Association between Milder Brain Deformation before a Shunt Operation and Improvement in Cognition and Gait in Idiopathic Normal Pressure Hydrocephalus

Yamamoto, Daisuke; Kazui, Hiroaki; Wada, Tamiki; Nomura, Keiko; Sugiyama, Hiromichi; Shimizu, Yoshiro; Yoshiyama, Kenji; Yoshida, Tetsuhiko; Kishima, Haruhiko; Yamashita, Fumio; Yoshimine, Toshiki; Takeda, Masatoshi

doi:10.1159/000347147

Cited by 18 publications

(12 citation statements)

References 72 publications

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“…The MRI scans did not show any changes in diameter and cross‐sectional area of the midbrain after shunting . Because shunting has been proven to improve gait function in NPH patients, the lack of change in midbrain diameter reported by Hiraoka et al . serves as evidence that refutes the original hypothesis that midbrain abnormalities are associated with gait dysfunction in NPH.…”

Section: Pathophysiology Of Gaitmentioning

confidence: 79%

Clinical manifestations of hydrocephalus: A review

Schwamb

Dalpiaz

Miao

et al. 2014

Neurology & Clinical Neurosc

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Background: Normal Pressure Hydrocephalus is a disease, which results from excess cerebral spinal fluid, it is often misdiagnosed for other degenerative diseases. Symptoms of Normal Pressure Hydrocephalus may be reversed with new treatment techniques such as shunting. Aims: The aim of this article is to review the pathophysiology of Normal Pressure Hydrocephalus, discuss how to distinguish it from other diseases and discuss treatment options, which show potential for treating Normal Pressure Hydrocephalus. Methods: PubMed was used to conduct searches regarding the subject matter of this article. Results: Gait, dementia and urinary incontinence, which are also referred to as Adam's Triad, are typical associated with Normal Pressure Hydrocephalus. The pathophysiology of these conditions has been outlined in this article. Review articles have been outlined which discuss the potential certain shunt operations have to treat Normal Pressure Hydrocephalus. Discussion: There are several known treatment options that have been successful when treating Normal Pressure Hydrocephalus. With the use of shunts to drain excess cerebral spinal fluid, it is possible to improve the patient's symptoms and thus improve their quality of life. Conclusion: Normal Pressure Hydrocephalus should be considered when treating elderly patients that show signs of Adam's Triad. There are numerous types of treatment options available that show promise as to relieving some of the symptoms that are associated with Normal Pressure Hydrocephalus.

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Section: Pathophysiology Of Gaitmentioning

confidence: 79%

Clinical manifestations of hydrocephalus: A review

Schwamb

Dalpiaz

Miao

et al. 2014

Neurology & Clinical Neurosc

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“…First, the number of participants was small. Second, we used the ROI method to avoid distortion problems because of severe brain deformation of patients with iNPH . Such distortions affect voxel‐based statistical image analyzing methods, such as statistical parametric mapping, and therefore we could not evaluate rCBF across the whole brain.…”

Section: Discussionmentioning

confidence: 99%

Apathy and right caudate perfusion in idiopathic normal pressure hydrocephalus: A case‐control study

Kanemoto

Kazui

Suehiro

et al. 2018

Int J Geriat Psychiatry

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Objectives: Apathy is prevalent in patients with idiopathic normal pressure hydrocephalus (iNPH), a treatable disorder resulting from ventricular enlargement. We assessed the relationship between apathy and regional cerebral blood flow (rCBF) in patients with iNPH.Methods: Before lumbo-peritoneal shunt surgery (LPS), 56 iNPH patients were evaluated on apathy and dysphoria subscales of the Neuropsychiatric inventory (NPI), and were divided into two groups according to NPI apathy score: 15 without apathy (iNPH−APA) and 41 with apathy (iNPH+APA). Among iNPH+APA, 29 patients were evaluated for apathy and dysphoria 3 months after LPS, and were divided into two groups on the basis of the change in NPI apathy score: 13 with improvement (iNPH+ImpAPA) and 16 without improvement in apathy (iNPH−ImpAPA). Nisopropyl-p-iodoamphetamine single photon emission computed tomography using the autoradiography method was performed before and after LPS, and rCBF was calculated in 22 regions of interest in the frontal cortex, basal ganglia, and limbic system. Results:In iNPH+APA, rCBF in the right caudate nuclei before LPS was significantly lower than that in iNPH−APA (P = 0.004; two-sample t test). Between iNPH−ImpAPA and iNPH+ImpAPA, a significant group-by-shunt interaction was observed for rCBF in only the right caudate nuclei (F 1, 28 = 11.75, P = 0.002; two-way repeated-measures analysis of variance), with increased rCBF in iNPH+ImpAPA but not in iNPH−ImpAPA.The significant group-by-shunt interaction persisted if change in NPI dysphoria scores was used as a covariate (F 1, 27 = 8.33, P = 0.008). Conclusions:Our findings suggest that right caudate dysfunction might cause apathy in iNPH patients. KEYWORDS apathy, brain perfusion, caudate nuclei, cognitive impairment, depressive mood, idiopathic normal pressure hydrocephalus, lumbo-peritoneal shunt surgery

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“…Several studies found long-term improvement of cognitive functions after shunt surgery [ 34 , 35 , 36 , 37 ], while others failed to demonstrate such an improvement [ 14 , 20 , 38 ]. However, comparability between studies is hampered both by the use of different neuropsychological test batteries and different time intervals between intervention and neuropsychological assessment.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Spinal Tap Test on Different Sensory Modalities of Postural Stability in Idiopathic Normal Pressure Hydrocephalus

Abram

Bohne

Bublak

et al. 2016

Dement Geriatr Cogn Disord Extra

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Background/Aims: Postural instability in patients with normal pressure hydrocephalus (NPH) is a most crucial symptom leading to falls with secondary complications. The aim of the current study was to evaluate the therapeutic effect of spinal tap on postural stability in these patients. Methods: Seventeen patients with clinical symptoms of NPH were examined using gait scale, computerized dynamic posturography (CDP), and neuropsychological assessment. Examinations were done before and after spinal tap test. Results: The gait score showed a significant improvement 24 h after spinal tap test in all subtests and in the sum score (p < 0.003), while neuropsychological assessment did not reveal significant differences 72 h after spinal tap test. CDP showed significant improvements after spinal tap test in the Sensory Organization Tests 2 (p = 0.017), 4 (p = 0.001), and 5 (p = 0.009) and the composite score (p = 0.01). Patients showed best performance in somatosensory and worst performance in vestibular dominated tests. Vestibular dominated tests did not improve significantly after spinal tap test, while somatosensory and visual dominated tests did. Conclusion: Postural stability in NPH is predominantly affected by deficient vestibular functions, which did not improve after spinal tap test. Conditions which improved best were mainly independent from visual control and are based on proprioceptive functions.

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Association between Milder Brain Deformation before a Shunt Operation and Improvement in Cognition and Gait in Idiopathic Normal Pressure Hydrocephalus

Cited by 18 publications

References 72 publications

Clinical manifestations of hydrocephalus: A review

Clinical manifestations of hydrocephalus: A review

Apathy and right caudate perfusion in idiopathic normal pressure hydrocephalus: A case‐control study

The Effect of Spinal Tap Test on Different Sensory Modalities of Postural Stability in Idiopathic Normal Pressure Hydrocephalus

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