiliation(s)
- Halil Onder
- Department of Neurology, Yozgat City Hospital, Yozgat, Turkey
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17
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Vanhala V, Junkkari A, Korhonen VE, Kurki MI, Hiltunen M, Rauramaa T, Nerg O, Koivisto AM, Remes AM, Perälä J, Suvisaari J, Lehto SM, Viinamäki H, Soininen H, Jääskeläinen JE, Leinonen V. Prevalence of Schizophrenia in Idiopathic Normal Pressure Hydrocephalus. Neurosurgery 2020; 84:883-889. [PMID: 29741669 PMCID: PMC6417909 DOI: 10.1093/neuros/nyy147] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 03/03/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is a progressive and potentially treatable neurodegenerative disease affecting elderly people, characterized by gait impairment and ventricular enlargement in brain imaging. Similar findings are seen in some patients with schizophrenia (SCZ). OBJECTIVE To determine the prevalence of SCZ among patients suffering from probable or possible iNPH and the specific effects of comorbid SCZ on the outcome of the cerebrospinal fluid (CSF) shunting. METHODS All medical records of the 521 iNPH patients in the NPH registry were retrospectively analyzed from 1991 until 2017. The prevalence of comorbidity of SCZ was determined and compared to that of general aged (≥65 yr) population in Finland. RESULTS We identified a total of 16 (3.1%) iNPH patients suffering from comorbid SCZ. The prevalence of SCZ among the iNPH patients was significantly higher compared to the general population (3.1% vs 0.9%, P < .001). All iNPH patients with comorbid SCZ were CSF shunted and 12 (75%) had a clinically verified shunt response 3 to 12 mo after the procedure. The CSF shunt response rate did not differ between patients with and without comorbid SCZ. CONCLUSION SCZ seems to occur 3 times more frequently among iNPH patients compared to the general aged population in Finland. The outcome of the treatment was not affected by comorbid SCZ and therefore iNPH patients suffering from comorbid SCZ should not be left untreated. These results merit validation in other populations. In addition, further research towards the potential connection between these chronic conditions is warranted.
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Affiliation(s)
- Vasco Vanhala
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland
| | - Antti Junkkari
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland
| | - Ville E Korhonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland
| | - Mitja I Kurki
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland.,Analytical and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, and Stanley Center for Psychiatric Research, Broad Institute for Harvard and MIT, Boston, Massachusetts
| | | | | | - Ossi Nerg
- Neurology of NeuroCenter, KUH and UEF, Kuopio, Finland
| | | | - Anne M Remes
- Medical Research Center, Oulu University Hospital, Oulu, Finland.,Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
| | - Jonna Perälä
- Department Health, Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Turku University Hospital and University of Turku, Turku, Finland
| | - Jaana Suvisaari
- Department Health, Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Social Psychiatry, School of Public Health, University of Tampere, Tampere, Finland
| | - Soili M Lehto
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.,Psychiatry and Clinical Research Centre, UEF, Kuopio Finland
| | | | | | - Juha E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland
| | - Ville Leinonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), Kuopio, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland.,Unit of Clinical Neuroscience, Neurosurgery, University of Oulu, Oulu, Finland
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18
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Junkkari A, Luikku AJ, Danner N, Jyrkkänen HK, Rauramaa T, Korhonen VE, Koivisto AM, Nerg O, Kojoukhova M, Huttunen TJ, Jääskeläinen JE, Leinonen V. The Kuopio idiopathic normal pressure hydrocephalus protocol: initial outcome of 175 patients. Fluids Barriers CNS 2019; 16:21. [PMID: 31340831 PMCID: PMC6657079 DOI: 10.1186/s12987-019-0142-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Kuopio University Hospital (KUH) idiopathic normal pressure hydrocephalus (iNPH) cerebrospinal fluid (CSF) shunting protocol is described together with the initial outcomes of 175 patients with probable iNPH treated according to this protocol from a defined population. Our secondary aim was to display the variety of differential diagnoses referred to the KUH iNPH outpatient clinic from 2010 until 2017. METHODS Patients were divided into four groups according to the prognostic tests: tap test (positive or negative) and infusion test (positive or negative). The short-term outcome was compared between groups. The 3-month outcome following shunt surgery was assessed by measuring gait speed improvement, using a 12-point iNPH grading scale (iNPHGS) and the 15D instrument. RESULTS From 341 patients suspected of iNPH, 88 patients were excluded from further research mostly due to deviation from the protocol's gait assessment guidelines. Hence 253 patients with suspected iNPH were included in the study, 177/253 (70%) of whom were treated with a CSF shunt. A favorable clinical outcome following surgery was observed in 79-93% of patients depending on the prognostic group. A moderate association (Cramer's V = 0.32) was found between the gait speed improvement rate and the prognostic group (X2, p = 0.003). Patients with a positive tap test had the highest gait speed improvement rate (75%). In addition, an improvement in walking speed was observed in 4/11 patients who had both a negative tap test and a negative infusion test. Other outcome measures did not differ between the prognostic groups. Conditions other than iNPH were found in 25% of the patients referred to iNPH outpatient clinic, with the most prevalent being Alzheimer's disease. CONCLUSIONS Our results emphasize the importance of a systematic diagnostic and prognostic workup especially in cases with an atypical presentation of iNPH. Additional diagnostic testing may be required, but should not delay adequate care. Active surgical treatment is recommended in patients with a high clinical probability of iNPH. Other neurological conditions contributed to most of the non iNPH diagnoses.
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Affiliation(s)
- A Junkkari
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), POB 100, 70029, Kuopio, Finland.
| | - A J Luikku
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), POB 100, 70029, Kuopio, Finland
| | - N Danner
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), POB 100, 70029, Kuopio, Finland
| | - H K Jyrkkänen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), POB 100, 70029, Kuopio, Finland
| | - T Rauramaa
- Department of Pathology, KUH and UEF, Kuopio, Finland
| | - V E Korhonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), POB 100, 70029, Kuopio, Finland
| | - A M Koivisto
- Neurology of NeuroCenter, KUH and UEF, Kuopio, Finland
| | - O Nerg
- Neurology of NeuroCenter, KUH and UEF, Kuopio, Finland
| | - M Kojoukhova
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), POB 100, 70029, Kuopio, Finland
| | - T J Huttunen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), POB 100, 70029, Kuopio, Finland
| | - J E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), POB 100, 70029, Kuopio, Finland
| | - V Leinonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital (KUH) and University of Eastern Finland (UEF), POB 100, 70029, Kuopio, Finland.,Unit of Clinical Neuroscience, Neurosurgery, University of Oulu, Oulu, Finland.,MRC Oulu, Oulu University Hospital, Oulu, Finland
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19
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Leinonen V, Rauramaa T, Johansson J, Bottelbergs A, Tesseur I, van der Ark P, Pemberton D, Koivisto AM, Jääskeläinen JE, Hiltunen M, Herukka SK, Blennow K, Zetterberg H, Jokinen P, Rokka J, Helin S, Haaparanta-Solin M, Solin O, Okamura N, Kolb HC, Rinne JO. S-[18F]THK-5117-PET and [11C]PIB-PET Imaging in Idiopathic Normal Pressure Hydrocephalus in Relation to Confirmed Amyloid-β Plaques and Tau in Brain Biopsies. J Alzheimers Dis 2019; 64:171-179. [PMID: 29865068 DOI: 10.3233/jad-180071] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Detection of pathological tau aggregates could facilitate clinical diagnosis of Alzheimer's disease (AD) and monitor drug effects in clinical trials. S-[18F]THK-5117 could be a potential tracer to detect pathological tau deposits in brain. However, no previous study have correlated S-[18F]THK-5117 uptake in PET with brain biopsy verified tau pathology in vivo. OBJECTIVE Here we aim to evaluate the association between cerebrospinal fluid (CSF) AD biomarkers, S-[18F]THK-5117, and [11C]PIB PET against tau and amyloid lesions in brain biopsy. METHODS Fourteen patients with idiopathic normal pressure hydrocephalus (iNPH) with previous shunt surgery including right frontal cortical brain biopsy and CSF Aβ1 - 42, total tau, and P-tau181 measures, underwent brain MRI, [11C]PIB PET, and S-[18F]THK-5117 PET imaging. RESULTS Seven patients had amyloid-β (Aβ, 4G8) plaques, two both Aβ and phosphorylated tau (Pτ, AT8) and one only Pτ in biopsy. As expected, increased brain biopsy Aβ was well associated with higher [11C]PIB uptake in PET. However, S-[18F]THK-5117 uptake did not show any statistically significant correlation with either brain biopsy Pτ or CSF P-tau181 or total tau. CONCLUSIONS S-[18F]THK-5117 lacked clear association with neuropathologically verified tau pathology in brain biopsy probably, at least partially, due to off-target binding. Further studies with larger samples of patients with different tau tracers are urgently needed. The detection of simultaneous Aβ and tau pathology in iNPH is important since that may indicate poorer and especially shorter response for CSF shunt surgery compared with no pathology.
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Affiliation(s)
- Ville Leinonen
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland and Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.,Unit of ClinicalNeuroscience, Neurosurgery, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Tuomas Rauramaa
- Institute of Clinical Medicine - Pathology, University of Eastern Finland andDepartment of Pathology, Kuopio University Hospital, Kuopio, Finland
| | | | - Astrid Bottelbergs
- Janssen Research and Development, A Division of Janssen Pharmaceutica, Beerse, Belgium
| | - Ina Tesseur
- Janssen Research and Development, A Division of Janssen Pharmaceutica, Beerse, Belgium
| | - Peter van der Ark
- Janssen Research and Development, A Division of Janssen Pharmaceutica, Beerse, Belgium
| | - Darrel Pemberton
- Janssen Research and Development, A Division of Janssen Pharmaceutica, Beerse, Belgium
| | - Anne M Koivisto
- Institute of Clinical Medicine - Neurology, Universityof Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Juha E Jääskeläinen
- Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland and Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Clinical Medicine - Neurology, Universityof Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine - Neurology, Universityof Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska Academy Hospital, Mölndal, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska Academy Hospital, Mölndal, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Department of MolecularNeuroscience, Institute of Neurology, University College London, Queen, Square, UK.,UK DementiaResearch Institute, London, UK
| | - Pekka Jokinen
- Turku PET Centre, University of Turku, Turku, Finland.,Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | - Johanna Rokka
- Radiopharmaceutical Chemistry Laboratory, Turku PET Centre, University of Turku, Turku, Finland.,Athinoula A. Martinos Center, Department of Radiology, Massachusetts GeneralHospital, Harvard Medical School, Charlestown, MA, USA
| | - Semi Helin
- Radiopharmaceutical Chemistry Laboratory, Turku PET Centre, University of Turku, Turku, Finland
| | - Merja Haaparanta-Solin
- PET Preclinical Imaging Laboratory, Turku PET Centre, University of Turku, Turku, Finland.,MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Olof Solin
- Radiopharmaceutical Chemistry Laboratory, Turku PET Centre, University of Turku, Turku, Finland.,Department of Chemistry, University of Turku, Turku, Finland.,Accelerator Laboratory, Turku PET Centre, Åbo Akademi University, Turku, Finland
| | | | | | - Juha O Rinne
- Turku PET Centre, University of Turku, Turku, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
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20
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Libard S, Alafuzoff I. Alzheimer's disease neuropathological change and loss of matrix/neuropil in patients with idiopathic Normal Pressure Hydrocephalus, a model of Alzheimer's disease. Acta Neuropathol Commun 2019; 7:98. [PMID: 31142354 PMCID: PMC6540414 DOI: 10.1186/s40478-019-0748-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 12/17/2022] Open
Abstract
Here, we assessed unique brain tissue samples, obtained from living subjects with idiopathic Normal Pressure Hydrocephalus (iNPH). Our cohort of 95 subjects with age ranging from 75 to 79 years, displayed a high prevalence of β-amyloid (Aβ) and hyperphosphorylated τ (HPτ) pathology (63 and 61%, respectively) in a frontal cortex biopsy obtained during shunt operation. These lesions, i.e., Alzheimer’s Disease Neuropathologic Change (ADNC), increased within 5 years and were more frequent in females. The extent of HPτ pathology was sparse, primarily seen as neurites and stained dots. Noteworthy, concomitant pathology was seen in 49% of the whole cohort, indicating a severity of ADNC corresponding to a low/intermediate level following the current recommendations. This observation is predictable as based on previous publications a substantial number of subjects with iNPH over time develop AD. Thus, iNPH can be considered as a model of AD. We noted a surprisingly remarkable neuronal preservation assessing Neuronal Nuclei (NeuN) in parallel with a substantial depletion of matrix/neuropil. This finding is intriguing as it suggests that loss of matrix/neuropil might be one of the first lesion of ADNC but also a hallmark lesion of iNPH. The latter observation is in line with the enlarged ventricles, a cardinal feature of iNPH. Furthermore, a positive correlation was observed between the extent of Aβ and NeuN but only in females indicating a neuronal preservation even when Aβ pathology is present. The assessment of a surgical biopsy as described here is certainly informative and thus it is surprising that a neuropathologic assessment in the setting of iNPH, while inserting a shunt, is seldom performed. Here, we observed ADNC and surprisingly remarkable neuronal preservation in a substantial number of iNPH subjects. Thus, these subjects allow us to observe the natural course of the disease and give us an opportunity for intervention at the earliest stages of AD, prior to severe neuronal damage.
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21
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Rinne JO, Suotunen T, Rummukainen J, Herukka SK, Nerg O, Koivisto AM, Rauramaa T, Någren K, Hiltunen M, Alafuzoff I, Rinne J, Jääskeläinen JE, Soininen H, Leinonen V. [11C]PIB PET Is Associated with the Brain Biopsy Amyloid-β Load in Subjects Examined for Normal Pressure Hydrocephalus. J Alzheimers Dis 2019; 67:1343-1351. [DOI: 10.3233/jad-180645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Juha O. Rinne
- Turku PET Centre, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Timo Suotunen
- Turku PET Centre, University of Turku, Turku, Finland
| | - Jaana Rummukainen
- Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ossi Nerg
- Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Anne M. Koivisto
- Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Rauramaa
- Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, Pathology, University of Eastern Finland, Kuopio, Finland
| | - Kjell Någren
- Department of Nuclear Medicine, PET and Cyclotron Unit, Odense University Hospital, Odense, Denmark
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Irina Alafuzoff
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Jaakko Rinne
- Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | - Juha E. Jääskeläinen
- Institute of Clinical Medicine, Neurosurgery, University of Eastern Finland, Kuopio, Finland
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Institute of Clinical Medicine, Neurosurgery, University of Eastern Finland, Kuopio, Finland
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Unit of Clinical Neuroscience, Neurosurgery, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland
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22
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Libard S, Laurell K, Cesarini KG, Alafuzoff I. Progression of Alzheimer's Disease-Related Pathology and Cell Counts in a Patient with Idiopathic Normal Pressure Hydrocephalus. J Alzheimers Dis 2019; 61:1451-1462. [PMID: 29376849 DOI: 10.3233/jad-170446] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We had an opportunity to assess the change observed in the brain regarding Alzheimer's disease (AD)-related alterations, cell count, and inflammation that took place during a period of 21 months in a subject with a definite diagnosis of AD and idiopathic Normal Pressure Hydrocephalus (iNPH). Four neuronal markers, i.e., synaptophysin, microtubule associated protein 2, non-phosphorylated neurofilament H (SMI32), and embryonic lethal abnormal visual system proteins 3/4 HuC/HuD (HuC/HuD); three microglial markers CD68, Human Leucocytic Antigen DR, ionized calcium-binding adaptor molecule 1, glial fibrillary acidic protein (GFAP); and AD-related markers, hyperphosphorylated τ (HPτ) and amyloid-β (Aβ, Aβ40, Aβ42) were assessed. Morphometrically assessed immunoreactivity of all neuronal and all microglial markers and Aβ42 decreased parallel with an increase in the HPτ in the frontal cortex. The expression of GFAP was stable with time. The first sample was obtained during the therapeutic shunting procedure for iNPH, and the second sample was obtained postmortem. Negligible reactive changes were observed surrounding the shunt channel. In conclusion, in the late stage of AD with time, a neuronal loss, increase in the HPτ, and decrease in Aβ42 and microglia was observed, whereas the expression of GFAP was rather stable. The observations described here suggest that when a brain biopsy has been obtained from an adult subject with iNPH, the assessment of postmortem brain is of major significance.
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Affiliation(s)
- Sylwia Libard
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden.,Department of Pathology, Uppsala University Hospital, Sweden
| | - Katarina Laurell
- Department of Pharmacology and Clinical Neuroscience, Östersund, Umeå University, Sweden
| | | | - Irina Alafuzoff
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden.,Department of Pathology, Uppsala University Hospital, Sweden
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23
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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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24
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Delayed symptom progression after ventriculoperitoneal shunt placement for normal pressure hydrocephalus. J Neurol Sci 2018; 393:105-109. [DOI: 10.1016/j.jns.2018.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/17/2018] [Accepted: 08/02/2018] [Indexed: 11/19/2022]
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25
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Leinonen V, Vanninen R, Rauramaa T. Cerebrospinal fluid circulation and hydrocephalus. HANDBOOK OF CLINICAL NEUROLOGY 2018; 145:39-50. [PMID: 28987185 DOI: 10.1016/b978-0-12-802395-2.00005-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Hydrocephalus (HC) is classically defined as dynamic imbalance between the production and absorption of cerebrospinal fluid (CSF) leading to enlarged ventricles. Potential causative factors include various brain disorders like tumors causing obstruction of CSF flow within the ventricular system or the subarachnoid space. Classification of HC is based on the site of CSF flow obstruction guiding optimal treatment, with endoscopic third ventriculostomy in intraventricular obstruction and CSF shunt in communicating HC. Another clinically relevant classification is acute and chronic; the most frequent chronic form is idiopathic normal-pressure hydrocephalus (iNPH). The reported incidence of HC varies according to the study population and classification used. The incidence of congenital HC is approximately 0.4-0.6/1,000 newborns and the annual incidence of iNPH varies from 0.5/100,000 to 5.5/100,000. Radiologically, ventricular dilatation may be nonspecific, and differentiation of iNPH from other neurodegenerative diseases may be ambiguous. There are no known specific microscopic findings of HC but a systematic neuropathologic examination is needed to detect comorbid diseases and possible etiologic factors of HC. Depending on the etiology of HC, there are several nonspecific signs potentially to be seen.
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Affiliation(s)
- Ville Leinonen
- Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland and Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
| | - Ritva Vanninen
- Department of Radiology, Institute of Clinical Medicine, University of Eastern Finland and Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Rauramaa
- Department of Pathology, Institute of Clinical Medicine, University of Eastern Finland and Department of Pathology, Kuopio University Hospital, Kuopio, Finland
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26
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Espay AJ, Da Prat GA, Dwivedi AK, Rodriguez-Porcel F, Vaughan JE, Rosso M, Devoto JL, Duker AP, Masellis M, Smith CD, Mandybur GT, Merola A, Lang AE. Deconstructing normal pressure hydrocephalus: Ventriculomegaly as early sign of neurodegeneration. Ann Neurol 2017; 82:503-513. [PMID: 28892572 DOI: 10.1002/ana.25046] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/21/2017] [Accepted: 09/01/2017] [Indexed: 12/27/2022]
Abstract
Idiopathic normal pressure hydrocephalus (NPH) remains both oversuspected on clinical grounds and underconfirmed when based on immediate and sustained response to cerebrospinal fluid diversion. Poor long-term postshunt benefits and findings of neurodegenerative pathology in most patients with adequate follow-up suggest that hydrocephalic disorders appearing in late adulthood may often result from initially unapparent parenchymal abnormalities. We critically review the NPH literature, highlighting the near universal lack of blinding and controls, absence of specific clinical, imaging, or pathological features, and ongoing dependence for diagnostic confirmation on variable cutoffs of gait response to bedside fluid-drainage testing. We also summarize our long-term institutional experience, in which postshunt benefits in patients with initial diagnosis of idiopathic NPH persist in only 32% of patients at 36 months, with known revised diagnosis in over 25% (Alzheimer's disease, dementia with Lewy bodies, and progressive supranuclear palsy). We postulate that previously reported NPH cases with "dual" pathology (ie, developing a "second" disorder) more likely represent ventriculomegalic presentations of selected neurodegenerative disorders in which benefits from shunting may be short-lived, with a consequently unfavorable risk-benefit ratio. Ann Neurol 2017;82:503-513.
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Affiliation(s)
- Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Gustavo A Da Prat
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH.,Sanatorio de la Trinidad Mitre, Departamento de Neurologia, Ciudad de Buenos Aires, Argentina
| | - Alok K Dwivedi
- Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center (TTUHSC), El Paso, TX
| | - Federico Rodriguez-Porcel
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Jennifer E Vaughan
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Michela Rosso
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Johnna L Devoto
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Andrew P Duker
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Mario Masellis
- Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, University of Toronto, and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Charles D Smith
- Departments of Neurology and Radiology, Magnetic Resonance Imaging & Spectroscopy Center, University of Kentucky, Lexington, KY
| | - George T Mandybur
- Mayfield Clinic, Department of Neurosurgery, University of Cincinnati, Cincinnati, OH
| | - Aristide Merola
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Anthony E Lang
- Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, ON, Canada
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27
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Hamezah HS, Durani LW, Ibrahim NF, Yanagisawa D, Kato T, Shiino A, Tanaka S, Damanhuri HA, Ngah WZW, Tooyama I. Volumetric changes in the aging rat brain and its impact on cognitive and locomotor functions. Exp Gerontol 2017; 99:69-79. [PMID: 28918364 DOI: 10.1016/j.exger.2017.09.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 09/02/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
Impairments in cognitive and locomotor functions usually occur with advanced age, as do changes in brain volume. This study was conducted to assess changes in brain volume, cognitive and locomotor functions, and oxidative stress levels in middle- to late-aged rats. Forty-four male Sprague-Dawley rats were divided into four groups: 14, 18, 23, and 27months of age. 1H magnetic resonance imaging (MRI) was performed using a 7.0-Tesla MR scanner system. The volumes of the lateral ventricles, medial prefrontal cortex (mPFC), hippocampus, striatum, cerebellum, and whole brain were measured. Open field, object recognition, and Morris water maze tests were conducted to assess cognitive and locomotor functions. Blood was taken for measurements of malondialdehyde (MDA), protein carbonyl content, and antioxidant enzyme activity. The lateral ventricle volumes were larger, whereas the mPFC, hippocampus, and striatum volumes were smaller in 27-month-old rats than in 14-month-old rats. In behavioral tasks, the 27-month-old rats showed less exploratory activity and poorer spatial learning and memory than did the 14-month-old rats. Biochemical measurements likewise showed increased MDA and lower glutathione peroxidase (GPx) activity in the 27-month-old rats. In conclusion, age-related increases in oxidative stress, impairment in cognitive and locomotor functions, and changes in brain volume were observed, with the most marked impairments observed in later age.
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Affiliation(s)
- Hamizah Shahirah Hamezah
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu 520-2192, Japan.
| | - Lina Wati Durani
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu 520-2192, Japan.
| | - Nor Faeizah Ibrahim
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu 520-2192, Japan; Department of Biochemistry, Faculty of Medicine, UKMMC, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Cheras, Kuala Lumpur, Malaysia.
| | - Daijiro Yanagisawa
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu 520-2192, Japan.
| | - Tomoko Kato
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu 520-2192, Japan.
| | - Akihiko Shiino
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu 520-2192, Japan.
| | - Sachiko Tanaka
- Department of Medical Statistics, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu 520-2192, Japan.
| | - Hanafi Ahmad Damanhuri
- Department of Biochemistry, Faculty of Medicine, UKMMC, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Cheras, Kuala Lumpur, Malaysia.
| | - Wan Zurinah Wan Ngah
- Department of Biochemistry, Faculty of Medicine, UKMMC, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Cheras, Kuala Lumpur, Malaysia.
| | - Ikuo Tooyama
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu 520-2192, Japan.
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28
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Korhonen VE, Solje E, Suhonen NM, Rauramaa T, Vanninen R, Remes AM, Leinonen V. Frontotemporal dementia as a comorbidity to idiopathic normal pressure hydrocephalus (iNPH): a short review of literature and an unusual case. Fluids Barriers CNS 2017; 14:10. [PMID: 28420385 PMCID: PMC5395836 DOI: 10.1186/s12987-017-0060-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/05/2017] [Indexed: 12/12/2022] Open
Abstract
Behavioural variant frontotemporal dementia (bvFTD) and idiopathic normal pressure hydrocephalus (iNPH) are neurodegenerative diseases that can present with similar symptoms. These include decline in executive functions, psychomotor slowness, and behavioural and personality changes. Ventricular enlargement is a key radiological finding in iNPH that may also be present in bvFTD caused by the C9ORF72 expansion mutation. Due to this, bvFTD has been hypothesized as a potential comorbidity to iNPH but bvFTD patients have never been identified in studies focusing in clinical comorbidities with iNPH. Here we describe a patient with the C9ORF72 expansion-associated bvFTD who also showed enlarged ventricles on brain imaging. The main clinical symptoms were severe gait disturbances and psychiatric problems with mild cognitive decline. Cerebrospinal fluid removal increased the patient's walking speed, so a ventriculoperitoneal shunt was placed. After insertion of the shunt, there was a significant improvement in walking speed as well as mild improvement in cognitive function but not in neuropsychiatric symptoms relating to bvFTD. Comorbid iNPH should be considered in bvFTD patients who have enlarged ventricles and severely impaired gait.
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Affiliation(s)
- V. E. Korhonen
- Department of Neurosurgery, Kuopio University Hospital, P.O. Box 100, 70029 KYS Kuopio, Finland
- University of Eastern Finland, P.O. Box 100, 70029 KYS Kuopio, Finland
| | - E. Solje
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - N. M. Suhonen
- Medical Research Center, Oulu University Hospital, P.O. Box 20, 90029 Oulu, Finland
- Unit of Clinical Neuroscience, Neurology, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland
| | - T. Rauramaa
- Institute of Clinical Medicine-Pathology, School of Medicine, University of Eastern, Kuopio, Finland
- Department of Pathology, Kuopio University Hospital, P.O. Box 162, 70211 Kuopio, Finland
| | - R. Vanninen
- Department of Radiology, Kuopio University Hospital, P.O. Box 100, 70029 KYS Kuopio, Finland
| | - A. M. Remes
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
- Medical Research Center, Oulu University Hospital, P.O. Box 20, 90029 Oulu, Finland
- Unit of Clinical Neuroscience, Neurology, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland
| | - V. Leinonen
- Department of Neurosurgery, Kuopio University Hospital, P.O. Box 100, 70029 KYS Kuopio, Finland
- University of Eastern Finland, P.O. Box 100, 70029 KYS Kuopio, Finland
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29
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Kojoukhova M, Vanha KI, Timonen M, Koivisto AM, Nerg O, Rummukainen J, Rauramaa T, Vanninen R, Jääskeläinen JE, Sutela A, Leinonen V. Associations of intracranial pressure with brain biopsy, radiological findings, and shunt surgery outcome in patients with suspected idiopathic normal pressure hydrocephalus. Acta Neurochir (Wien) 2017; 159:51-61. [PMID: 27878614 DOI: 10.1007/s00701-016-3025-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/09/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND It remains unclear how intracranial pressure (ICP) measures are associated with brain biopsies and radiological markers. Here, we aim to investigate associations between ICP and radiological findings, brain biopsies, and shunt surgery outcome in patients with suspected idiopathic normal pressure hydrocephalus (iNPH). METHOD In this study, we retrospectively analyzed data from 73 patients admitted with suspected iNPH to Kuopio University Hospital. Of these patients, 71% underwent shunt surgery. The NPH registry included data on clinical and radiological examinations, 24-h intraventricular pressure monitoring, and frontal cortical biopsy. RESULTS The mean ICP and mean ICP pulse wave amplitude were not associated with the shunt response. Aggregations of Alzheimer's disease (AD)-related proteins (amyloid-β, hyperphosphorylated tau) in frontal cortical biopsies were associated with a poor shunt response (P = 0.014). High mean ICP was associated with Evans' index (EI; P = 0.025), disproportional sylvian and suprasylvian subarachnoid spaces (P = 0.014), and focally dilated sulci (P = 0.047). Interestingly, a high pulse wave amplitude was associated with AD-related biopsy findings (P = 0.032), but the mean ICP was not associated with the brain biopsy. The ICP was not associated with medial temporal lobe atrophy, temporal horn widths, or white matter changes. ICP B waves were associated with less atrophy of the medial temporal lobe (P = 0.018) and more severe disproportionality between the sylvian and suprasylvian subarachnoid spaces (P = 0.001). CONCLUSIONS The EI and disproportional sylvian and suprasylvian subarachnoid spaces were associated with mean ICP. Disproportionality was also associated with ICP B waves. These associations, although rather weak, with elevated ICP in 24-h measurements, support their value in iNPH diagnostics and suggest that these radiological markers are potentially related to the pathogenesis of iNPH. Interestingly, our results suggested that elevated pulse wave amplitude might be associated with brain amyloid accumulation.
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Affiliation(s)
- Maria Kojoukhova
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, P.O. Box 100, 70029, Kuopio, Finland.
| | - Krista-Irina Vanha
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, P.O. Box 100, 70029, Kuopio, Finland
| | - Matti Timonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, P.O. Box 100, 70029, Kuopio, Finland
| | - Anne M Koivisto
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Ossi Nerg
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Jaana Rummukainen
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Rauramaa
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine-Pathology, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, P.O. Box 100, 70029, Kuopio, Finland
| | - Anna Sutela
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, P.O. Box 100, 70029, Kuopio, Finland
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30
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Laiterä T, Paananen J, Helisalmi S, Sarajärvi T, Huovinen J, Laitinen M, Rauramaa T, Alafuzoff I, Remes AM, Soininen H, Haapasalo A, Jääskeläinen JE, Leinonen V, Hiltunen M. Effects of Alzheimer’s Disease-Associated Risk Loci on Amyloid-β Accumulation in the Brain of Idiopathic Normal Pressure Hydrocephalus Patients. J Alzheimers Dis 2016; 55:995-1003. [DOI: 10.3233/jad-160554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Tiina Laiterä
- Institute of Clinical Medicine – Neurology, University of Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland and Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Jussi Paananen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Seppo Helisalmi
- Institute of Clinical Medicine – Neurology, University of Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Timo Sarajärvi
- Institute of Clinical Medicine – Neurology, University of Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Joel Huovinen
- Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland and Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Marjo Laitinen
- Institute of Clinical Medicine – Neurology, University of Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Rauramaa
- Institute of Clinical Medicine – Pathology, University of Eastern Finland and Department of Pathology, Kuopio University Hospital, Kuopio, Finland
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Irina Alafuzoff
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anne M. Remes
- Institute of Clinical Medicine – Neurology, University of Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine – Neurology, University of Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juha E. Jääskeläinen
- Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland and Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Ville Leinonen
- Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland and Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Clinical Medicine – Neurology, University of Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
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31
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Junkkari A, Häyrinen A, Rauramaa T, Sintonen H, Nerg O, Koivisto AM, Roine RP, Viinamäki H, Soininen H, Luikku A, Jääskeläinen JE, Leinonen V. Health-related quality-of-life outcome in patients with idiopathic normal-pressure hydrocephalus - a 1-year follow-up study. Eur J Neurol 2016; 24:58-66. [PMID: 27647684 DOI: 10.1111/ene.13130] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE This prospective study explored the factors affecting the health-related quality-of-life (HRQoL) outcome in patients with idiopathic normal-pressure hydrocephalus (iNPH) 1 year after the installation of the cerebrospinal fluid shunt. METHODS The HRQoL outcome was evaluated using a 15D instrument, in which the minimum clinically significant change/difference has been estimated to be ±0.015. The follow-up data (15D, Mini-Mental State Examination, Beck Depression Inventory, iNPH Grading Scale), frontal cortical biopsy, Charlson Age Comorbidity Index and body mass index of 145 patients diagnosed with iNPH by clinical and radiological examination were analyzed. RESULTS At 1-year follow-up, 63 (43%) patients had experienced a clinically significant improvement in HRQoL. Multivariate binary logistic regression analysis indicated that the absence of amyloid-β and hyperphosphorylated tau pathology in the frontal cortical biopsy (53% vs. 33%; absolute risk difference, 20%; adjusted odds ratio, 2.27; 95% confidence interval, 1.07-4.84; P < 0.05) and lower body mass index (adjusted odds ratio, 0.90, 95% confidence interval, 0.82-0.98; P < 0.05) predicted favorable HRQoL outcome 1 year after the shunting. CONCLUSIONS Less than half of the patients with iNPH experienced clinically significant favorable HRQoL outcome, partly explained by the patient's characteristics and comorbidities. The HRQoL approach reveals aspects that are important for the patient's well-being, but may also improve the quality of the outcome assessment of cerebrospinal fluid shunting. Study results may help clinicians to estimate which patients will benefit shunt surgery.
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Affiliation(s)
- A Junkkari
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - A Häyrinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - T Rauramaa
- Department of Pathology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - H Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Nerg
- Neurology of NeuroCenter, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - A M Koivisto
- Neurology of NeuroCenter, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - R P Roine
- Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland.,Group administration of the Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - H Viinamäki
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - H Soininen
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - A Luikku
- Neurology of NeuroCenter, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - J E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - V Leinonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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