1
|
Rýdlo O, Bubeníková A, Häcklová K, Skalický P, Leško R, Ebelová A, Netuka D, IIIrd VB, Beneš V, Bradáč O. Comparison of decline in different cognitive domain in patients with normal pressure hydrocephalus. Neurosurg Rev 2024; 47:167. [PMID: 38632175 PMCID: PMC11024017 DOI: 10.1007/s10143-024-02410-3] [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: 08/08/2023] [Revised: 01/20/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
We sought to describe the cognitive profile of patients with Idiopathic Normal Pressure Hydrocephalus (iNPH) using a comprehensive neuropsychological battery. Based on age and education correlated norms, we aimed to compare performance in each measured cognitive domain: executive functions (EFs), verbal memory (VM), non-verbal memory (nVM), visuoconstructional abilities (VA) and attention/psychomotor speed (A/PS). Patients diagnosed with iNPH underwent comprehensive neuropsychological evaluation before shunting. Their performance was compared to the age and education correlated norms. Correlation of different cognitive domains in iNPH profile was performed. A total of 53 iNPH patients (73.21 ± 5.48 years) were included in the study. All of the measured cognitive domains were significantly damaged. The most affected domains were EFs and VM (p<0.001 and p<0.001, respectively). A/PS domain was affected milder than EFs and VM (p<0.001). The least affected domains were nVM (p<0.001) and VA (p<0.001). Patients with iNPH are affected in all cognitive domains and the cognitive decline is uneven across these domains. The impairment of memory was shown to depend on the presented material. VM was shown to be much more severely affected than nVM and along with VM, EFs were shown to be the most affected. A/PS speed was shown to be less affected than VM and EFs and the least affected domains were nVM and VA.
Collapse
Affiliation(s)
- Ondřej Rýdlo
- Department of Neuropsychology, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
- Department of Neurosurgery, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Adéla Bubeníková
- Department of Neurosurgery, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic.
- Department of Neurosurgery and Neurooncology, First Medical Faculty, Charles University and Military University Hospital, Prague, Czech Republic.
| | - Klára Häcklová
- Department of Neuropsychology, First Medical Faculty, Charles University and Military University Hospital, Prague, Czech Republic
| | - Petr Skalický
- Department of Neurosurgery, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Róbert Leško
- Department of Neurosurgery, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Adéla Ebelová
- Department of Anaesthesiology and Intensive Care, Sligo University Hospital, Sligo, Ireland
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Medical Faculty, Charles University and Military University Hospital, Prague, Czech Republic
| | - Vladimír Beneš IIIrd
- Department of Neurosurgery, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, First Medical Faculty, Charles University and Military University Hospital, Prague, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery, Second Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
- Department of Neurosurgery and Neurooncology, First Medical Faculty, Charles University and Military University Hospital, Prague, Czech Republic
| |
Collapse
|
2
|
Zipfel J, Kohlmann-Dell’Acqua C, Noell S, Trakolis L. 17 years of experience with shunt systems in normal pressure hydrocephalus - From differential pressure to gravitational valves. World Neurosurg X 2024; 22:100293. [PMID: 38450246 PMCID: PMC10914590 DOI: 10.1016/j.wnsx.2024.100293] [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: 03/08/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
Objective Complication rate of shunting for normal pressure hydrocephalus (NPH) has significantly improved over the last decades. Especially the use of overdrainage protection has reduced the incidence of subdural hematoma and collections. However, gravitational valves were associated with other complications of shunt dysfunction. We present our 17 years of experience with patients with normal pressure hydrocephalus who changed from a differential pressure valve to a gravitational valve system. Methods We retrospectively identified all patients with the diagnosis of normal pressure hydrocephalus, in whom primary shunt implantation was performed between 2004 and 2020. Shunt implantation was performed as per our internal standard. Review of imaging, charts and patient reports was performed. Results In total, 409 patients were included in the analysis. Mean age was 73.0 ± 7.1years. Between 2004 and 2010, predominantly Hakim valves (n = 100, 24.4%) were implanted, whilst from 2009 until 2020, proGAV valves (n = 296, 72.4%) were used. Mean follow-up was 8.9 ± 4.5 years. Initial subjective improvement of symptoms was reported in 69.9%, whilst this number decreased at the last follow-up to 29.8%. No significant differences were observed between the valves in the frequency of surgery for subdural hematoma. Shunt assistant implantation was performed in 17% of patients with Hakim valve, in 9.5% of patients with proGAV, a shunt assistant was added. Shunt obstruction was significantly higher in proGAV valves (p < 0.001). Conclusions Our findings confirm the observation of frequent overdrainage in shunts without anti-siphon/gravitational component. Gravitational valves on the other hand may be associated with more obstruction.
Collapse
Affiliation(s)
- Julian Zipfel
- Department of Neurosurgery, University Hospital Tuebingen, Germany
- Centre for Clinical Studies, Neuropsychiatric Study Centre, University Hospital Tuebingen, Germany
| | - Cristina Kohlmann-Dell’Acqua
- Department of Neurosurgery, University Hospital Tuebingen, Germany
- Centre for Clinical Studies, Neuropsychiatric Study Centre, University Hospital Tuebingen, Germany
| | - Susan Noell
- Department of Neurosurgery, University Hospital Tuebingen, Germany
| | | |
Collapse
|
3
|
Greenberg ABW, Mekbib KY, Mehta NH, Kiziltug E, Duy PQ, Smith HR, Junkkari A, Leinonen V, Hyman BT, Chan D, Curry Jr WT, Arnold SE, Barker II FG, Frosch MP, Kahle KT. Utility of cortical tissue analysis in normal pressure hydrocephalus. Cereb Cortex 2024; 34:bhae001. [PMID: 38275188 PMCID: PMC10839843 DOI: 10.1093/cercor/bhae001] [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] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/27/2024] Open
Abstract
Clinical improvement following neurosurgical cerebrospinal fluid shunting for presumed idiopathic normal pressure hydrocephalus is variable. Idiopathic normal pressure hydrocephalus patients may have undetected Alzheimer's disease-related cortical pathology that confounds diagnosis and clinical outcomes. In this study, we sought to determine the utility of cortical tissue immuno-analysis in predicting shunting outcomes in idiopathic normal pressure hydrocephalus patients. We performed a pooled analysis using a systematic review as well as analysis of a new, original patient cohort. Of the 2707 screened studies, 3 studies with a total of 229 idiopathic normal pressure hydrocephalus patients were selected for inclusion in this meta-analysis alongside our original cohort. Pooled statistics of shunting outcomes for the 229 idiopathic normal pressure hydrocephalus patients and our new cohort of 36 idiopathic normal pressure hydrocephalus patients revealed that patients with Aβ + pathology were significantly more likely to exhibit shunt nonresponsiveness than patients with negative pathology. Idiopathic normal pressure hydrocephalus patients with Alzheimer's disease -related cortical pathology may be at a higher risk of treatment facing unfavorable outcomes following cerebrospinal fluid shunting. Thus, cortical tissue analysis from living patients may be a useful diagnostic and prognostic adjunct for patients with presumed idiopathic normal pressure hydrocephalus and potentially other neurodegenerative conditions affecting the cerebral cortex.
Collapse
Affiliation(s)
- Ana B W Greenberg
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, United States
| | - Kedous Y Mekbib
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, United States
| | - Neel H Mehta
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Emre Kiziltug
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, United States
| | - Phan Q Duy
- 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
| | - Antti Junkkari
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, United States
| | - Ville Leinonen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio 70211, Finland
| | - 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
| | - Frederick G Barker II
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Matthew P Frosch
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, 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
| |
Collapse
|
4
|
Pyrgelis ES, Paraskevas GP, Constantinides VC, Boufidou F, Papaioannou M, Stefanis L, Kapaki E. Alzheimer's Disease CSF Biomarkers as Possible Indicators of Tap-Test Response in Idiopathic Normal Pressure Hydrocephalus. Brain Sci 2023; 13:1593. [PMID: 38002553 PMCID: PMC10670082 DOI: 10.3390/brainsci13111593] [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: 08/30/2023] [Revised: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
The aim of the present study is the evaluation of established Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers in patients with idiopathic normal-pressure hydrocephalus (iNPH), both individually and as a total profile, and the investigation of their use as potential predictors of Tap-test responsiveness. Fifty-three patients with iNPH participated in the study. Aβ42, Aβ40, total Tau and phospho-Tau proteins were measured in duplicate with double-sandwich ELISA assays. Clinical evaluation involved a 10 m timed walk test before an evacuative lumbar puncture (LP) and every 24 h for three consecutive days afterwards. Neuropsychological assessment involved a mini-mental state examination, frontal assessment battery, 5-word test and CLOX drawing test 1 and 2, which were also performed before and 48 h after LP. Response in the Tap-test was defined as a 20% improvement in gait and/or a 10% improvement in neuropsychological tests. The Aβ42/Aβ40 ratio was found to be significantly higher in Tap-test responders than non-responders. Total Tau and phospho-Tau CSF levels also differed significantly between these two groups, with Tap-test responders presenting with lower levels compared to non-responders. Regarding the AD CSF biomarker profile (decreased amyloid and increased Tau proteins levels), patients with a non-AD profile were more likely to have a positive response in the Tap-test than patients with an AD profile.
Collapse
Affiliation(s)
- Efstratios-Stylianos Pyrgelis
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece; (E.-S.P.); (V.C.C.); (L.S.)
- 1st Department of Neurology, Neurochemistry and Biological Markers Unit, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece; (G.P.P.); (F.B.); (M.P.)
| | - George P. Paraskevas
- 1st Department of Neurology, Neurochemistry and Biological Markers Unit, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece; (G.P.P.); (F.B.); (M.P.)
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Rimini 1, 12462 Athens, Greece
| | - Vasilios C. Constantinides
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece; (E.-S.P.); (V.C.C.); (L.S.)
- 1st Department of Neurology, Neurochemistry and Biological Markers Unit, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece; (G.P.P.); (F.B.); (M.P.)
| | - Fotini Boufidou
- 1st Department of Neurology, Neurochemistry and Biological Markers Unit, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece; (G.P.P.); (F.B.); (M.P.)
| | - Myrto Papaioannou
- 1st Department of Neurology, Neurochemistry and Biological Markers Unit, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece; (G.P.P.); (F.B.); (M.P.)
| | - Leonidas Stefanis
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece; (E.-S.P.); (V.C.C.); (L.S.)
| | - Elisabeth Kapaki
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece; (E.-S.P.); (V.C.C.); (L.S.)
- 1st Department of Neurology, Neurochemistry and Biological Markers Unit, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece; (G.P.P.); (F.B.); (M.P.)
| |
Collapse
|
5
|
Braun M, Boström G, Ingelsson M, Kilander L, Löwenmark M, Nyholm D, Burman J, Niemelä V, Freyhult E, Kultima K, Virhammar J. Levels of inflammatory cytokines MCP-1, CCL4, and PD-L1 in CSF differentiate idiopathic normal pressure hydrocephalus from neurodegenerative diseases. Fluids Barriers CNS 2023; 20:72. [PMID: 37833765 PMCID: PMC10571396 DOI: 10.1186/s12987-023-00472-x] [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: 07/09/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Neuroinflammatory processes have been suggested to play a role in the pathophysiology of neurodegenerative diseases and post-hemorrhagic hydrocephalus, but have rarely been investigated in patients with idiopathic normal pressure hydrocephalus (iNPH). The aim of this study was to investigate whether levels of inflammatory proteins in CSF are different in iNPH compared to healthy controls and patients with selected neurodegenerative disorders, and whether any of these markers can aid in the differential diagnosis of iNPH. METHODS Lumbar CSF was collected from 172 patients from a single center and represented iNPH (n = 74), Alzheimer's disease (AD) (n = 21), mild cognitive impairment (MCI) due to AD (n = 21), stable MCI (n = 22), frontotemporal dementia (n = 13), and healthy controls (HC) (n = 21). Levels of 92 inflammatory proteins were analyzed using a proximity extension assay. As a first step, differences between iNPH and HC were investigated, and proteins that differed between iNPH and HC were then compared with those from the other groups. The linear regressions were adjusted for age, sex, and plate number. RESULTS Three proteins showed higher (MCP-1, p = 0.0013; CCL4, p = 0.0008; CCL11, p = 0.0022) and one lower (PD-L1, p = 0.0051) levels in patients with iNPH compared to HC. MCP-1 was then found to be higher in iNPH than in all other groups. CCL4 was higher in iNPH than in all other groups, except in MCI due to AD. PD-L1 was lower in iNPH compared to all other groups, except in stable MCI. Levels of CCL11 did not differ between iNPH and the differential diagnoses. In a model based on the four proteins mentioned above, the mean area under the receiver operating characteristic curve used to discriminate between iNPH and the other disorders was 0.91. CONCLUSIONS The inflammatory cytokines MCP-1 and CCL4 are present at higher-and PD-L1 at lower-levels in iNPH than in the other investigated diagnoses. These three selected cytokines may have diagnostic potential in the work-up of patients with iNPH.
Collapse
Affiliation(s)
- Madelene Braun
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Gustaf Boström
- Department of Public Health and Caring Sciences, Molecular Geriatrics, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences, Molecular Geriatrics, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, Departments of Medicine and Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Molecular Geriatrics, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Malin Löwenmark
- Department of Public Health and Caring Sciences, Molecular Geriatrics, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Dag Nyholm
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Joachim Burman
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Valter Niemelä
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Eva Freyhult
- Department of Cell and Molecular Biology, Uppsala University, Uppsala, Sweden
| | - Kim Kultima
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Johan Virhammar
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
6
|
Pizzarotti B, Allali G. Increased prevalence of normal pressure hydrocephalus in both variants of frontotemporal dementia: a 10-year retrospective study. Brain Commun 2023; 5:fcad240. [PMID: 37731905 PMCID: PMC10508318 DOI: 10.1093/braincomms/fcad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 06/23/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Beatrice Pizzarotti
- Neurology Service, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, 1011 Lausanne, Switzerland
| | - Gilles Allali
- Leenaards Memory Center, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, 1011 Lausanne, Switzerland
| |
Collapse
|
7
|
Yun SY, Choi KS, Suh CH, Kim SC, Heo H, Shim WH, Jo S, Chung SJ, Lim JS, Lee JH, Kim D, Kim SO, Jung W, Kim HS, Kim SJ, Kim JH. Risk estimation for idiopathic normal-pressure hydrocephalus: development and validation of a brain morphometry-based nomogram. Eur Radiol 2023; 33:6145-6156. [PMID: 37059905 DOI: 10.1007/s00330-023-09612-1] [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: 06/06/2022] [Revised: 02/10/2023] [Accepted: 03/09/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES To develop and validate a nomogram based on MRI features for predicting iNPH. METHODS Patients aged ≥ 60 years (clinically diagnosed with iNPH, Parkinson's disease, or Alzheimer's disease or healthy controls) who underwent MRI including three-dimensional T1-weighted volumetric MRI were retrospectively identified from two tertiary referral hospitals (one hospital for derivation set and the other for validation set). Clinical and imaging features for iNPH were assessed. Deep learning-based brain segmentation software was used for 3D volumetry. A prediction model was developed using logistic regression and transformed into a nomogram. The performance of the nomogram was assessed with respect to discrimination and calibration abilities. The nomogram was internally and externally validated. RESULTS A total of 452 patients (mean age ± SD, 73.2 ± 6.5 years; 200 men) were evaluated as the derivation set. One hundred eleven and 341 patients were categorized into the iNPH and non-iNPH groups, respectively. In multivariable analysis, high-convexity tightness (odds ratio [OR], 35.1; 95% CI: 4.5, 275.5), callosal angle < 90° (OR, 12.5; 95% CI: 3.1, 50.0), and normalized lateral ventricle volume (OR, 4.2; 95% CI: 2.7, 6.7) were associated with iNPH. The nomogram combining these three variables showed an area under the curve of 0.995 (95% CI: 0.991, 0.999) in the study sample, 0.994 (95% CI: 0.990, 0.998) in the internal validation sample, and 0.969 (95% CI: 0.940, 0.997) in the external validation sample. CONCLUSION A brain morphometry-based nomogram including high-convexity tightness, callosal angle < 90°, and normalized lateral ventricle volume can help accurately estimate the probability of iNPH. KEY POINTS • The nomogram with MRI findings (high-convexity tightness, callosal angle, and normalized lateral ventricle volume) helped in predicting the probability of idiopathic normal-pressure hydrocephalus. • The nomogram may facilitate the prediction of idiopathic normal-pressure hydrocephalus and consequently avoid unnecessary invasive procedures such as the cerebrospinal fluid tap test, drainage test, and cerebrospinal fluid shunt surgery.
Collapse
Affiliation(s)
- Su Young Yun
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kyu Sung Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Soo Chin Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hwon Heo
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sungyang Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Donghyun Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
8
|
Onder H, Kocer B, Comoglu S. The effect of Alzheimer's disease comorbidity in tap test response in idiopathic normal pressure hydrocephalus? Int Psychogeriatr 2023; 35:529-530. [PMID: 35118937 DOI: 10.1017/s1041610221002726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Halil Onder
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Bilge Kocer
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Selcuk Comoglu
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
9
|
Hansson W, Johansson E, Birgander R, Eklund A, Malm J. Cerebral Microbleeds-Long-Term Outcome After Cerebrospinal Fluid Shunting in Idiopathic Normal Pressure Hydrocephalus. Neurosurgery 2023; 93:300-308. [PMID: 36853021 DOI: 10.1227/neu.0000000000002409] [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: 08/25/2022] [Accepted: 12/14/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Cerebral microbleeds (CMBs) are common in idiopathic normal pressure hydrocephalus (INPH) and have been suggested as radiological markers of a brain prone to bleeding. The presence of CMBs might be relevant when selecting patients for shunt surgery. OBJECTIVE To evaluate whether CMBs increases long-term risk of hemorrhagic complications and mortality or affects outcomes after cerebrospinal fluid shunt surgery in a cohort of patients with INPH. METHODS One hundred and forty nine shunted patients with INPH (mean age, 73 years) were investigated with MRI (T2* or susceptibility-weighted imaging sequences) preoperatively. CMBs were scored with the Microbleed Anatomic Rating Scale. Patients were observed for a mean of 6.5 years (range 2 weeks to 13 years) after surgery. Hemorrhagic events and death were noted. Improvement in gait was evaluated 3 to 6 months after surgery. RESULTS At baseline, 74 patients (50%) had CMBs. During follow-up, 7 patients (5%) suffered a hemorrhagic stroke and 43 (29%) suffered a subdural hematoma/hygroma with a median time from surgery of 30.2 months (IQR 50). Overall, having CMBs was not associated with suffering a subdural hematoma/hygroma or hemorrhagic stroke during follow-up with 1 exception that an extensive degree of CMBs (≥50 CMB) was more common in patients suffering a hemorrhagic stroke ( P = .03). CMBs were associated with increased mortality ( P = .02, Kaplan-Meier, log-rank test). The presence of CMBs did not affect gait outcome ( P = .28). CONCLUSION CMBs were associated with hemorrhagic stroke and mortality. CMBs do not seem to reduce the possibility of gait improvement after shunt surgery or contribute to the risk of hemorrhagic complications regarding subdural hematoma or hygroma.
Collapse
Affiliation(s)
- William Hansson
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Elias Johansson
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | | | - Anders Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| |
Collapse
|
10
|
Yang F, Yang L, Fang X, Deng Y, Mao R, Yan A, Wei W. Increased Cerebrospinal Fluid Levels of Soluble Triggering Receptor Expressed on Myeloid Cells 2 and Chitinase-3-Like Protein 1 in Idiopathic Normal-Pressure Hydrocephalus. J Alzheimers Dis 2023:JAD221180. [PMID: 37182875 DOI: 10.3233/jad-221180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Neurodegenerative disease pathology is associated with neuroinflammation, but evidence on idiopathic normal pressure hydrocephalus (iNPH) remains limited and cerebrospinal fluid (CSF) biomarker profiles need to be elucidated. OBJECTIVE To investigate whether iNPH pathological mechanisms are associated with greater CSF markers of core Alzheimer's disease pathology (amyloid-β42 (Aβ 42), phosphorylated tau (P-tau)), neurodegeneration (total tau (T-tau)), and neuroinflammation (soluble triggering receptor expressed on myeloid cells 2 (sTREM2), chitinase-3-like protein 1 (YKL-40)). METHODS The study analyzed lumbar CSF samples from 63 patients with iNPH and 20 age-matched orthopedic surgery patients who had no preoperative gait or cognitive impairment (control group). Aβ 42, T-tau, P-tau, sTREM2, and YKL-40 in different subgroups were investigated. RESULTS CSF sTREM2 levels were significantly higher in the iNPH group than in the control group, but no significant between-group difference was noted in YKL-40. Moreover, YKL-40 levels were significantly higher in the tap test non-responders than in the tap test responders (p = 0.021). At the 1-year follow-up after shunt surgery, the CSF P-tau levels were significantly lower (p = 0.020) in those with gait improvement and the CSF sTREM2 levels were significantly lower (p = 0.041) in those with cognitive improvement. In subgroup analysis, CSF sTREM2 levels were strongly correlated with CSF YKL-40 in the iNPH group (r = 0.443, p < 0.001), especially in the tap test non-responders (r = 0.653, p = 0.002). CONCLUSION YKL-40 and sTREM2 are disease-specific markers of neuroinflammation, showing higher CSF levels in iNPH. In addition, sTREM2 is positively associated with YKL-40, indicating that interactions of glial cells play an important role in iNPH pathogenesis.
Collapse
Affiliation(s)
- Fuxia Yang
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Lu Yang
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Xuhao Fang
- Department of Neurosurgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yao Deng
- Department of Neurosurgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Renling Mao
- Department of Neurosurgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Aijuan Yan
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Wenshi Wei
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| |
Collapse
|
11
|
Zaksaite T, Loveday C, Edginton T, Spiers HJ, Smith AD. Hydrocephalus: A neuropsychological and theoretical primer. Cortex 2023; 160:67-99. [PMID: 36773394 DOI: 10.1016/j.cortex.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/09/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
Hydrocephalus is a common neurological condition, the hallmark feature of which is an excess in production, or accumulation, of cerebrospinal fluid in the ventricles. Although it is associated with diffuse damage to paraventricular brain areas, patients are broadly typified by a particular pattern of cognitive impairments that include deficits in working memory, attention, and spatial abilities. There have, however, been relatively few neuropsychological accounts of the condition. Moreover, theories of the relationship between aetiology and impairment appear to have emerged in isolation of each other, and proffer fundamentally different accounts. In this primer, we aim to provide a comprehensive and contemporary overview of hydrocephalus for the neuropsychologist, covering cognitive sequelae and theoretical interpretations of their origins. We review clinical and neuropsychological assays of cognitive profiles, along with the few studies that have addressed more integrative behaviours. In particular, we explore the distinction between congenital or early-onset hydrocephalus with a normal-pressure variant that can be acquired later in life. The relationship between these two populations is a singularly interesting one in neuropsychology since it can allow for the examination of typical and atypical developmental trajectories, and their interaction with chronic and acute impairment, within the same broad neurological condition. We reflect on the ramifications of this for our subject and suggest avenues for future research.
Collapse
Affiliation(s)
- Tara Zaksaite
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - Catherine Loveday
- School of Social Sciences, University of Westminster, 115 New Cavendish St, London W1W 6UW, UK
| | - Trudi Edginton
- Department of Psychology, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Hugo J Spiers
- Department of Experimental Psychology, Division of Psychology and Language Sciences, University College London, 26 Bedford Way, London, WC1H 0AP, UK
| | - Alastair D Smith
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK; Brain Research and Imaging Centre, University of Plymouth, 7 Derriford Rd, Plymouth, PL6 8BU, UK.
| |
Collapse
|
12
|
Lilja-Lund O, Maripuu M, Kockum K, Andersson J, Lindam A, Nyberg L, Laurell K. Longitudinal neuropsychological trajectories in idiopathic normal pressure hydrocephalus: a population-based study. BMC Geriatr 2023; 23:29. [PMID: 36647004 PMCID: PMC9843855 DOI: 10.1186/s12877-023-03747-y] [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: 11/22/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is a progressive syndrome affecting gait, incontinence, and cognition in a significant number of older adults. Still, prospective studies on early development of symptoms are scarce. AIM To investigate how neuropsychological functions develop before and in already diagnosed iNPH over a two-year period in a population-based material. METHOD A sample of 104 participants (median [IQR] 75 [72-80] years old) from the general population underwent CT-imaging and clinical assessment at baseline and follow-up. We used the iNPH symptom scale covering four domains (Neuropsychology, Gait, Balance, Incontinence) and additional tests of executive functions. Morphological signs were rated with the iNPH Radscale. Non-parametric statistics with Bonferroni corrections and a significance-level of p < 0.05 were used. RESULTS Median (IQR) time to follow-up was 25 (23-26) months. Effect size (ES) for individuals who developed iNPH (n = 8) showed a large (ES r = -0.55) decline in the Gait domain and on the Radscale (ES r = -0.60), with a medium deterioration in declarative memory (ES r = -0.37). Those having iNPH at baseline (n = 12) performed worse on one executive sub-function i.e., shifting (p = 0.045). CONCLUSION Besides deterioration in gait and radiology, our results suggest that a neuropsychological trajectory for those developing iNPH includes a reduction in declarative memory. Executive dysfunction was limited to those already having iNPH at baseline. These findings could suggest that memory impairments are included in the early development of iNPH.
Collapse
Affiliation(s)
- Otto Lilja-Lund
- grid.12650.300000 0001 1034 3451Department of Clinical Sciences, Neuroscience, Umeå University, Umeå, Sweden
| | - Martin Maripuu
- grid.12650.300000 0001 1034 3451Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
| | - Karin Kockum
- grid.12650.300000 0001 1034 3451Department of Clinical Sciences, Neuroscience, Umeå University, Umeå, Sweden
| | - Johanna Andersson
- grid.12650.300000 0001 1034 3451Department of Clinical Sciences, Neuroscience, Umeå University, Umeå, Sweden
| | - Anna Lindam
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Unit of Research, Education and Development Östersund Hospital, Umeå University, Umeå, Sweden
| | - Lars Nyberg
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Radiology, Umeå University, Umeå, Sweden ,grid.12650.300000 0001 1034 3451Department of Integrative Medical Biology, Umeå University, Umeå, Sweden ,grid.12650.300000 0001 1034 3451Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden ,grid.5510.10000 0004 1936 8921Center for Lifespan Changes in Brain and Cognition, University of Oslo, Oslo, Norway
| | - Katarina Laurell
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
13
|
Recognizing Atypical Presentations of Alzheimer's Disease: The Importance of CSF Biomarkers in Clinical Practice. Diagnostics (Basel) 2022; 12:diagnostics12123011. [PMID: 36553018 PMCID: PMC9776656 DOI: 10.3390/diagnostics12123011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Besides the typical amnestic presentation, neuropathological studies indicate that Alzheimer's disease (AD) may present with atypical clinical pictures. The relative frequencies of typical and atypical or mixed presentations within the entire spectrum of AD remain unclear, while some mixed or atypical presentations may have not received adequate attention for them to be included in diagnostic criteria. We investigated the spectrum of clinical presentations in patients with the AD CSF biomarker profile (high tau and phospho-tau, low Aβ42 levels), hospitalized in a tertiary academic center. Among 98 patients with the CSF AD profile, 46% of patients had the typical presentation of "hippocampal" amnestic dementia. Additionally, 23.5% and 15.3% fulfilled the criteria of mixed or atypical presentations, respectively, as described in the IWG-2 criteria. The remaining 15.3% had unusual presentations, including non-logopenic (semantic and non-fluent agrammatic) primary progressive aphasia, corticobasal syndrome, and Richardson syndrome, or could be diagnosed with normal pressure hydrocephalus. Despite selection bias (academic center), atypical clinical presentations of AD may be more common than previously thought. CSF biomarkers seem to be a useful tool for antemortem identification of such patients, which is likely to affect therapeutic decisions. Some of the unusual presentations described above should be incorporated in diagnostic criteria.
Collapse
|
14
|
Cerebrospinal Fluid Biomarkers in iNPH: A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12122976. [PMID: 36552981 PMCID: PMC9777226 DOI: 10.3390/diagnostics12122976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a neurological syndrome characterized by the clinical triad of gait disorder, cognitive impairment and urinary incontinence. It has attracted interest because of the possible reversibility of symptoms, especially with timely treatment. The main pathophysiological theory is based on a vicious circle of disruption in circulation of cerebrospinal fluid (CSF) that leads to the deceleration of its absorption. Data regarding CSF biomarkers in iNPH are contradictory and no definite CSF biomarker profile has been recognized as in Alzheimer's disease (AD), which often co-exists with iNPH. In this narrative review, we investigated the literature regarding CSF biomarkers in iNPH, both the established biomarkers total tau protein (t-tau), phosphorylated tau protein (p-tau) and amyloid peptide with 42 amino acids (Aβ42), and other molecules, which are being investigated as emerging biomarkers. The majority of studies demonstrate differences in CSF concentrations of Aβ42 and tau-proteins (t-tau and p-tau) among iNPH patients, healthy individuals and patients with AD and vascular dementia. iNPH patients present with lower CSF Aβ42 and p-tau concentrations than healthy individuals and lower t-tau and p-tau concentrations than AD patients. This could prove helpful for improving diagnosis, differential diagnosis and possibly prognosis of iNPH patients.
Collapse
|
15
|
Koutsouras GW, Steinmetz E, Tichenor M, Schmidt B, Mohan YS, Krishnamurthy S. Endoscopic Third Ventriculostomy and Cortical Biopsy in Patients With Normal Pressure Hydrocephalus. Cureus 2022; 14:e31523. [DOI: 10.7759/cureus.31523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/16/2022] Open
|
16
|
Sakurai A, Tsunemi T, Shimada T, Kawamura K, Nakajima M, Miyajima M, Hattori N. Effect of comorbid Parkinson's disease and Parkinson's disease dementia on the course of idiopathic normal pressure hydrocephalus. J Neurosurg 2022; 137:1302-1309. [PMID: 35276660 DOI: 10.3171/2022.1.jns212282] [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: 10/27/2021] [Accepted: 01/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to analyze the effect of concomitant Parkinson's disease (PD) and PD dementia (PD/PDD) on the course of idiopathic normal pressure hydrocephalus (iNPH), especially as related to the outcome of lumboperitoneal shunt (LPS) surgery. METHODS The authors retrospectively analyzed patients with iNPH without accompanying disorders (iNPH alone [iNPHa]) and iNPH concomitant with PD/PDD (iNPHc+PD/PDD) who had presented to their department between 2010 and 2019. The diagnosis of iNPHc+PD/PDD was established using the diagnostic criteria of the Movement Disorder Society. The effect of LPS surgery on clinical symptoms and striatum volumes was evaluated. RESULTS Thirty-three patients with iNPHa and 23 patients with iNPHc+PD/PDD were identified. Comorbid PD/PDD significantly worsened clinical outcome as measured by the iNPH grading scale, modified Rankin Scale (mRS), and Hoehn and Yahr (HY) scale. LPS surgery improved the iNPH score including gait disturbance (p < 0.01), cognitive impairment (p = 0.02), and urinary disturbance (p < 0.01) in iNPHa and improved gait disturbance (p = 0.01) and urinary disturbance (p = 0.03) in iNPHc+PD/PDD for 1 year. Comorbid synucleinopathies maintained worse mRS scores and HY stages for 3 years, and LPS surgery extended overall survival (p = 0.003), as well as the period of sustained mRS scores (p = 0.04) and HY stages (p = 0.004) in iNPHc+PD/PDD. Both caudate and putamen volumes were reduced in iNPHa (p < 0.01) compared to those in controls and in patients with iNPHc+PD/PDD compared to those in patients with PD/PDD (p < 0.01), and LPS surgery restored caudate volumes in both groups. CONCLUSIONS These results revealed that comorbid PD/PDD deteriorates the clinical course of iNPH and that LPS surgery is recommended regardless of this comorbidity.
Collapse
Affiliation(s)
- Anri Sakurai
- 1Department of Neurology, Juntendo University School of Medicine, Tokyo
| | - Taiji Tsunemi
- 1Department of Neurology, Juntendo University School of Medicine, Tokyo
| | - Tomoyo Shimada
- 1Department of Neurology, Juntendo University School of Medicine, Tokyo
| | - Kaito Kawamura
- 2Department of Neurosurgery, Juntendo University School of Medicine, Tokyo; and
| | - Madoka Nakajima
- 2Department of Neurosurgery, Juntendo University School of Medicine, Tokyo; and
| | - Masakazu Miyajima
- 3Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Nobutaka Hattori
- 1Department of Neurology, Juntendo University School of Medicine, Tokyo
| |
Collapse
|
17
|
Eide PK, Pripp AH, Berge B, Hrubos-Strøm H, Ringstad G, Valnes LM. Altered glymphatic enhancement of cerebrospinal fluid tracer in individuals with chronic poor sleep quality. J Cereb Blood Flow Metab 2022; 42:1676-1692. [PMID: 35350917 PMCID: PMC9441729 DOI: 10.1177/0271678x221090747] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic sleep disturbance is a risk factor for dementia disease, possibly due to impaired sleep-dependent clearance of toxic metabolic by-products. We compared enrichment of a cerebrospinal fluid (CSF) tracer within brain of patients reporting good or poor sleep quality, assessed by the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Tracer enrichment in a selection of brain regions was assessed using multiphase magnetic resonance imaging up to 48 hours after intrathecal administration of the contrast agent gadobutrol (0.5 ml of 1 mmol/ml) serving as tracer. Tracer enrichment differed between patients with good (PSQI ≤5) and poor (PSQI >5) sleep quality in a cohort of non-dementia individuals (n = 44; age 42.3 ± 14.5 years), and in patients with the dementia subtype idiopathic normal pressure hydrocephalus (n = 24; age 71.0 ± 4.9 years). Sleep impairment was associated with increased CSF tracer enrichment in several brain regions. Cortical brain volume as well as entorhinal cortex thickness was reduced in the oldest cohort and was correlated with the severity of sleep disturbance and the degree of cortical tracer enrichment. We suggest chronic sleep disturbance is accompanied by altered glymphatic function along enlarged perivascular spaces.
Collapse
Affiliation(s)
- Per Kristian Eide
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Harald Hrubos-Strøm
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Otorhinolaryngology, Surgical Division, Akershus University Hospital, Nordbyhagen, Norway
| | - Geir Ringstad
- Department of Radiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Lars Magnus Valnes
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| |
Collapse
|
18
|
Xiao H, Hu F, Ding J, Ye Z. Cognitive Impairment in Idiopathic Normal Pressure Hydrocephalus. Neurosci Bull 2022; 38:1085-1096. [PMID: 35569106 PMCID: PMC9468191 DOI: 10.1007/s12264-022-00873-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/25/2022] [Indexed: 01/03/2023] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a significant cause of the severe cognitive decline in the elderly population. There is no cure for iNPH, but cognitive symptoms can be partially alleviated through cerebrospinal fluid (CSF) diversion. In the early stages of iNPH, cognitive deficits occur primarily in the executive functions and working memory supported by frontostriatal circuits. As the disease progresses, cognition declines continuously and globally, leading to poor quality of life and daily functioning. In this review, we present recent advances in understanding the neurobiological mechanisms of cognitive impairment in iNPH, focusing on (1) abnormal CSF dynamics, (2) dysfunction of frontostriatal and entorhinal-hippocampal circuits and the default mode network, (3) abnormal neuromodulation, and (4) the presence of amyloid-β and tau pathologies.
Collapse
Affiliation(s)
- Haoyun Xiao
- Institute of Neuroscience, Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, 200031, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Fan Hu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zheng Ye
- Institute of Neuroscience, Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, 200031, China.
| |
Collapse
|
19
|
Langheinrich T, Chen C, Thomas O. Update on the Cognitive Presentations of iNPH for Clinicians. Front Neurol 2022; 13:894617. [PMID: 35937049 PMCID: PMC9350547 DOI: 10.3389/fneur.2022.894617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022] Open
Abstract
This mini-review focuses on cognitive impairment in iNPH. This symptom is one of the characteristic triad of symptoms in a condition long considered to be the only treatable dementia. We present an update on recent developments in clinical, neuropsychological, neuroimaging and biomarker aspects. Significant advances in our understanding have been made, notably regarding biomarkers, but iNPH remains a difficult diagnosis. Stronger evidence for permanent surgical treatment is emerging but selection for treatment remains challenging, particularly with regards to cognitive presentations. Encouragingly, there has been increasing interest in iNPH, but more research is required to better define the underlying pathology and delineate it from overlapping conditions, in order to inform best practise for the clinician managing the cognitively impaired patient. In the meantime, we strongly encourage a multidisciplinary approach and a structured service pathway to maximise patient benefit.
Collapse
Affiliation(s)
- Tobias Langheinrich
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
- *Correspondence: Tobias Langheinrich
| | - Cliff Chen
- Department of Neuropsychology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Owen Thomas
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| |
Collapse
|
20
|
Goh ET, Lock C, Tan AJL, Tan BL, Liang S, Pillay R, Kumar S, Ahmad-Annuar A, Narayanan V, Kwok J, Tan YJ, Ng ASL, Tan EK, Czosnyka Z, Czosnyka M, Pickard JD, Keong NC. Clinical Outcomes After Ventriculo-Peritoneal Shunting in Patients With Classic vs. Complex NPH. Front Neurol 2022; 13:868000. [PMID: 35903111 PMCID: PMC9315242 DOI: 10.3389/fneur.2022.868000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Normal pressure hydrocephalus (NPH) is a neurological condition characterized by a clinical triad of gait disturbance, cognitive impairment, and urinary incontinence in conjunction with ventriculomegaly. Other neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease, and vascular dementia share some overlapping clinical features. However, there is evidence that patients with comorbid NPH and Alzheimer's or Parkinson's disease may still exhibit good clinical response after CSF diversion. This study aims to evaluate clinical responses after ventriculo-peritoneal shunt (VPS) in a cohort of patients with coexisting NPH and neurodegenerative disease. Methods The study has two components; (i) a pilot study was performed that specifically focused upon patients with Complex NPH and following the inclusion of the Complex NPH subtype into consideration for the clinical NPH programme, (ii) a retrospective snapshot study was performed to confirm and characterize differences between Classic and Complex NPH patients being seen consecutively over the course of 1 year within a working subspecialist NPH clinic. We studied the characteristics of patients with Complex NPH, utilizing clinical risk stratification and multimodal biomarkers. Results There was no significant difference between responders and non-responders to CSF diversion on comorbidity scales. After VPS insertion, significantly more Classic NPH patients had improved cognition compared to Complex NPH patients (p = 0.005). Improvement in gait and urinary symptoms did not differ between the groups. 26% of the Classic NPH group showed global improvement of the triad, and 42% improved in two domains. Although only 8% showed global improvement of the triad, all Complex NPH patients improved in gait. Conclusions Our study has demonstrated that the presence of neurodegenerative disorders co-existing with NPH should not be the sole barrier to the consideration of high-volume tap test or lumbar drainage via a specialist NPH programme. Further characterization of distinct cohorts of NPH with differing degrees of CSF responsiveness due to overlay from neurodegenerative or comorbidity risk burden may aid toward more precise prognostication and treatment strategies. We propose a simplistic conceptual framework to describe NPH by its Classic vs. Complex subtypes to promote the clinical paradigm shift toward subspecialist geriatric neurosurgery by addressing needs for rapid screening tools at the clinical-research interface.
Collapse
Affiliation(s)
- Eng Tah Goh
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Christine Lock
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Audrey Jia Luan Tan
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Bee Ling Tan
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Sai Liang
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Robin Pillay
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Sumeet Kumar
- Department of Neuroradiology, National Neuroscience Institute, Singapore, Singapore
| | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vairavan Narayanan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Janell Kwok
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Yi Jayne Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Adeline SL Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Eng King Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Zofia Czosnyka
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Marek Czosnyka
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - John D. Pickard
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Nicole C. Keong
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- *Correspondence: Nicole C. Keong
| |
Collapse
|
21
|
Thavarajasingam SG, El-Khatib M, Vemulapalli KV, Iradukunda HAS, Laleye J, Russo S, Eichhorn C, Eide PK. Cerebrospinal fluid and venous biomarkers of shunt-responsive idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis. Acta Neurochir (Wien) 2022; 164:1719-1746. [PMID: 35230552 PMCID: PMC9233649 DOI: 10.1007/s00701-022-05154-5] [Citation(s) in RCA: 4] [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: 01/06/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is a neurodegenerative disease and dementia subtype involving disturbed cerebrospinal fluid (CSF) homeostasis. Patients with iNPH may improve clinically following CSF diversion through shunt surgery, but it remains a challenge to predict which patients respond to shunting. It has been proposed that CSF and blood biomarkers may be used to predict shunt response in iNPH. OBJECTIVE To conduct a systematic review and meta-analysis to identify which CSF and venous biomarkers predict shunt-responsive iNPH most accurately. METHODS Original studies that investigate the use of CSF and venous biomarkers to predict shunt response were searched using the following databases: Embase, MEDLINE, Scopus, PubMed, Google Scholar, and JSTOR. Included studies were assessed using the ROBINS-I tool, and eligible studies were evaluated utilising univariate meta-analyses. RESULTS The study included 13 studies; seven addressed lumbar CSF levels of amyloid-β 1-42, nine studies CSF levels of Total-Tau, six studies CSF levels of Phosphorylated-Tau, and seven studies miscellaneous biomarkers, proteomics, and genotyping. A meta-analysis of six eligible studies conducted for amyloid-β 1-42, Total-Tau, and Phosphorylated-Tau demonstrated significantly increased lumbar CSF Phosphorylated-Tau (- 0.55 SMD, p = 0.04) and Total-Tau (- 0.50 SMD, p = 0.02) in shunt-non-responsive iNPH, though no differences were seen between shunt responders and non-responders for amyloid-β 1-42 (- 0.26 SMD, p = 0.55) or the other included biomarkers. CONCLUSION This meta-analysis found that lumbar CSF levels of Phosphorylated-Tau and Total-Tau are significantly increased in shunt non-responsive iNPH compared to shunt-responsive iNPH. The other biomarkers, including amyloid-β 1-42, did not significantly differentiate shunt-responsive from shunt-non-responsive iNPH. More studies on the Tau proteins examining sensitivity and specificity at different cut-off levels are needed for a robust analysis of the diagnostic efficiency of the Tau proteins.
Collapse
Affiliation(s)
| | | | | | | | - Joshua Laleye
- Faculty of Medicine, Imperial College London, London, UK
| | - Salvatore Russo
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | - Christian Eichhorn
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Per K Eide
- Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
22
|
Jang H, Park YH, Choe YS, Kang SH, Kang ES, Lee S, Seo SW, Kim HJ, Na DL. Amyloid Positive Hydrocephalus: A Hydrocephalic Variant of Alzheimer's Disease? J Alzheimers Dis 2021; 85:1467-1479. [PMID: 34958024 DOI: 10.3233/jad-215110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) and normal pressure hydrocephalus (NPH) commonly coexist. OBJECTIVE We aimed to characterize an overlapping syndrome of AD and NPH that presents with gait disturbance, ventriculomegaly on magnetic resonance imaging, and significant amyloid deposition on positron emission tomography (PET). METHODS Of 114 patients who underwent cerebrospinal fluid (CSF) drainage for a possible diagnosis of NPH between 2015 and 2020 in Samsung Medical Center, we identified 24 patients (21.1%) with the NPH patients with amyloid deposition on PET, which we referred to as hydrocephalic AD in this study. We compared their clinical and imaging findings with those of 123 typical AD without hydrocephalic signs/symptoms. We also investigated the frequency and potential predictors of the tap test response in hydrocephalic AD. RESULTS Evans' index was 0.36±0.03, and a disproportionately enlarged subarachnoid space was present in 54.2% of the hydrocephalic AD patients. The mean age (75.2±7.3 years) and the APOE4 frequency (68.2%) did not differ from those of AD controls. However, the hydrocephalic AD patients showed better memory and language performance, and a thinner cingulate cortex. About 42% of the hydrocephalic AD patients responded to the tap test, of whom seven underwent shunt surgery. Cognition did not improve, whereas gait improved after shunt surgery in all. CONCLUSION Hydrocephalic AD has different neuropsychological and imaging characteristics from typical AD. Future studies are warranted to further investigate the effect of CSF removal on their clinical course and to elucidate the pathophysiological interaction between amyloid and NPH.
Collapse
Affiliation(s)
- Hyemin Jang
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu-Hyun Park
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Sim Choe
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hoon Kang
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.,Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Sook Kang
- Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seunghoon Lee
- Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk L Na
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, South Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| |
Collapse
|
23
|
Tang Y, Yuan X, Duan J, Zhang X, Chen J, Zhou Y, Song F, Zhou D. White Matter Characteristics of Cognitive Impairment in Tap-Test Positive Idiopathic Normal Pressure Hydrocephalus: A Diffusion Tensor Tract-Based Spatial Study. Front Neurosci 2021; 15:774638. [PMID: 34924943 PMCID: PMC8678068 DOI: 10.3389/fnins.2021.774638] [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: 09/12/2021] [Accepted: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
The present study was designed to systemically evaluate changes in the diffusion tensor imaging (DTI)-derived parameters of iNPH (idiopathic normal pressure hydrocephalus) patients with different responses to the tap test (TT), and to correlate cognitive impairment with white matter (WM) degeneration. This study included 22 iNPH patients and 14 healthy controls with structural magnetic resonance imaging (MRI) and DTI scanning. DTI was used to explore the differences in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) for all participants. DTI parameters were evaluated using an ROI (region of interest)-based and tract-based spatial statistics (TBSS) approach. Neuropsychological assessments and the idiopathic normal pressure hydrocephalus grading scoring scale (iNPHGS) were performed. Compared to the TT non-responders, the TT responders group had significantly lower FA values in the corpus callosum, cingulum cingulate gyrus, superior longitudinal fasciculus, and lower AD values in the right cingulum cingulate gyrus and the left posterior thalamic radiation. Besides, the MD values were significantly increased in the corpus callosum, left anterior corona radiata, and the RD values in the corpus callosum and cingulum cingulate gyrus. In addition, the cognitive improvement was negatively correlated with FA of the corpus callosum, cingulum cingulate gyrus, and MD values of the genu of corpus callosum. While, the cognitive improvement was positively related to the AD of the cingulum cingulate gyrus, superior longitudinal, and RD values of the corpus callosum, cingulum cingulate gyrus and uncinate fasciculus. The ROI specific WM lesions in iNPH patients are the underlying basis for cognitive impairment.
Collapse
Affiliation(s)
- Yufeng Tang
- Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Xiaoqin Yuan
- Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Jinfeng Duan
- Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Xianwen Zhang
- Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Jiao Chen
- Department of Radiology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Ying Zhou
- Department of Radiology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Fangzhou Song
- Basic Medicine College, Chongqing Medical University, Chongqing, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
24
|
Nimni M, Weiss P, Cohen C, Laviv Y. Neuropsychological assessments and cognitive profile mostly associated with shunt surgery in idiopathic normal pressure hydrocephalus patients: diagnostic and predictive parameters and practical implications. Acta Neurochir (Wien) 2021; 163:3373-3386. [PMID: 34480204 DOI: 10.1007/s00701-021-04976-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cognitive decline is a well-documented feature of idiopathic normal pressure hydrocephalus (iNPH) that can be reversible following cerebrospinal fluid tap tests (CSF-TT). The current gold standard for selecting iNPH patients for shunt surgery is measurable improvement in gait tests following CSF-TT. However, the diagnostic significance and predictive role of pre-surgical cognitive evaluations in probable iNPH patients is still controversial. PURPOSE To find the neuropsychological (NPSY) tests and cognitive aspects mostly associated with shunt surgery in iNPH. MATERIAL AND METHODS A retrospective comparison between probable iNPH patients who, after undergoing CSF-TT with gait and cognitive evaluations, ended up receiving a shunt (group 1) and probable iNPH patients who ended up with no shunt surgery (group 2). Differences in the diagnostic and predictive results of variety of NPSY tests at baseline, pre-CSF-TT, and post-CSF-TT were used for thorough statistical calculations. RESULTS A total of 147 patients with probable iNPH were included. Of those, 58 (39.45%, group 1) patients underwent shunt surgery, while 89 (60.55%, group 2) did not. For the vast majority of the cognitive tests used, no statistically significant differences were found between the groups at baseline (pre-CSF-TT). Following CSF-TT, the "naming" component of the Cognistat test was the only single test to show statically significant difference in improvement between the two groups. Combining at least two tests led to increased levels of accuracy and specificity; however, the sensitivity remained < 50. The only two combinations that were associated with sensitivity ≥ 70 were either any improvement in the Cognistat test (p = 0.627) or any improvement in either its naming, memory, or judgment components (p = 0.015). CONCLUSION Cognitive tests, even when combined to cover several cognitive aspects, are not sensitive enough to act as an independent reliable diagnostic and predictive tool, especially when relying on their scores as baseline. In order to avoid cumbersome and unnecessary tests to our patients and to reduce the number of patients who are denied proper treatment due to misdiagnosis, we recommend to use NPSY tests that examine the cognitive aspects of naming and memory, in addition to 2-3 tests for executive functions.
Collapse
Affiliation(s)
- Mor Nimni
- Neurosurgery Department, Beilinson Hospital, Rabin Medical Center, Tel-Aviv University, Zeev Jabutinsky Rd 39, 49100, Petah Tikva, Israel
| | - Penina Weiss
- The Occupational Therapist Service, Beilinson Hospital, Rabin Medical Center, Tel-Aviv University, Petah Tikva, Israel
| | - Chen Cohen
- The Occupational Therapist Service, Beilinson Hospital, Rabin Medical Center, Tel-Aviv University, Petah Tikva, Israel
| | - Yosef Laviv
- Neurosurgery Department, Beilinson Hospital, Rabin Medical Center, Tel-Aviv University, Zeev Jabutinsky Rd 39, 49100, Petah Tikva, Israel.
| |
Collapse
|
25
|
Klostranec JM, Vucevic D, Bhatia KD, Kortman HGJ, Krings T, Murphy KP, terBrugge KG, Mikulis DJ. Current Concepts in Intracranial Interstitial Fluid Transport and the Glymphatic System: Part II-Imaging Techniques and Clinical Applications. Radiology 2021; 301:516-532. [PMID: 34698564 DOI: 10.1148/radiol.2021204088] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The glymphatic system is a recently discovered network unique to the central nervous system that allows for dynamic exchange of interstitial fluid (ISF) and cerebrospinal fluid (CSF). As detailed in part I, ISF and CSF transport along paravascular channels of the penetrating arteries and possibly veins allow essential clearance of neurotoxic solutes from the interstitium to the CSF efflux pathways. Imaging tests to investigate this neurophysiologic function, although challenging, are being developed and are reviewed herein. These include direct visualization of CSF transport using postcontrast imaging techniques following intravenous or intrathecal administration of contrast material and indirect glymphatic assessment with detection of enlarged perivascular spaces. Application of MRI techniques, including intravoxel incoherent motion, diffusion tensor imaging, and chemical exchange saturation transfer, is also discussed, as are methods for imaging dural lymphatic channels involved with CSF efflux. Subsequently, glymphatic function is considered in the context of proteinopathies associated with neurodegenerative diseases and traumatic brain injury, cytotoxic edema following acute ischemic stroke, and chronic hydrocephalus after subarachnoid hemorrhage. These examples highlight the substantial role of the glymphatic system in neurophysiology and the development of certain neuropathologic abnormalities, stressing the importance of its consideration when interpreting neuroimaging investigations. © RSNA, 2021.
Collapse
Affiliation(s)
- Jesse M Klostranec
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Diana Vucevic
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Kartik D Bhatia
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Hans G J Kortman
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Timo Krings
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Kieran P Murphy
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Karel G terBrugge
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - David J Mikulis
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| |
Collapse
|
26
|
Tsantzali I, Boufidou F, Sideri E, Mavromatos A, Papaioannou MG, Foska A, Tollos I, Paraskevas SG, Bonakis A, Voumvourakis KI, Tsivgoulis G, Kapaki E, Paraskevas GP. From Cerebrospinal Fluid Neurochemistry to Clinical Diagnosis of Alzheimer's Disease in the Era of Anti-Amyloid Treatments. Report of Four Patients. Biomedicines 2021; 9:biomedicines9101376. [PMID: 34680493 PMCID: PMC8533180 DOI: 10.3390/biomedicines9101376] [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] [Received: 08/31/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 12/26/2022] Open
Abstract
Analysis of classical cerebrospinal fluid biomarkers, especially when incorporated in a classification/diagnostic system such as the AT(N), may offer a significant diagnostic tool allowing correct identification of Alzheimer’s disease during life. We describe four patients with more or less atypical or mixed clinical presentation, in which the classical cerebrospinal fluid biomarkers amyloid peptide with 42 and 40 amino acids (Aβ42 and Aβ40, respectively), phospho-tau (τP-181) and total tau (τΤ) were measured. Despite the unusual clinical presentation, the biomarker profile was compatible with Alzheimer’s disease in all four patients. The measurement of classical biomarkers in the cerebrospinal fluid may be a useful tool in identifying the biochemical fingerprints of Alzheimer’s disease, especially currently, due to the recent approval of the first disease-modifying treatment, allowing not only typical but also atypical cases to be enrolled in trials of such treatments.
Collapse
Affiliation(s)
- Ioanna Tsantzali
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (I.T.); (E.S.); (A.M.); (A.F.); (I.T.); (A.B.); (K.I.V.); (G.T.)
| | - Fotini Boufidou
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Eginition” Hospital, 11528 Athens, Greece; (F.B.); (M.G.P.); (S.G.P.); (E.K.)
| | - Eleni Sideri
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (I.T.); (E.S.); (A.M.); (A.F.); (I.T.); (A.B.); (K.I.V.); (G.T.)
| | - Antonis Mavromatos
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (I.T.); (E.S.); (A.M.); (A.F.); (I.T.); (A.B.); (K.I.V.); (G.T.)
| | - Myrto G. Papaioannou
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Eginition” Hospital, 11528 Athens, Greece; (F.B.); (M.G.P.); (S.G.P.); (E.K.)
| | - Aikaterini Foska
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (I.T.); (E.S.); (A.M.); (A.F.); (I.T.); (A.B.); (K.I.V.); (G.T.)
| | - Ioannis Tollos
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (I.T.); (E.S.); (A.M.); (A.F.); (I.T.); (A.B.); (K.I.V.); (G.T.)
| | - Sotirios G. Paraskevas
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Eginition” Hospital, 11528 Athens, Greece; (F.B.); (M.G.P.); (S.G.P.); (E.K.)
| | - Anastasios Bonakis
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (I.T.); (E.S.); (A.M.); (A.F.); (I.T.); (A.B.); (K.I.V.); (G.T.)
| | - Konstantinos I. Voumvourakis
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (I.T.); (E.S.); (A.M.); (A.F.); (I.T.); (A.B.); (K.I.V.); (G.T.)
| | - Georgios Tsivgoulis
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (I.T.); (E.S.); (A.M.); (A.F.); (I.T.); (A.B.); (K.I.V.); (G.T.)
| | - Elisabeth Kapaki
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Eginition” Hospital, 11528 Athens, Greece; (F.B.); (M.G.P.); (S.G.P.); (E.K.)
| | - George P. Paraskevas
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (I.T.); (E.S.); (A.M.); (A.F.); (I.T.); (A.B.); (K.I.V.); (G.T.)
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Eginition” Hospital, 11528 Athens, Greece; (F.B.); (M.G.P.); (S.G.P.); (E.K.)
- Correspondence: ; Tel.: +30-2105832466
| |
Collapse
|
27
|
Cerebrospinal Fluid Biomarkers for Alzheimer's Disease in the Era of Disease-Modifying Treatments. Brain Sci 2021; 11:brainsci11101258. [PMID: 34679323 PMCID: PMC8534246 DOI: 10.3390/brainsci11101258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/19/2021] [Accepted: 09/21/2021] [Indexed: 01/04/2023] Open
Abstract
Correct in vivo diagnosis of Alzheimer’s disease (AD) helps to avoid administration of disease-modifying treatments in non-AD patients, and allows the possible use of such treatments in clinically atypical AD patients. Cerebrospinal fluid (CSF) biomarkers offer a tool for AD diagnosis. A reduction in CSF β-amyloid (marker of amyloid plaque burden), although compatible with Alzheimer’s pathological change, may also be observed in other dementing disorders, including vascular cognitive disorders due to subcortical small-vessel disease, dementia with Lewy bodies and normal-pressure hydrocephalus. Thus, for the diagnosis of AD, an abnormal result of CSF β-amyloid may not be sufficient, and an increase in phospho-tau (marker of tangle pathology) is also required in order to confirm AD diagnosis in patients with a typical amnestic presentation and reveal underlying AD in patients with atypical or mixed and diagnostically confusing clinical presentations.
Collapse
|
28
|
Valsecchi N, Mantovani P, Piserchia VA, Giannini G, Cevoli S, Aspide R, Oppi F, Milletti D, Cortelli P, Elder BD, Palandri G. The Role of Simultaneous Medical Conditions in Idiopathic Normal Pressure Hydrocephalus. World Neurosurg 2021; 157:e29-e39. [PMID: 34562629 DOI: 10.1016/j.wneu.2021.09.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is a chronic neurologic syndrome that affects the elderly population in a context of concomitant medical conditions. The aim of this study was to understand the significance of comorbidities using 4 validated and specific clinical scores: Cumulative Illness Rating Scale (CIRS), American Society of Anesthesiologists (ASA) score, Comorbidity Index (CMI), and Charlson Comorbidity Index (CCI). METHODS From 2015 until 2019, the Bologna PRO-Hydro multidisciplinary team selected 63 patients for shunt surgery. All comorbidity scores were collected during preoperative anesthesia evaluation. Positive shunt response was defined as an improvement in overall disability (assessed with modified Rankin Scale [mRS]), in risk of fall (assessed with Tinetti Permormance Orientated Mobility Assessment, Tinetti) and in INPH specific symptoms (assessed with INPH Grading Scale, INPHGS). RESULTS Patients with elevated values of CIRS had worse performance in gait and balance at Tinetti scale, both before (P = 0.039) and after surgery (P = 0.005); patients with high values of CMI had inferior values of Tinetti at baseline (P = 0.027) and higher mRS after surgery (P = 0.009); ASA 2 patients had better postoperative Tinetti scores than ASA 3 patients (P = 0.027). A positive or negative shunt response was not significantly correlated with patients' preoperative comorbidity scores. CONCLUSIONS Patients with multiple comorbidities have a worse preoperative condition compared to patients with less concomitant diseases, and the proposed comorbidity scores, CIRS in particular, are useful clinical tools for the anesthesiologist. Comorbidities, though, do not impact overall postoperative outcome.
Collapse
Affiliation(s)
- Nicola Valsecchi
- Ophthalmology Unit, DIMES, Alma Mater Studiorum University of Bologna and S. Orsola-Malpighi Teaching Hospital, Bologna, Italy.
| | - Paolo Mantovani
- UOC Neurochirurgia, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Vito Antonio Piserchia
- UOC Anestesia e rianimazione Ospedale Bellaria, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; Clinica Neurologica Metropolitana NEUROMET, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sabina Cevoli
- Clinica Neurologica Metropolitana NEUROMET, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raffaele Aspide
- UOC Anestesia e rianimazione Ospedale Bellaria, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federico Oppi
- UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia
| | - David Milletti
- UOSI Medicina Riabilitativa Intensiva, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giorgio Palandri
- UOC Neurochirurgia, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| |
Collapse
|
29
|
Mallon DH, Malhotra P, Naik M, Edison P, Perry R, Carswell C, Win Z. The role of amyloid PET in patient selection for extra-ventricular shunt insertion for the treatment of idiopathic normal pressure hydrocephalus: A pooled analysis. J Clin Neurosci 2021; 90:325-331. [PMID: 34275571 DOI: 10.1016/j.jocn.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Idiopathic Normal Pressure Hydrocephalus (iNPH) can be effectively treated through shunt insertion. However, most shunted patients experience little or no clinical benefit, which suggests suboptimal patient selection. While contentious, multiple studies have reported poorer shunt outcomes associated with concomitant Alzheimer's disease. Prompted by this observation, multiple studies have assessed the role of amyloid PET, a specific test for Alzheimer's disease, in patient selection for shunting. METHODS A comprehensive literature search was performed to identify studies that assessed the association between amyloid PET result and the clinical response to shunting in patients with suspected iNPH. Pooled diagnostic statistics were calculated. RESULTS Across three relevant studies, a total of 38 patients with suspected iNPH underwent amyloid PET imaging and shunt insertion. Twenty-three patients had a positive clinical response to shunting. 18/28 (64.3%) of patients with a negative amyloid PET and 5/10 (50%) with a positive amyloid PET had a positive response to shunting. The pooled sensitivity, specificity and accuracy was 33.3%, 76.2% and 58.3%. None of these statistics reached statistical significance. CONCLUSION The results of this pooled analysis do not support the selection of patients with suspected iNPH for shunting on the basis of amyloid PET alone. However, due to small cohort sizes and weakness in study design, further high-quality studies are required to properly determine the role of amyloid PET in assessing this complex patient group.
Collapse
Affiliation(s)
- Dermot H Mallon
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK; Imperial College London, Charing Cross Hospital, London, UK.
| | - Paresh Malhotra
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Mitesh Naik
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Paul Edison
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK; Imperial College London, Charing Cross Hospital, London, UK
| | - Richard Perry
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Christopher Carswell
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK; Imperial College London, Charing Cross Hospital, London, UK
| | - Zarni Win
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| |
Collapse
|
30
|
Ding D, Wang X, Li Q, Li L, Wu J. Research on the Glial-Lymphatic System and Its Relationship With Alzheimer's Disease. Front Neurosci 2021; 15:605586. [PMID: 34220413 PMCID: PMC8242204 DOI: 10.3389/fnins.2021.605586] [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: 09/12/2020] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Metabolic waste clearance is essential to maintain body homeostasis, in which the lymphatic system plays a vital role. Conversely, in recent years, studies have identified the glial-lymphatic system in the brain, which primarily comprises the inflow of fluid along the para-arterial space. Aquaporin-4 mediates the convection of interstitial fluid in the brain and outflow along the paravenous space. β-Amyloid deposition is a characteristic pathological change in Alzheimer's disease, and some studies have found that the glial-lymphatic system plays an important role in its clearance. Thus, the glial-lymphatic system may influence Alzheimer's disease severity and outcome; therefore, this review summarizes the current and available research on the glial-lymphatic system and Alzheimer's disease.
Collapse
Affiliation(s)
- Danhua Ding
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinyu Wang
- Department of Rheumatology, Peking University Third Hospital, Beijing, China
| | - Qianqian Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lanjun Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
31
|
Leary OP, Svokos KA, Klinge PM. Reappraisal of Pediatric Normal-Pressure Hydrocephalus. J Clin Med 2021; 10:jcm10092026. [PMID: 34065105 PMCID: PMC8125971 DOI: 10.3390/jcm10092026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 12/13/2022] Open
Abstract
While normal-pressure hydrocephalus (NPH) is most commonly diagnosed in older adulthood, a significant body of literature has accumulated over half a century documenting the clinical phenomenon of an NPH-like syndrome in pediatric patients. As in adult NPH, it is likely that pediatric NPH occurs due to a heterogeneous array of developmental, structural, and neurodegenerative pathologies, ultimately resulting in aberrant cerebrospinal fluid (CSF) flow and distribution within and around the brain. In this review, we aimed to systematically survey the existing clinical evidence supporting the existence of a pediatric form of NPH, dating back to the original recognition of NPH as a clinically significant subtype of communicating hydrocephalus. Leveraging emergent trends from the old and more recent published literature, we then present a modern characterization of pediatric NPH as a disorder firmly within the same disease spectrum as adult NPH, likely with overlapping etiology and pathophysiological mechanisms. Exemplary cases consistent with the diagnosis of pediatric NPH selected from the senior author’s neurosurgical practice are then presented alongside the systematic review to aid in discussion of the typical clinical and radiographic manifestations of pediatric NPH. Common co-morbidities and modern surgical treatment options are also described.
Collapse
Affiliation(s)
- Owen P. Leary
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (O.P.L.); (K.A.S.)
| | - Konstantina A. Svokos
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (O.P.L.); (K.A.S.)
| | - Petra M. Klinge
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (O.P.L.); (K.A.S.)
- Rhode Island Hospital, APC Building 6th Floor, 593 Eddy Street, Providence, RI 02903, USA
- Correspondence:
| |
Collapse
|
32
|
Ko PW, Lee HW, Lee M, Youn YC, Kim S, Kim JH, Kang K, Suk K. Increased plasma levels of chitinase 3-like 1 (CHI3L1) protein in patients with idiopathic normal-pressure hydrocephalus. J Neurol Sci 2021; 423:117353. [PMID: 33652290 DOI: 10.1016/j.jns.2021.117353] [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: 09/10/2020] [Revised: 01/22/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
Idiopathic normal-pressure hydrocephalus (iNPH) is an uncommon neurological disorder with no known pathological hallmarks. INPH may share common degenerative pathways with other neurological diseases, such as Alzheimer's disease (AD). However, the reversible properties of iNPH may share differing pathophysiological mechanisms with other diseases. This study aimed at assessing the diagnostic value of plasma chitinase 3-like 1 (CHI3L1) protein levels as a disease-specific biomarker for iNPH. We selected both iNPH and AD patients as well as normal and disease control subjects from an enrolled dementia registry. A total of 121 AD, 80 iNPH, 13 idiopathic Parkinson's disease, and 23 mild cognitive impairment patients with 83 healthy controls were included in the final analysis. The Aβ42, total tau, and phosphorylated tau levels within the cerebrospinal fluid, as well as plasma levels of CHI3L1, were measured using commercially available enzyme-linked immunosorbent assay kits. CHI3L1 levels for iNPH patients were higher than those of the other groups. Analysis of covariance adjusting for age showed significantly increased plasma CHI3L1 levels in iNPH patients than in the controls (p < 0.001). CHI3L1 plasma levels may be useful in differentiating iNPH patients from healthy individuals.
Collapse
Affiliation(s)
- Pan-Woo Ko
- Department of Neurology, Daegu Health College Hospital, Daegu, Republic of Korea
| | - Ho-Won Lee
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Brain Science & Engineering Institute, Kyungpook National University, Daegu, Republic of Korea
| | - Myunghoon Lee
- Research Center, D&P Biotech Inc, Seoul, Republic of Korea
| | - Young Chul Youn
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Jong-Heon Kim
- Brain Science & Engineering Institute, Kyungpook National University, Daegu, Republic of Korea
| | - Kyunghun Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Kyoungho Suk
- Department of Pharmacology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Brain Science & Engineering Institute, Kyungpook National University, Daegu, Republic of Korea.
| |
Collapse
|
33
|
Yamada S, Ito H, Ishikawa M, Yamamoto K, Yamaguchi M, Oshima M, Nozaki K. Quantification of Oscillatory Shear Stress from Reciprocating CSF Motion on 4D Flow Imaging. AJNR Am J Neuroradiol 2021; 42:479-486. [PMID: 33478942 DOI: 10.3174/ajnr.a6941] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/05/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Oscillatory shear stress could not be directly measured in consideration of direction, although cerebrospinal fluid has repetitive movements synchronized with heartbeat. Our aim was to evaluate the important of oscillatory shear stress in the cerebral aqueduct and foramen magnum in idiopathic normal pressure hydrocephalus by comparing it with wall shear stress and the oscillatory shear index in patients with idiopathic normal pressure hydrocephalus. MATERIALS AND METHODS By means of the 4D flow application, oscillatory shear stress, wall shear stress, and the oscillatory shear index were measured in 41 patients with idiopathic normal pressure hydrocephalus, 23 with co-occurrence of idiopathic normal pressure hydrocephalus and Alzheimer-type dementia, and 9 age-matched controls. These shear stress parameters at the cerebral aqueduct were compared with apertures and stroke volumes at the foramen of Magendie and cerebral aqueduct. RESULTS Two wall shear stress magnitude peaks during a heartbeat were changed to periodic oscillation by converting oscillatory shear stress. The mean oscillatory shear stress amplitude and time-averaged wall shear stress values at the dorsal and ventral regions of the cerebral aqueduct in the idiopathic normal pressure hydrocephalus groups were significantly higher than those in controls. Furthermore, those at the ventral region of the cerebral aqueduct in the idiopathic normal pressure hydrocephalus group were also significantly higher than those in the co-occurrence of idiopathic normal pressure hydrocephalus with Alzheimer-type dementia group. The oscillatory shear stress amplitude at the dorsal region of the cerebral aqueduct was significantly associated with foramen of Magendie diameters, whereas it was strongly associated with the stroke volume at the upper end of the cerebral aqueduct rather than that at the foramen of Magendie. CONCLUSIONS Oscillatory shear stress, which reflects wall shear stress vector changes better than the conventional wall shear stress magnitude and the oscillatory shear index, can be directly measured on 4D flow MR imaging. Oscillatory shear stress at the cerebral aqueduct was considerably higher in patients with idiopathic normal pressure hydrocephalus.
Collapse
Affiliation(s)
- S Yamada
- From the Department of Neurosurgery (S.Y., K.N.), Shiga University of Medical Science, Shiga, Japan .,Department of Neurosurgery and Normal Pressure Hydrocephalus Center (S.Y., K.Y., M.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan.,Interfaculty Initiative in Information Studies/Institute of Industrial Science (S.Y., M.O.), The University of Tokyo, Tokyo, Japan
| | - H Ito
- Medical System Research and Development Center (H.I.), Fujifilm Corporation, Tokyo, Japan
| | | | - K Yamamoto
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center (S.Y., K.Y., M.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan
| | - M Yamaguchi
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center (S.Y., K.Y., M.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan
| | - M Oshima
- Interfaculty Initiative in Information Studies/Institute of Industrial Science (S.Y., M.O.), The University of Tokyo, Tokyo, Japan
| | - K Nozaki
- From the Department of Neurosurgery (S.Y., K.N.), Shiga University of Medical Science, Shiga, Japan
| |
Collapse
|
34
|
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.
Collapse
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
| | | |
Collapse
|
35
|
Normal pressure hydrocephalus: Diagnostic delay. ACTA ACUST UNITED AC 2020; 40:656-663. [PMID: 33275344 PMCID: PMC7808784 DOI: 10.7705/biomedica.5382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Indexed: 11/21/2022]
Abstract
Introduction: Normotensive hydrocephalus is a differential diagnosis in the evaluation of the dementia syndrome. The diagnostic protocols would allow detecting this pathology that has more effective treatment than other dementias. Objective: To describe a population with clinical suspicion of normal pressure hydrocephalus evaluated in a Colombian psychiatric hospital and discuss the possible reasons for its diagnostic and therapeutic delay. Materials and methods: We conducted a retrospective study of medical records to identify patients with suspected normal pressure hydrocephalus during a 5-year period. Results: Thirty-five patients with suspected normal pressure hydrocephalus underwent diagnostic lumbar puncture and five of them were considered candidates for a peritoneal-venous shunt, but none underwent this surgical procedure. After three to six months of the lumbar puncture, the gait pattern improved in 22.8% of the patients, cognition in 22.8%, and sphincter control in 11.4%. Improvement was not sustained in the long term (1 year) in any of them. Conclusion: This study suggests the poor implementation of the protocols for evaluating patients with cognitive deficits and delays in the diagnosis of normal pressure hydrocephalus. A small number of patients were identified as candidates for treatment. Normal pressure hydrocephalus is a potentially reversible clinical entity with the placement of a peritoneal ventricular shunt, but delays in diagnosis and treatment have deleterious consequences for patients and their families.
Collapse
|
36
|
Niermeyer M, Gaudet C, Malloy P, Piryatinsky I, Salloway S, Klinge P, Lee A. Frontal Behavior Syndromes in Idiopathic Normal Pressure Hydrocephalus as a Function of Alzheimer's Disease Biomarker Status. J Int Neuropsychol Soc 2020; 26:883-893. [PMID: 32430087 PMCID: PMC7554119 DOI: 10.1017/s1355617720000387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Cognitive impairment and apathy are well-documented features of idiopathic normal pressure hydrocephalus (iNPH). However, research examining other neuropsychiatric manifestations of iNPH is scant, and it is unknown whether the neuropsychiatric presentation differs for iNPH patients with comorbid Alzheimer's disease (AD) versus iNPH without AD. This study aims to advance our understanding of neuropsychiatric syndromes associated with iNPH. METHODS Fifty patients from Butler Hospital's Normal Pressure Hydrocephalus Clinic met inclusion criteria. Caregiver ratings on the Frontal Systems Behavior Scale (FrSBe) were examined to appraise changes in apathy, executive dysfunction, and disinhibition. Patients also completed cognitive tests of global cognition, psychomotor speed, and executive functioning. AD biomarker status was determined by either amyloid-beta (Aβ) positron emission tomography (PET) imaging or cerebrospinal fluid (CSF) total tau to Aβ-42 ratio. RESULTS Results revealed clinically significant elevations on the FrSBe's apathy and executive dysfunction scales and modest correlations among these scales and cognitive measures. Of the 44 patients with available neuroimaging or CSF draw data, 14 presented with comorbid AD. Relative to the iNPH-only group, the iNPH + AD group showed a larger increase from pre-illness to current informant ratings on the executive dysfunction scale, but not the apathy or disinhibition scales. CONCLUSIONS These results replicate and extend prior research by identifying apathy and executive dysfunction as prominent neuropsychiatric symptoms of iNPH and suggest comorbid AD exacerbates dysexecutive behaviors. Future research is warranted to examine the effects of comorbid AD pathology in response to shunt surgery for iNPH, neuropsychiatric symptom changes, and resultant caregiver burden.
Collapse
Affiliation(s)
- Madison Niermeyer
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT
| | - Chad Gaudet
- Department of Psychology, University of Rhode Island, Kingston, RI
| | - Paul Malloy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
- Memory and Aging Program, Butler Hospital, Providence, RI
| | - Irene Piryatinsky
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA
| | - Stephen Salloway
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
- Memory and Aging Program, Butler Hospital, Providence, RI
- Department of Neurology, Warren Alpert Medical School, Brown University, Providence, RI
| | - Petra Klinge
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, RI
- Lifespan Physician Group, Rhode Island Hospital, Providence, RI
| | - Athene Lee
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
- Memory and Aging Program, Butler Hospital, Providence, RI
| |
Collapse
|
37
|
Kaestner S, Behrends R, Roth C, Graf K, Deinsberger W. Treatment for secondary deterioration in idiopathic normal pressure hydrocephalus in the later course of the disease: a retrospective analysis. Acta Neurochir (Wien) 2020; 162:2431-2439. [PMID: 32623600 DOI: 10.1007/s00701-020-04475-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) shunting is a highly effective treatment for idiopathic normal pressure hydrocephalus (iNPH). However, secondary deterioration can occur at a later time. Thus, the current study aimed to evaluate the incidence rate and causes of secondary deterioration. METHODS A retrospective analysis was conducted on all patients with iNPH who were treated with implantation of a CSF shunt since 1993. A meticulous shunt workup was recommended to all patients who presented to our department with secondary deterioration during their follow-up visits. Data about the proportion of patients with such deterioration and its causes, subsequent treatment, and clinical outcome were obtained. RESULTS A total of 169 patients were included, and the mean follow-up time was 69.2 months. In total, 119 (70.4%) patients presented with a total of 153 secondary deteriorations. In 9 cases (5.9%), the deterioration was caused by delayed subdural hematoma and in 27 (22.1%) cases, by shunt dysfunction. Invasive shunt testing was commonly required to validate shunt failure. Moreover, 19 of 27 patients experienced a satisfactory improvement after revision surgery. In total, 86 deteriorations were attributed to nonsurgical causes, and the valve pressure was decreased in 79 patients, with only 16.5% presenting with a satisfactory improvement after lowering of valve pressure. CONCLUSIONS Most patients with shunted iNPH presented with deterioration in the later course of the disease. Shunt dysfunction was considered a cause of secondary deterioration. Moreover, shunt revision surgery was a highly effective treatment, and patients with deterioration should undergo screening procedures for shunt dysfunction, including invasive shunt testing.
Collapse
Affiliation(s)
- Stefanie Kaestner
- Department of Neurosurgery, Klinikum Kassel, Moencheberg Str. 41-43, 34125, Kassel, Germany.
- Kassel School of Medicine, University of Southampton, 12 University Rd, Southampton, SO17 1BJ, UK.
| | - Rhea Behrends
- Kassel School of Medicine, University of Southampton, 12 University Rd, Southampton, SO17 1BJ, UK
| | - Christian Roth
- Department of Neurology, Red Cross Clinic, Hanstein Str. 29, 34121, Kassel, Germany
| | - Katharina Graf
- Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstraße 29, 35392, Giessen, Germany
| | - Wolfgang Deinsberger
- Department of Neurosurgery, Klinikum Kassel, Moencheberg Str. 41-43, 34125, Kassel, Germany
- Kassel School of Medicine, University of Southampton, 12 University Rd, Southampton, SO17 1BJ, UK
| |
Collapse
|
38
|
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.
Collapse
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
| |
Collapse
|
39
|
Eide PK, Valnes LM, Pripp AH, Mardal KA, Ringstad G. Delayed clearance of cerebrospinal fluid tracer from choroid plexus in idiopathic normal pressure hydrocephalus. J Cereb Blood Flow Metab 2020; 40:1849-1858. [PMID: 31495299 PMCID: PMC7446558 DOI: 10.1177/0271678x19874790] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Impaired clearance of amyloid-β from choroid plexus is one proposed mechanism behind amyloid deposition in Alzheimer's disease. The present study examined whether clearance from choroid plexus of a cerebrospinal fluid tracer, serving as a surrogate marker of a metabolic waste product, is altered in idiopathic normal pressure hydrocephalus (iNPH), one sub-type of dementia. In a prospective observational study of close to healthy individuals (reference cohort; REF) and individuals with iNPH, we performed standardized T1-weighted magnetic resonance imaging scans before and through 24 h after intrathecal administration of a cerebrospinal fluid tracer (the magnetic resonance imaging contrast agent gadobutrol). Changes in normalized T1 signal within the choroid plexus and cerebrospinal fluid of lateral ventricles were quantified using FreeSurfer. The normalized T1 signal increased to maximum within choroid plexus and cerebrospinal fluid of lateral ventricles 6-9 h after intrathecal gadobutrol in both the REF and iNPH cohorts (enrichment phase). Peak difference in normalized T1 signals between REF and iNPH individuals occurred after 24 h (clearance phase). The results gave evidence for gadobutrol resorption from cerebrospinal fluid by choroid plexus, but with delay in iNPH patients. Whether choroid plexus has a role in iNPH pathogenesis in terms of delayed clearance of amyloid-β remains to be shown.
Collapse
Affiliation(s)
- Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Kent-Andre Mardal
- Department of Mathematics, University of Oslo, Oslo, Norway.,Center for Biomedical Computing, Simula Research Laboratory, Lysaker, Norway
| | - Geir Ringstad
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| |
Collapse
|
40
|
Nakajo K, Uda T, Goto T, Morisako H, Nishijima S, Kawashima T, Tanoue Y, Nagahama A, Sasaki T, Ko S, Ohata K. Changes in cognitive function after resection of lesions in the anterior part of the lateral ventricle via an interhemispheric transcallosal approach. J Clin Neurosci 2020; 79:39-44. [PMID: 33070915 DOI: 10.1016/j.jocn.2020.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/02/2020] [Accepted: 07/11/2020] [Indexed: 11/18/2022]
Abstract
Anterior callosotomy to about 20 mm has been considered relatively safe empirically. The present study aimed to compare cognitive function before and after resection of tumors in the anterior part of the lateral ventricle. We analyzed 6 patients with intraventricular tumors located in the anterior horn or body of the lateral ventricle who underwent surgical excision via interhemispheric transcallosal approach at Osaka City University Hospital between March 2015 and August 2018. And clinical and imaging studies, neuropsychological function using MMSE, WAIS-III and WMS-R and surgical complications were retrospectively reviewed based on the medical records at our institution. As a result, 4 patients achieved gross total resection of the tumor and 2 patients achieved subtotal resection. 4 patients showed hydrocephalus, which disappeared in each case within 6 months after tumor resection. Mean length of callosotomy was 16.9 mm (range, 15.5-26.1 mm). One patient showed postoperative transient deficits including aphasia, microphonia, ballism in all extremities and hemiplegia, and another patient experienced subjective difficulty when talking. These symptoms disappeared within 3 months after tumor resection. Scores from the MMSE and WAIS-III showed no significant postoperative deterioration. Performance intelligence quotient (P = 0.04), full intelligence quotient (P = 0.04) and perceptual organization (P = 0.03) of WAIS-III were significantly improved after surgery compared with preoperatively. In conclusion, anterior corpus callosotomy of about 20 mm for intraventricular tumor in the anterior horn or body of the lateral ventricle might have little effect on cognitive function in the chronic phase, although the influence of hydrocephalus cannot be ignored.
Collapse
Affiliation(s)
- Kosuke Nakajo
- The Departments of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Takehiro Uda
- The Departments of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takeo Goto
- The Departments of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Morisako
- The Departments of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shugo Nishijima
- The Departments of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toshiyuki Kawashima
- The Departments of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuta Tanoue
- The Departments of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Atsufumi Nagahama
- The Departments of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Sasaki
- The Departments of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Saya Ko
- The Departments of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenji Ohata
- The Departments of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
41
|
de Laurentis C, Cristaldi P, Arighi A, Cavandoli C, Trezza A, Sganzerla EP, Giussani CG, Di Cristofori A. Role of aquaporins in hydrocephalus: what do we know and where do we stand? A systematic review. J Neurol 2020; 268:4078-4094. [PMID: 32747978 DOI: 10.1007/s00415-020-10122-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Glymphatic fluid circulation may be considered the lymphatic system of the brain and the main role of such system seems to be played by aquaporins (AQPs), a family of proteins which regulates water exchange, in particular AQP4 and 1. Alterations of glymphatic fluid circulation through AQPs variations are now emerging as central elements in the pathophysiology of different brain conditions, like hydrocephalus. This systematic review provides an insight about the role of AQPs in hydrocephalus establishment and compensation, investigating their possible role as diagnostic tools or therapeutic targets. METHODS PubMed database was screened searching for the relevant existing literature in English language published until February 29th 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. RESULTS A total of 40 articles met the inclusion criteria for our systematic analysis. AQP4 resulted the most studied water channel, followed by AQP1. The changes in cerebrospinal fluid (CSF), brain parenchyma and choroid plexus (CP) in different hydrocephalus type were analyzed. Moreover, important pharmacological interactions regarding AQP and molecules or conditions were discussed. A very interesting result is the general consensus on increase of AQP4 in hydrocephalic patients, unless in patients suffering from idiopathic normal pressure hydrocephalus, where AQP4 shows a tendency in reduction. CONCLUSION AQP seem to play a central role in the pathophysiology of hydrocephalus and in its compensation mechanisms. Further studies are required to definitively establish their precise roles and their quantitative changes to allow their utilization as diagnostic tools or therapeutic targets.
Collapse
Affiliation(s)
- Camilla de Laurentis
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy.,Department of Surgery and Medicine, Università degli Studi Milano-Bicocca, Milan, MI, Italy
| | - Paola Cristaldi
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy.,Department of Surgery and Medicine, Università degli Studi Milano-Bicocca, Milan, MI, Italy
| | - Andrea Arighi
- Unit of Neurology - UOSD Malattie Neurodegenerative, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy.,Dino Ferrari Center - Università degli Studi di Milano, Milan, MI, Italy
| | - Clarissa Cavandoli
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy.,Università degli Studi di Milano, Milan, MI, Italy
| | - Andrea Trezza
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy
| | - Erik P Sganzerla
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy.,Department of Surgery and Medicine, Università degli Studi Milano-Bicocca, Milan, MI, Italy
| | - Carlo G Giussani
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy.,Department of Surgery and Medicine, Università degli Studi Milano-Bicocca, Milan, MI, Italy
| | - Andrea Di Cristofori
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy.
| |
Collapse
|
42
|
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.
Collapse
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
| |
Collapse
|
43
|
Prevalence of possible idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia: a replication study. BMC Psychiatry 2020; 20:273. [PMID: 32487126 PMCID: PMC7268331 DOI: 10.1186/s12888-020-02690-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We recently reported that older patients with schizophrenia (SZ) show possible idiopathic normal pressure hydrocephalus (iNPH) more frequently than the general population. In this study, we estimated the prevalence of iNPH in a larger number of older SZ patients and explored useful examination values for diagnosis in the SZ population. METHODS We enrolled older inpatients with SZ (n = 39, mean age = 68.6 ± 7.7 years) from several psychiatric hospitals in Ehime, Japan and acquired brain imaging data using computed tomography. We evaluated three iNPH symptoms (dementia, gait disturbance, and urinary incontinence). In addition, we combined these data with our previous data to elucidate the relationship between iNPH and characteristics of SZ symptoms. RESULTS In total, five (12.8%) patients were diagnosed with possible iNPH. Evans' index for patients with iNPH was significantly higher than for those without iNPH (p = 0.002). The number of disproportionately enlarged subarachnoid space hydrocephalus (DESH) findings was significantly higher in patients with iNPH than in those without iNPH (p < 0.001). Using combined data, Drug-Induced Extra-pyramidal Symptoms Scale (DIEPSS) subscales of gait and bradykinesia showed an increasing trend in the SZ with iNPH group. CONCLUSIONS We reconfirmed that older inpatients with SZ experienced possible iNPH more frequently than the general population. We should pay attention to the DIEPSS subscales of gait and bradykinesia and DESH findings in addition to the three main symptoms of iNPH and Evans' index so as to not miss SZ patients with iNPH.
Collapse
|
44
|
Ghaffari-Rafi A, Gorenflo R, Hu H, Viereck J, Liow K. Role of psychiatric, cardiovascular, socioeconomic, and demographic risk factors on idiopathic normal pressure hydrocephalus: A retrospective case-control study. Clin Neurol Neurosurg 2020; 193:105836. [PMID: 32371292 DOI: 10.1016/j.clineuro.2020.105836] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Currently, predicting and preventing idiopathic normal pressure hydrocephalus (iNPH) remains challenging, especially for patients without a history of cerebrovascular disease. By exploring the role of cardiovascular and psychiatric history, demographics, and socioeconomic status in iNPH, will provide better direction for elucidating the etiology or addressing healthcare inequalities. PATIENTS AND METHODS To investigate iNPH with respect to the selected risk factors, we conducted a retrospective case-control study from a neuroscience institute in Hawaii with a patient pool of 25,843. After excluding patients with a history of cerebrovascular disease, we identified 29 cases which meet the American-European guidelines for iNPH diagnosis. Meanwhile, 116 controls matched to age, sex, and race were also randomly selected. RESULTS Median age at diagnosis was 83 (IQR: 74-88), with cases estimated 22 years older than controls (95 % CI: 14.00-29.00; p = 0.0000001). Patients with iNPH were more likely to be White (OR 4.01, 95 % CI: 1.59-10.11; p = 0.0042) and less likely Native Hawaiian and other Pacific Islander (OR 0.010, 95 % CI: 0.00-0.78; p = 0.014). Median household income was $2874 (95 % CI: 0.000089-6905; p = 0.088) greater amongst iNPH cases. Effect size amongst cardiovascular risk factors was not found statistically significant (i.e., body mass index, hyperlipidemia, type 2 diabetes mellitus, hypertension, coronary artery disease or prior myocardial infarction history, peripheral vascular disease, smoking status, congestive heart failure, atrial fibrillation/flutter, and history of prosthetic valve replacement). However, iNPH patients were more likely to have a history of alcohol use disorder (OR 8.29, 95 % CI: 0.99-453.87; p = 0.050) and history of a psychiatric disorder (OR 2.48; 95 % CI: 1.08-5.68; p = 0.029). Odds ratio for autoimmune disorder, thyroid disorder, glaucoma, and seizures did not reach statistical significance. CONCLUSION Patient race (i.e., White; Native Hawaiian or other Pacific Islander) was found associated with iNPH development. Meanwhile, after excluding those with cerebrovascular disease, cardiovascular risk factors were not found associated with iNPH. Lastly, iNPH cases were more inclined to have a history of alcohol use disorder and prior psychiatric disorder. Overall, this data reveals that a racial disparity exists amongst iNPH, as well as highlights the role of various cardiovascular and psychiatric risk factors, which can potentially provide direction in etiology elucidation.
Collapse
Affiliation(s)
- Arash Ghaffari-Rafi
- University of Hawai'i at Mānoa, John A. Burns School of Medicine, Honolulu, Hawai'i, USA; University College London, Queen Square Institute of Neurology, London, England, UK.
| | - Rachel Gorenflo
- University of Hawai'i at Mānoa, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
| | - Huanli Hu
- University of Hawai'i at Mānoa, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
| | - Jason Viereck
- University of Hawai'i at Mānoa, John A. Burns School of Medicine, Honolulu, Hawai'i, USA; Hawaii Pacific Neuroscience, Honolulu, Hawai'i, USA
| | - Kore Liow
- University of Hawai'i at Mānoa, John A. Burns School of Medicine, Honolulu, Hawai'i, USA; Hawaii Pacific Neuroscience, Honolulu, Hawai'i, USA
| |
Collapse
|
45
|
Garrett MD. Multiple Causes of Dementia as Engineered Senescence. EUROPEAN JOURNAL OF MEDICAL AND HEALTH SCIENCES 2020; 2. [DOI: 10.24018/ejmed.2020.2.2.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
All traumas—cranial, cardiovascular, hormone, viral, bacterial, fungi, parasites, misfolded protein, genetic, behavior, environmental and medication—affect the brain. This paper itemizes studies showing the many different causes of dementia including Alzheimer’s disease. Causes interact with each other, act sequentially by preparing the optimal conditions for its successor, initiate other diseases, allow for other traumas to accumulate and degrade protective features of the brain. Since such age-related cognitive impairment is not exclusively a human attribute there might be support for an evolutionary theory of dementia. Relying on theories of antagonistic pleiotropy and polymorphism, the brain has been designed to sequester trauma. Because of increased longevity, the short-term tactic of sequestering trauma becomes a long-term liability. We are engineered to sequester these insults until a tipping point is reached. Dementia is an evolutionary trade-off for longevity. We cannot cure dementia without understanding the overall biology of aging.
Collapse
|
46
|
Reeves BC, Karimy JK, Kundishora AJ, Mestre H, Cerci HM, Matouk C, Alper SL, Lundgaard I, Nedergaard M, Kahle KT. Glymphatic System Impairment in Alzheimer's Disease and Idiopathic Normal Pressure Hydrocephalus. Trends Mol Med 2020; 26:285-295. [PMID: 31959516 PMCID: PMC7489754 DOI: 10.1016/j.molmed.2019.11.008] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/11/2019] [Accepted: 11/20/2019] [Indexed: 12/31/2022]
Abstract
Approximately 10% of dementia patients have idiopathic normal pressure hydrocephalus (iNPH), an expansion of the cerebrospinal fluid (CSF)-filled brain ventricles. iNPH and Alzheimer's disease (AD) both exhibit sleep disturbances, build-up of brain metabolic wastes and amyloid-β (Aβ) plaques, perivascular reactive astrogliosis, and mislocalization of astrocyte aquaporin-4 (AQP4). The glia-lymphatic (glymphatic) system facilitates brain fluid clearance and waste removal during sleep via glia-supported perivascular channels. Human studies have implicated impaired glymphatic function in both AD and iNPH. Continued investigation into the role of glymphatic system biology in AD and iNPH models could lead to new strategies to improve brain health by restoring homeostatic brain metabolism and CSF dynamics.
Collapse
Affiliation(s)
- Benjamin C Reeves
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, USA
| | - Jason K Karimy
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, USA
| | - Adam J Kundishora
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, USA
| | - Humberto Mestre
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - H Mert Cerci
- Istanbul Universty-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul 34096, Turkey
| | - Charles Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, USA
| | - Seth L Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Iben Lundgaard
- Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden; Wallenberg Center for Molecular Medicine, Lund University, 221 84 Lund, Sweden
| | - Maiken Nedergaard
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, NY 14642, USA; Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristopher T Kahle
- Departments of Neurosurgery, Pediatrics, and Cellular and Molecular Physiology; and Yale-Rockefeller National Institutes of Health (NIH) Centers for Mendelian Genomics, Yale School of Medicine, New Haven, CT 06510, USA.
| |
Collapse
|
47
|
Kuroda T, Honma M, Mori Y, Futamura A, Sugimoto A, Yano S, Kinno R, Murakami H, Ono K. Increased Presence of Cerebral Microbleeds Correlates With Ventricular Enlargement and Increased White Matter Hyperintensities in Alzheimer's Disease. Front Aging Neurosci 2020; 12:13. [PMID: 32082141 PMCID: PMC7004967 DOI: 10.3389/fnagi.2020.00013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/15/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: To investigate whether the number of cerebral microbleeds (CMB) could be a useful indicator to predict glymphatic system dysfunction in Alzheimer's disease (AD) patients, by comparing the degree of cerebral spinal fluid (CSF) and interstitial fluid (ISF) stasis. Methods: Forty probable AD patients were included, with those exhibiting two or more CMB were included in the multiple CMB group (mCMB, n = 21, mean = 11.1), and none or one CMB included in the non-multiple CMB group (nmCMB, n = 19, mean = 0.84). CMB was defined in axial gradient recalled echo (GRE) T2*-weighted images. Evans index (EI) was calculated to measure lateral ventricle enlargement, Voxel-based Specific Regional Analysis System for Alzheimer's Disease (VSRAD) software was used to determine the extent of gray and white matter atrophy, and Fazekas scale (FS) was used to determine white matter hyperintensities (WMH). Results: EI was significantly larger in mCMB than in nmCMB, while the gray and white matter volume was not different between groups. Thus, the difference in lateral ventricle enlargement between AD with and without multiple CMB reflects a combination of the degree of brain atrophy and the extent of CSF stasis. FS was higher in mCMB than in the nmCMB, suggesting the failure of ISF elimination was more severe in mCMB cases. Conclusion: The difference in lateral ventricle enlargement and WMH between AD with or without multiple CMB may reflect a difference in the degree of CSF/ISF stagnation.
Collapse
Affiliation(s)
- Takeshi Kuroda
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Motoyasu Honma
- Department of Physiology, Showa University School of Medicine, Tokyo, Japan
| | - Yukiko Mori
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Akinori Futamura
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Azusa Sugimoto
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Satoshi Yano
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Ryuta Kinno
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Hidetomo Murakami
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenjiro Ono
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| |
Collapse
|
48
|
Irie R, Otsuka Y, Hagiwara A, Kamagata K, Kamiya K, Suzuki M, Wada A, Maekawa T, Fujita S, Kato S, Nakajima M, Miyajima M, Motoi Y, Abe O, Aoki S. A Novel Deep Learning Approach with a 3D Convolutional Ladder Network for Differential Diagnosis of Idiopathic Normal Pressure Hydrocephalus and Alzheimer's Disease. Magn Reson Med Sci 2020; 19:351-358. [PMID: 31969525 PMCID: PMC7809147 DOI: 10.2463/mrms.mp.2019-0106] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose: Idiopathic normal pressure hydrocephalus (iNPH) and Alzheimer’s disease (AD) are geriatric diseases and common causes of dementia. Recently, many studies on the segmentation, disease detection, or classification of MRI using deep learning have been conducted. The aim of this study was to differentiate iNPH and AD using a residual extraction approach in the deep learning method. Methods: Twenty-three patients with iNPH, 23 patients with AD and 23 healthy controls were included in this study. All patients and volunteers underwent brain MRI with a 3T unit, and we used only whole-brain three-dimensional (3D) T1-weighted images. We designed a fully automated, end-to-end 3D deep learning classifier to differentiate iNPH, AD and control. We evaluated the performance of our model using a leave-one-out cross-validation test. We also evaluated the validity of the result by visualizing important areas in the process of differentiating AD and iNPH on the original input image using the Gradient-weighted Class Activation Mapping (Grad-CAM) technique. Results: Twenty-one out of 23 iNPH cases, 19 out of 23 AD cases and 22 out of 23 controls were correctly diagnosed. The accuracy was 0.90. In the Grad-CAM heat map, brain parenchyma surrounding the lateral ventricle was highlighted in about half of the iNPH cases that were successfully diagnosed. The medial temporal lobe or inferior horn of the lateral ventricle was highlighted in many successfully diagnosed cases of AD. About half of the successful cases showed nonspecific heat maps. Conclusion: Residual extraction approach in a deep learning method achieved a high accuracy for the differential diagnosis of iNPH, AD, and healthy controls trained with a small number of cases.
Collapse
Affiliation(s)
- Ryusuke Irie
- Department of Radiology, Juntendo University School of Medicine.,Department of Radiology, Graduate School of Medicine, The University of Tokyo
| | - Yujiro Otsuka
- Department of Radiology, Juntendo University School of Medicine.,Milliman, Inc
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University School of Medicine.,Department of Radiology, Graduate School of Medicine, The University of Tokyo
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine
| | - Kouhei Kamiya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo
| | | | - Akihiko Wada
- Department of Radiology, Juntendo University School of Medicine
| | - Tomoko Maekawa
- Department of Radiology, Juntendo University School of Medicine.,Department of Radiology, Graduate School of Medicine, The University of Tokyo
| | - Shohei Fujita
- Department of Radiology, Juntendo University School of Medicine.,Department of Radiology, Graduate School of Medicine, The University of Tokyo
| | - Shimpei Kato
- Department of Radiology, Juntendo University School of Medicine.,Department of Radiology, Graduate School of Medicine, The University of Tokyo
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University School of Medicine
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center
| | - Yumiko Motoi
- Department of Neurology, Juntendo University School of Medicine.,Department of Diagnosis, Prevention and Treatment of Dementia, Juntendo University Graduate School of Medicine
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine
| |
Collapse
|
49
|
Normal Pressure Hydrocephalus: Clinical Symptoms, Cerebrospinal Fluid Flow Metrics and White Matter Changes. J Comput Assist Tomogr 2020; 44:59-64. [PMID: 31939883 DOI: 10.1097/rct.0000000000000959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to investigate correlations between clinical symptoms, cerebrospinal fluid flow metrics, hydrocephalus index, small-vessel disease, and white matter (WM) changes in normal pressure hydrocephalus (NPH). METHODS Aquaductal stroke volumes (ASVs), Z Evans index, Fazekas grading (FG), and diffusion tensor imaging measurements from WM bundles of 37 patients with NPH were retrospectively evaluated. Mann-Whitney U test between clinical symptoms and other variables and Spearman ρ correlations for relationships between variables and Kruskal-Wallis to correlate FG with nonclinical variables were used. RESULTS Patients with NPH had increased ASV (median 53 μL). No correlation was found between Z Evans index and ASV. Three groups of patients with dementia or ataxia or incontinence had increased ASV values than their counterparts without symptoms (55 vs 48.5 μL, 75 vs 47 μL, 64 vs 49.5 μL, respectively). Patients having 2 common symptoms of dementia and ataxia and patients having all 3 symptoms of dementia, ataxia, and incontinence were compared with ASV values of 63.5 versus 78 μL, respectively. Patients with FG 1 had median ASV values of 45 μL; FG 2, 82.5 μL; and FG 3, 59 μL. Patients with dementia had significantly higher apparent diffusion coefficient (ADC) values of corona radiata (CR) on both sides. There were no significant WM changes in patients with ataxia and incontinence. The Z Evans index was positively correlated with ADC values of CR on both sides and genu of corpus callosum. Fazekas grading was found positively correlated with ADC and negatively correlated with FA values of CR. CONCLUSIONS Patients with NPH, regardless of stages of the diseases, have increased ASV values and could benefit from shunting. Decreasing ASV values of patients with FG 3 comparing with those with FG 2 support the hypothesis of decreasing compliance of brain with aging and increasing severity of small-vessel disease.
Collapse
|
50
|
Azuma S, Kazui H, Kanemoto H, Suzuki Y, Sato S, Suehiro T, Matsumoto T, Yoshiyama K, Kishima H, Shimosegawa E, Tanaka T, Ikeda M. Cerebral blood flow and Alzheimer's disease-related biomarkers in cerebrospinal fluid in idiopathic normal pressure hydrocephalus. Psychogeriatrics 2019; 19:527-538. [PMID: 30916850 DOI: 10.1111/psyg.12435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/26/2018] [Accepted: 01/13/2019] [Indexed: 11/26/2022]
Abstract
AIM Alzheimer's disease (AD) pathology is highly prevalent in patients with idiopathic normal pressure hydrocephalus (iNPH), and the presence of AD pathology may involve regional cerebral blood flow (rCBF). In this study, we examined the relationship between rCBF and AD-related biomarkers in the cerebrospinal fluid of iNPH patients. METHODS Patients with iNPH (n = 39) were classified into groups with (iNPH/AD+) (n=15) and without (iNPH/AD-) (n=24) high biomarker probability of AD (i.e. combined low amyloid β 42 and high total tau in the cerebrospinal fluid). rCBF was quantified in 17 regions of interest by N-isopropyl-p-[123 I]iodoamphetamine single-photon emission computed tomography with the autoradiography method. We compared rCBF between the iNPH/AD- and iNPH/AD+ groups at baseline using a t-test and then compared changes in rCBF after shunt surgery between the groups using a paired t-test and two-way repeated measures ANOVA. RESULTS At baseline, there were no significant differences in rCBF between the groups in most regions apart from the putamen. After shunt surgery, a significant increase in rCBF in the putamen, amygdala, hippocampus, and parahippocampal gyrus was observed in iNPH/AD- patients. In iNPH/AD+ patients, no significant improvement in rCBF was observed in any region. In repeated measures analysis of variance, a significant group × shunt interaction was observed in the parietal lobe, frontal lobe, posterior cingulate cortex, precuneus, lateral temporal lobe, amygdala, hippocampus, parahippocampal gyrus, and putamen. CONCLUSIONS Improvement in rCBF after shunt surgery in iNPH/AD+ patients may be poorer than that in iNPH AD- patients.
Collapse
Affiliation(s)
- Shingo Azuma
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroaki Kazui
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Neuropsychiatry, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Psychiatry, Mizuma Hospital, Kaizuka, Japan.,Cognitive Reserve Research Center, Osaka Kawasaki Rehabilitation University, Kaizuka, Japan
| | - Yukiko Suzuki
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Japan
| | - Shunsuke Sato
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Suehiro
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takuya Matsumoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Eku Shimosegawa
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshihisa Tanaka
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| |
Collapse
|