Amyloid deposits and response to shunt surgery in idiopathic normal-pressure hydrocephalus

Hiraoka, Kotaro; Narita, Wataru; Kikuchi, Hiroe; Baba, Toru; Kanno, Shigenori; Iizuka, Osamu; Tashiro, Masato; Furumoto, Shozo; Okamura, Nobuyuki; Furukawa, Koichi; Arai, Hiroyuki; Iwata, Ren; Mori, Etsuro; Yanai, Kazuhiko

doi:10.1016/j.jns.2015.06.029

Cited by 33 publications

(28 citation statements)

References 21 publications

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“…A recent positron-emission tomography study demonstrated that patients with significant cortical amyloid deposits exhibit less cognitive improvement following shunt surgery. 35 High-convexity tightness or DESH is probably more strongly related to comorbidity than to reversibility. Elderly individuals who exhibit DESH on MR imaging can be asymptomatic for 5 or more years, 36 which suggests that DESH is not well-correlated with pathophysiologic severity and reversibility.…”

Section: Discussionmentioning

confidence: 99%

High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus

Narita

Nishio

Baba

et al. 2016

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus

Narita

Nishio

Baba

et al. 2016

AJNR Am J Neuroradiol

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“…However in some studies AD pathology severity precluded clinical improvement [ 16 – 18 , 20 ]. The different findings could be partially explained by methodological issues such as different sample size, frequently small sample size [ 12 , 14 , 16 , 18 ], different methods used to measure Aβ in brain by means of biopsy or PET [ 22 ] or CSF [ 31 ], and application of different outcome measures such as subjective report [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some showing similar improvement in both groups, others showing improvement in gait only in participants with comorbid AD pathology found on brain biopsy obtained during shunt surgery [ 12 , 14 , 16 – 20 ]. Additionally, a study of 39 participants using phosphorylated tau and amyloid beta 1–42 ratio as measure of AD pathology in ventricular CSF showed less improvement in gait and cognition among participants with high ratio [ 21 ], while another small study of 10 participants using PET amyloid beta (Aβ) imaging showed less cognitive improvement in participants with high Aβ [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Alzheimer’s disease pathology and shunt surgery outcome in normal pressure hydrocephalus

Yaşar

Jusué-Torres²,

et al. 2017

PLoS ONE

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We aimed to determine whether presence of AD neuropathology predicted cognitive, gait and balance measures in patients with idiopathic normal pressure hydrocephalus (iNPH) after shunt surgery. This is a prospective study of gait and balance measured by Timed Up and Go (TUG) and Tinetti tests, and cognitive function measured by Mini Mental Status Exam (MMSE), before and after shunt surgery in participants 65 years and older with iNPH at the Johns Hopkins University. Random effects models were used and adjusted for confounders. 88 participants were included in the analysis with a median (IQR) time of 104 (57–213) days between surgery and follow-up. 23 (25%) participants had neuritic plaques present (NP+) and were significantly older [76.4 (6.0) years], but were otherwise similar in all demographics and outcome measures, when compared to the group without neuritic plaques (NP-). NP- and NP+ participants equally improved on measures of TUG (β = -3.27, 95% CI -6.24, -0.30, p = 0.03; β = -2.37, 95% CI -3.90, -0.86, p = 0.02, respectively), Tinetti-total (β = 1.95, 95% CI 1.11, 2.78, p<0.001; β = 1.72, 95% CI 0.90, 2.53, p<0.001, respectively), -balance (β = 0.81, 95% CI 0.23, 1.38, p = 0.006; β = 0.87, 95% CI 0.40, 1.34, p<0.001, respectively) and -gait (β = 1.03, 95% CI 0.61, 1.45, p<0.001; β = 0.84, 95% CI 0.16, 1.53, p = 0.02, respectively), while neither NP- nor NP+ showed significant improvement on MMSE (β = 0.10, 95% CI -0.27, 0.46, p = 0.61, β = 0.41, 95% CI -0.27, 1.09, p = 0.24, respectively). In summary, 26% of participants with iNPH had coexisting AD pathology, which does not significantly influence the clinical response to shunt surgery.

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“…Cerebral imaging shows ventricular dilation, whereas the subarachnoid space on both sides of the superior sagittal sinus is comparatively small [1]. Unlike in acute or subacute obstructive hydrocephalus, response to surgical shunt treatment in NPH is difficult to predict [2]. At autopsy, many of these patients display pathological findings suggesting neurodegenerative disease.…”

Section: Introductionmentioning

confidence: 99%

Small cisterno-lumbar gradient of phosphorylated Tau protein in geriatric patients with suspected normal pressure hydrocephalus

Djukic

Spreer

Lange

et al. 2016

Fluids Barriers CNS

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BackgroundThe composition of the cerebrospinal fluid (CSF) is not homogeneous, and concentrations of proteins from different origins diverge among ventricular, cisternal and lumbar CSF fractions. Concentrations of blood-derived proteins increase and of brain-derived proteins decrease from ventricular to lumbar fractions. We studied whether the origin of the CSF portion analysed may affect results in CSF analysis for dementia.MethodsIn 16 geriatric patients with suspected normal pressure hydrocephalus [age 82.5 (76/87) years; median (25th/75th percentile)] a lumbar spinal tap of 40 ml was performed. The CSF was sequentially collected in 8 fractions of 5 ml with the 1st fraction corresponding to lumbar CSF, the 8th to cisterna magna-near CSF. Fractions were analysed for total protein, albumin, Tau protein (Tau), phosphorylated Tau (pTau), Amyloid beta 1–42 (Aβ1–42), Amyloid beta 1–40 (Aβ1–40), and the Aβ1–42/Aβ1–40 ratio.ResultsThe concentrations of total protein and albumin increased from cisternal to lumbar fractions due to diffusion-related accumulation from blood to CSF with significantly higher concentrations in fraction 1 compared to fraction 8. The concentrations of Tau showed a non-significant trend towards decreased values in lumbar samples, and pTau was slightly, but significantly decreased in the lumbar fraction 1 [26.5 (22.5/35.0) pg/ml] compared to the cistern-near fraction 8 [27.0 (24.2/36.3) pg/ml] (p = 0.02, Wilcoxon signed rank test). Aβ1-42, Aβ1-40, and the Aβ1-42/Aβ1-40 ratio remained almost constant.ConclusionsAccording to the flow-related diverging dynamics of blood-derived and brain-derived proteins in CSF, the concentrations of Tau and pTau tended to be lower in lumbar compared to cisternal CSF fractions after a spinal tap of 40 ml. The differences reached statistical significance for pTau only. The small differences will not affect clinical interpretation of markers of dementia in the vast majority of cases.Electronic supplementary materialThe online version of this article (doi:10.1186/s12987-016-0039-9) contains supplementary material, which is available to authorized users.

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Amyloid deposits and response to shunt surgery in idiopathic normal-pressure hydrocephalus

Cited by 33 publications

References 21 publications

High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus

High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus

Alzheimer’s disease pathology and shunt surgery outcome in normal pressure hydrocephalus

Small cisterno-lumbar gradient of phosphorylated Tau protein in geriatric patients with suspected normal pressure hydrocephalus

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