Comparison of cerebrospinal fluid space between probable normal pressure hydrocephalus and Alzheimer’s disease

Abstract

IntroductionIdiopathic normal pressure hydrocephalus (INPH) is a potentially reversible syndrome characterized by complex symptoms, difficulty in diagnosis and a lack of detailed clinical description, and it is difficult to distinguish from Alzheimer’s disease (AD). The objective of this study was to design a method for measuring the actual amount of hydrocephalus in patients with INPH and to evaluate INPH.MethodsAll subjects underwent a 3D T1-weighted MRI. Statistical parametric mapping 12 was used for preprocessing images, statistical analysis, and voxel-based morphometric gray matter (GM) volume, white matter (WM) volume, and cerebrospinal fluid (CSF) volume analysis. The demographic and clinical characteristics of the groups were compared using a t-test for continuous variables and a chi-square test for categorical variables. Pearson’s correlation analysis and Bonferroni’s statistic-corrected one-way ANOVA were used to determine the relationship among demographic variables. Receiver operating characteristic (ROC) curves were used to assess the accuracy of the callosal angle (CA), WM ratio, and CSF ratio in distinguishing probable INPH from AD.ResultsThe study included 42 patients with INPH, 32 patients with AD, and 24 healthy control subjects (HCs). There were no differences among the three groups in basic characteristics except for Mini-Mental State Examination (MMSE). There was a correlation between the intracranial CSF ratio and CA. The WM ratio and CSF ratio in patients with INPH and AD were statistically different. Furthermore, the combination of CA, WM ratio, and CSF ratio had a greater differential diagnostic value between INPH and AD patients than CA alone.ConclusionINPH can be accurately assessed by measuring intracranial CSF ratio, and the addition of WM ratio and CSF ratio significantly improved the differential diagnostic value of probable INPH from AD compared to CA alone.

Positive association between omega-3/6 polyunsaturated fatty acids and idiopathic normal pressure hydrocephalus: a mendelian randomization study

“…In 1965, Hakim and Adams proposed the hypothesis that iNPH was caused by an increase in CSF-volume and compensatory ventricular enlargement ( Hakim and Adams, 1965 ). Some research results have shown that iNPH patients have significantly reduced white matter volume, while cerebrospinal fluid volume, cerebrospinal fluid ratio, and total intracranial volume are significantly increased, supporting this hypothesis ( Li et al, 2023 ). Currently, the main causes of CSF-volume increase are believed to be CSF absorption disorders and increased CSF production ( Wang et al, 2020 ).…”

Structural neuroimaging markers of normal pressure hydrocephalus versus Alzheimer’s dementia and Parkinson’s disease, and hydrocephalus versus atrophy in chronic TBI—a narrative review

“…Yamada et al’s studies on indices characterizing CSF spaces for the optimal distinction of probable NPH from healthy controls ( 29 ), AD, and NPH-and-AD cohorts on T2-MRI ( 38 ) were also based on semi-quantitative approaches relying on automatic segmentation of brain tissue. In a recent study of CSF distribution, the normalized WM and CSF volumes derived using VBM, along with the CA were shown to provide improved distinction between probable NPH and AD using MRI sequences when compared to the CA alone ( 77 ).…”