Cerebrospinal Fluid Alzheimer’s Biomarkers and Neurofilament Light Profile of Idiopathic Normal Pressure Hydrocephalus in China: A PUMCH Cohort Study

2021 ◽  
pp. 1-8
Author(s):  
Chenhui Mao ◽  
Longze Sha ◽  
Caiyan Liu ◽  
Shanshan Chu ◽  
Jie Li ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cohort Study ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Accurate Diagnosis ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Standard Protocol ◽  
Neurofilament Light ◽  
Csf Biomarker ◽  
And Control

<b><i>Introduction:</i></b> Idiopathic normal pressure hydrocephalus (iNPH) is one of the potentially reversible dementias. Early and accurate diagnosis is important for patients’ prognosis. Emerging evidence shows fluid biomarkers are useful in diagnosis and pathophysiological research of iNPH. <b><i>Methods:</i></b> Probable iNPH and Alzheimer’s disease (AD) patients were recruited. Clinical diagnosis was performed according to international guidelines. CSF collection complied with a standard protocol. Commercial accessible ELISA kits were introduced for measurement of CSF <i>t</i>-tau, <i>p</i>-tau<sub>181</sub>, Aβ<sub>42</sub>, and NfL. <b><i>Results:</i></b> Twenty-seven iNPH, 27 AD, and 18 controls were included. The profiles of CSF <i>t</i>-tau, <i>p</i>-tau<sub>181</sub>, and <i>t</i>-tau/Aβ<sub>42</sub> in the iNPH and AD were significantly different (<i>p</i> &#x3c; 0.0001). The profiles of CSF <i>t</i>-tau, <i>p</i>-tau<sub>181</sub>, and <i>t</i>-tau/Aβ<sub>42</sub> in the iNPH and control were not different (<i>p</i> &#x3e; 0.05). Level of CSF Aβ<sub>42</sub> in iNPH was significantly lower than control (<i>p</i> &#x3c; 0.0001) and also significantly higher than AD (<i>p</i> &#x3c; 0.05). NfL level in iNPH and AD was increased, but its level in iNPH was significantly lower than that in AD (<i>p</i> = 0.005). NfL and <i>t</i>-tau level in the iNPH group was significantly correlated (coefficient = 0.649, <i>p</i> = 0.005), but not in AD (coefficient = 0.298, <i>p</i> = 0.157). <b><i>Conclusion:</i></b> Alzheimer’s CSF biomarker profile of iNPH subjects showed moderately decreased Aβ<sub>42</sub> and normal <i>t</i>-tau, <i>p</i>-tau<sub>181</sub>, and <i>t</i>-tau/Aβ<sub>42</sub>, which was distinguishable from AD. The different profiles and correlation of <i>t</i>-tau and NfL suggested different pathophysiology of AD and iNPH. <i>t</i>-tau was relatively an AD-specific neurodegenerative biomarker compared to NfL.

scholarly journals Evaluating the cerebrospinal fluid tap test with the Hellström iNPH scale for patients with idiopathic normal pressure hydrocephalus

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Johanna Rydja ◽  
Andreas Eleftheriou ◽  
Fredrik Lundin
Keyword(s):  
Cerebrospinal Fluid ◽  
Scale Score ◽  
Normal Pressure Hydrocephalus ◽  
Postoperative Outcome ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Urinary Continence ◽  
Predictive Values ◽  
Tap Test ◽  
Total Scale Score

Abstract Background The cerebrospinal fluid tap test (CSF TT) is used for selecting shunt surgery candidates among patients with idiopathic normal pressure hydrocephalus (iNPH). We aimed to evaluate the predictive value of the CSF TT, by using the Hellström iNPH scale for shunted iNPH patients with a standardized method. Methods One hundred and sixteen shunt-operated iNPH patients were retrospectively included in this study. The gait and balance domains in the iNPH scale were used as outcome measures for the CSF TT and the total iNPH scale score as the postoperative outcome. A positive response to CSF TT was defined as a change of ≥ 5 points in the gait domain and ≥ 16 points in the balance domain. Differences between CSF TT responders and non-responders, sensitivity, specificity, positive and negative predictive values, accuracy, and correlations between changes from baseline to post CSF TT and from baseline to the postoperative follow-up, were calculated. Results In the CSF TT there were 63.8% responders in the gait domain and correspondingly 44.3% in the balance domain. CSF TT responders had a significantly better postoperative outcome in the total scale score (gait P ≤ 0.001, balance P ≤ 0.012) and gait CSF TT responders improved more in gait (P ≤ 0.001) and balance CSF TT responders in balance (P ≤ 0.001). No differences between CSF TT gait or balance responders could be found in neuropsychological or urinary continence assessments postoperatively. The sensitivity and specificity of the CSF TT and the outcome of the total iNPH scale score postoperatively were 68.1% and 52.0% for gait and 47.8% and 68.0% for balance, respectively. Conclusions The CSF TT, with the Hellström iNPH scale as the outcome measure, has clear limitations in predicting postoperative results. The gait domain may be used to predict outcomes for gait, but the balance domain is too insensitive.

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

2021 ◽  
Author(s):  
Rongrong Hua ◽  
Chunyan Liu ◽  
Xing Liu ◽  
Jinwu Zhu ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Predictive Value ◽  
Test Group ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Binary Logistic Regression Analysis ◽  
Csf Biomarkers ◽  
Tap Test ◽  
T Tau

Abstract Background: The value of cerebrospinal fluid (CSF) biomarkers for idiopathic normal pressure hydrocephalus (iNPH) needs to be determined. This prospective study aimed to reveal the correlation between CSF biomarkers and clinical symptoms of iNPH, and its predictive value for tap test responsiveness.Methods: Thirty-nine suspected iNPH patients were recruited, contributed qualified CSF, and accepted a tap test and unified pre- and post-test evaluation of neurological function. Results: The analysis of biomarkers from their CSF showed a decrease of tau and its phosphorylated form, especially in the tap test (+) group. In addition, the responsiveness of the tap test was also related to the number of combined symptoms (p<0.01). A correlation was also found between the end pressure or pressure difference of CSF and tap test responsiveness (p<0.05). The results of 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) gave the highest sensitivity and specificity, which were 94.12% and 72.73%, respectively.Conclusions: It may be accessed in judgment of tap test responsiveness, which is beneficial for the feasibility of clinical application.

IMPROVEMENT AFTER CEREBROSPINAL FLUID DRAINAGE IS RELATED TO LEVELS OF N-ACETYL-ASPARTATE IN IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS

Neurosurgery ◽  
2008 ◽  
Vol 62 (1) ◽  
pp. 135-142 ◽  
Author(s):  
Niklas Lenfeldt ◽  
Jon Hauksson ◽  
Richard Birgander ◽  
Anders Eklund ◽  
Jan Malm
Keyword(s):  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Magnetic Resonance Spectroscopy ◽  
Normal Pressure Hydrocephalus ◽  
Proton Magnetic Resonance ◽  
Proton Magnetic Resonance Spectroscopy ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Resonance Spectroscopy ◽  
Frontal White Matter

AbstractOBJECTIVEThis study uses proton magnetic resonance spectroscopy to investigate whether or not idiopathic normal pressure hydrocephalus is associated with neuronal dysfunction or ischemia in the brain. We evaluate whether or not proton magnetic resonance spectroscopy is useful for predicting improvement after long-term external lumbar drainage (ELD) of cerebrospinal fluid.METHODSEighteen patients (mean age, 73 yr; six women) and 10 matching controls participated. Participants were characterized by clinical features, cognitive and motor function tests, and cerebrospinal fluid hydrodynamics (patients only). Signals from N-acetyl-aspartate (NAA), choline, lactate, and creatine (Cr) (reference) were sampled once in controls and twice in patients (before and after a 3-day ELD of ∼ 135 mL/24 h) by proton magnetic resonance spectroscopy (1.5 T) from a 7.2-mL volume in the frontal white matter. Improvement was defined by video recordings of the patients' gait.RESULTSSixteen patients finished the ELD (one patient had meningitis, and one patient had catheter insertion failure) with a mean drain volume of 395 mL. NAA/Cr ratios were lower in patients than in controls (1.60 versus 1.84, P = 0.02), but no difference was found for choline/Cr ratios. No lactate signals were detected. Fifty percent of patients improved after ELD. They had higher NAA/Cr ratios than nonimproved patients (1.70 versus 1.51, P = 0.01), but no differences were found in choline/Cr ratios or drain volume.CONCLUSIONNAA/Cr ratios were decreased in patients with idiopathic normal pressure hydrocephalus, which is consistent with neuronal dysfunction in the frontal white matter. Improved patients had NAA/Cr ratios close to normal, indicating that enough functional neurons are a prerequisite for the cerebrospinal fluid drainage to have an effect.

Cerebrospinal fluid biomarkers profile of idiopathic normal pressure hydrocephalus

2018 ◽  
Vol 125 (4) ◽  
pp. 673-679 ◽  
Author(s):  
Tommaso Schirinzi ◽  
Giulia Maria Sancesario ◽  
Giulia Di Lazzaro ◽  
Alessio D’Elia ◽  
Paola Imbriani ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Cerebrospinal Fluid Biomarkers
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