Gray matter volumes at high-convexity and medial surface are related to clinical symptoms of idiopathic normal pressure hydrocephalus

Background: The first aim of our study was to determine whether cortical 18F-florbetaben retention was different between healthy controls and idiopathic normal-pressure hydrocephalus (INPH) patients. Our second aim was to investigate whether there were any relationships between 18F-florbetaben retention and either hippocampal volume or clinical symptoms in INPH patients. Methods: Seventeen patients diagnosed with INPH and 8 healthy controls underwent studies with magnetic resonance imaging and 18F-florbetaben positron emission tomography imaging. Results: Automated region-of-interest analysis showed significant increases in 18F-florbetaben uptake in several brain regions in INPH patients compared to control subjects, with especially remarkable increases in the frontal (bilateral), parietal (bilateral), and occipital (bilateral) cortices. In the INPH group, right hippocampal volume was found to be negatively correlated with right frontal 18F-florbetaben retention. Korean-Mini Mental State Examination scores negatively correlated with right occipital 18F-florbetaben retention. Higher 18F-florbetaben retention correlated significantly with a higher Clinical Dementia Rating Scale score in the right occipital cortex. Conclusions: Our results indicate that INPH might be a disease exhibiting a characteristic pattern of cortical 18F-florbetaben retention. 18F-florbetaben retention in the frontal cortex may be related to hippocampal neuronal degeneration. Our findings may also help us understand the potential pathophysiology of cognitive impairments associated with INPH.

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The role of diffusion tensor imaging in idiopathic normal pressure hydrocephalus: A literature review

The Neuroradiology Journal ◽

10.1177/1971400920975153 ◽

2020 ◽

pp. 197140092097515

Author(s):

Irene Grazzini ◽

Duccio Venezia ◽

Gian Luca Cuneo

Keyword(s):

Diffusion Tensor Imaging ◽

Normal Pressure Hydrocephalus ◽

Clinical Symptoms ◽

Diffusion Tensor ◽

Clinical History ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Csf Shunt ◽

Magnetic Resonance Imaging Mri

Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome that comprises a triad of gait disturbance, dementia and urinary incontinence, associated with ventriculomegaly in the absence of elevated intraventricular cerebrospinal fluid (CSF) pressure. It is important to identify patients with iNPH because some of its clinical features may be reversed by the insertion of a CSF shunt. The diagnosis is based on clinical history, physical examination and brain imaging, especially magnetic resonance imaging (MRI). Recently, some papers have investigated the role of diffusion tensor imaging (DTI) in evaluating white matter alterations in patients with iNPH. DTI analysis in specific anatomical regions seems to be a promising MR biomarker of iNPH and could also be used in the differential diagnosis from other dementias. However, there is a substantial lack of structured reviews on this topic. Thus, we performed a literature search and analyzed the most recent and pivotal articles that investigated the role of DTI in iNPH in order to provide an up-to-date overview of the application of DTI in this setting. We reviewed studies published between January 2000 and June 2020. Thirty-eight studies and four reviews were included. Despite heterogeneity in analysis approaches, the majority of studies reported significant correlations between DTI and clinical symptoms in iNPH patients, as well as different DTI patterns in patients with iNPH compared to those with Alzheimer or Parkinson diseases. It remains to be determined whether DTI could predict the success after CSF shunting.

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Predictive Value of Cerebrospinal Fluid Biomarkers for Tap Test Responsiveness in Patients With Suspected Idiopathic Normal Pressure Hydrocephalus

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.665878 ◽

2021 ◽

Vol 13 ◽

Author(s):

Rongrong Hua ◽

Chunyan Liu ◽

Xing Liu ◽

Jinwu Zhu ◽

Jie Zhang ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Normal Pressure Hydrocephalus ◽

Predictive Value ◽

Clinical Symptoms ◽

Test Group ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Binary Logistic Regression Analysis ◽

Csf Biomarkers ◽

Tap Test

Background: The value of cerebrospinal fluid (CSF) biomarkers for assessing idiopathic normal pressure hydrocephalus (iNPH) must be determined. This prospective study aimed to reveal the correlation between CSF biomarkers and clinical symptoms of iNPH and the predictive value of these biomarkers for tap test responsiveness.Methods: Thirty-nine patients with suspected iNPH were recruited, contributed qualified CSF, and underwent a tap test and unified pre- and post-test evaluations of the neurological function.Results: The analysis of biomarkers from the patients’ CSF showed decreased levels of tau and its phosphorylated form, especially in the tap test (+) group. The responsiveness of the tap test was also related to the number of combined symptoms (p < 0.01), and a correlation was found between the end pressure or pressure difference in CSF and tap test responsiveness (p < 0.05). The results of the binary logistic regression analysis showed that P (tap test responsiveness) = 1/1 + e∧ − (−5.505 + 55.314 * ratio of p/T-tau − 1.586 * numbers of combined symptoms). The combined indicators (−5.505 + 0.553 * percentage of p/T-tau − 1.586 * numbers of combined symptoms) resulted in the highest sensitivity and specificity of 94.12% and 72.73%, respectively.Conclusions: CSF biomarkers may be assessed to judge tap test responsiveness, which is beneficial for the feasibility of a clinical application.

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Preliminary Exploration of the Sequence of Nerve Fiber Bundles Involvement for Idiopathic Normal Pressure Hydrocephalus: A Correlation Analysis Using Diffusion Tensor Imaging

Frontiers in Neuroscience ◽

10.3389/fnins.2021.794046 ◽

2021 ◽

Vol 15 ◽

Author(s):

Wenjun Huang ◽

Xuhao Fang ◽

Shihong Li ◽

Renling Mao ◽

Chuntao Ye ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Normal Pressure Hydrocephalus ◽

Clinical Symptoms ◽

Diffusion Tensor ◽

Mmse Score ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Shunt Surgery ◽

Adc Value ◽

Frontal Horn

The study preliminarily explored the sequence and difference of involvement in different neuroanatomical structures in idiopathic normal pressure hydrocephalus (INPH). We retrospectively analyzed the differences in diffusion tensor imaging (DTI) parameters in 15 ROIs [including the bilateral centrum semiovale (CS), corpus callosum (CC) (body, genu, and splenium), head of the caudate nucleus (CN), internal capsule (IC) (anterior and posterior limb), thalamus (TH), and the bilateral frontal horn white matter hyperintensity (FHWMH)] between 27 INPH patients and 11 healthy controls and the correlation between DTI indices and clinical symptoms, as evaluated by the INPH grading scale (INPHGS), the Mini-Mental State Examination (MMSE), and the timed up and go test (TUG-t), before and 1 month after shunt surgery. Significant differences were observed in DTI parameters from the CS (pFA1 = 0.004, pADC1 = 0.005) and the genu (pFA2 = 0.022; pADC2 = 0.001) and body (pFA3 = 0.003; pADC3 = 0.002) of the CC between the groups. The DTI parameters from the CS were strongly correlated with the MMSE score both pre-operatively and post-operatively. There was association between apparent diffusion coefficient (ADC) values of anterior and posterior limbs of the IC and MMSE. The DTI parameters of the head of the CN were correlated with motion, and the ADC value was significantly associated with the MMSE score. The FA value from TH correlated with an improvement in urination after shunt surgery. We considered that different neuroanatomical structures are affected differently by disease due to their positions in neural pathways and characteristics, which is further reflected in clinical symptoms and the prognosis of shunt surgery.

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Outcome of modern shunt therapy in patients with idiopathic normal pressure hydrocephalus 6 years postoperatively

Journal of Neurosurgery ◽

10.3171/2014.6.jns131211 ◽

2014 ◽

Vol 121 (4) ◽

pp. 771-775 ◽

Cited By ~ 29

Author(s):

Leonie Gölz ◽

Finn-Hannes Ruppert ◽

Ullrich Meier ◽

Johannes Lemcke

Keyword(s):

Normal Pressure Hydrocephalus ◽

Clinical Symptoms ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Safe Procedure ◽

Medium Term ◽

Excellent Outcome ◽

Cerebral Diseases ◽

Preoperative Score

Object Shunt therapy in idiopathic normal pressure hydrocephalus (iNPH) can improve symptoms in 84% of patients 1 year postoperatively. Therefore, implantation of a ventriculoperitoneal shunt (VPS) prevents or at least prolongs the time during which patients are not dependent on care from others because of gait disorder or dementia. In this study, the medium-term results of modern shunt therapy were evaluated. Methods The authors retrospectively studied outcome in iNPH patients in whom VPSs were implanted. At yearly follow-up examinations over at least 6 years, clinical symptoms were recorded according to the NPH recovery rate (NPH-RR): (preoperative Kiefer Scale [KS] score − postoperative KS score)/(preoperative KS score × 10). Time and cause of death over this period were also analyzed. Results Among the 147 patients treated for iNPH in the period between 1997 and 2006, 69 had died at the time of the authors' survey. Sixty-one patients reached the 6-year examination. The median age was 64 years (range 33–83 years) at the time of VPS implantation and 73 years (range 41–91 years) at the time of this study. Six years after shunt implantation, the median KS score was significantly lower than the preoperative score (4.3 vs 8.1 points). Fifty-nine percent of 61 patients had an excellent outcome, 15% had satisfactory benefit, and 26% had unsatisfactory results 6 years postoperatively. Three of the 147 patients who underwent implantation of a VPS died of cerebral diseases 4–10 years postoperatively. Conclusions Implantation of a VPS is a safe procedure and can improve symptoms in 74% of patients with iNPH in the longer term.

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Default mode network connectivity in patients with idiopathic normal pressure hydrocephalus

Journal of Neurosurgery ◽

10.3171/2015.1.jns141633 ◽

2016 ◽

Vol 124 (2) ◽

pp. 350-358 ◽

Cited By ~ 12

Author(s):

Hui Ming Khoo ◽

Haruhiko Kishima ◽

Naoki Tani ◽

Satoru Oshino ◽

Tomoyuki Maruo ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Default Mode Network ◽

Resting State ◽

Clinical Symptoms ◽

Region Of Interest ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Urinary Continence ◽

Resting State Functional Connectivity ◽

Default Mode

OBJECT Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder characterized by gait disturbance, cognitive impairment, and incontinence. It is unclear whether the pathophysiology of iNPH is associated with alterations in the default mode network (DMN). The authors investigated alterations in the DMN of patients with iNPH and sought to determine whether a relationship exists between the resting-state functional connectivity of the DMN and a patient’s clinical symptoms. METHODS Resting-state functional MRI (rs-fMRI) was performed in 16 preoperative patients with iNPH and 15 neurologically healthy control subjects of a similar age. Independent component and dual-regression analyses were used to quantify DMN connectivity. The patients’ clinical symptoms were rated according to the iNPH grading scale (iNPHGS). Each of their specific clinical symptoms were rated according to the cognitive, gait, and urinary continence domains of iNPHGS, and neurocognitive status was assessed using the Mini-Mental State Examination, Frontal Assessment Battery (FAB), and Trail Making Test Part A. The strength of DMN connectivity was compared between patients and controls, and the correlation between DMN connectivity and iNPHGS was examined using both region of interest (ROI)-based analysis and voxel-based analysis. The correlation between DMN connectivity and each of the specific clinical symptoms, as well as neurocognitive status, was examined using voxel-based analysis. RESULTS Both ROI-based and voxel-based analyses revealed reduced DMN connectivity in patients with iNPH. ROI-based analysis showed increased DMN connectivity with worsening clinical symptoms of iNPH. Consistently, voxel-based analyses revealed that DMN connectivity correlated positively with the iNPHGS score, as well as the cognitive and urinary continence domain scores, and negatively with the FAB score. The significant peak in correlation in each case was localized to the precuneus. CONCLUSIONS This is the first study to establish alterations in the DMN of patients with iNPH. DMN connectivity may be a useful indicator of the severity of clinical symptoms in patients with iNPH.

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