Gait characteristics and effects of the cerebrospinal fluid tap test in probable idiopathic normal pressure hydrocephalus

Liu, Chunyan; Hua, Rongrong; Wei, Youping; Li, Hongliang; Yang, Qian; Liu, Xing; Xing, Yan

doi:10.1016/j.clineuro.2021.106952

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Comparisons of the temporospatial gait variables between pre- and post-tap tests in the whole group of participants showed that CSF removal by tap test had some gait benefits and improved left step length, right step time, stride length and time, cadence, and gait speed, which was consistent with previous reports that showed improvements in stride length 10 , 22 , 49 and gait speed 10 , 22 , 28 , 49 . The results of this study differed from previously reported studies which showed improvement in step width 22 but our study did not.…”

Section: Discussionsupporting

confidence: 90%

Clinical improvements in temporospatial gait variables after a spinal tap test in individuals with idiopathic normal pressure hydrocephalus

Bovonsunthonchai,

Witthiwej,

Vachalathiti

et al. 2024

Sci Rep

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Idiopathic Normal Pressure Hydrocephalus (iNPH) is a neurological condition that often presents gait disturbance in the early stages of the disease and affects other motor activities. This study investigated changes in temporospatial gait variables after cerebrospinal fluid (CSF) removal using a spinal tap test in individuals with idiopathic normal pressure hydrocephalus (iNPH), and explored if the tap test responders and non-responders could be clinically identified from temporospatial gait variables. Sixty-two individuals with iNPH were recruited from an outpatient clinic, eleven were excluded, leaving a total of 51 who were included in the analysis. Temporospatial gait variables at self-selected speed were recorded at pre- and 24-h post-tap tests which were compared using Paired t-tests, Cohen’s d effect size, and percentage change. A previously defined minimal clinical important change (MCIC) for gait speed was used to determine the changes and to classify tap test responders and non-responders. A mixed model ANOVA was used to determine the within-group, between-group, and interaction effects. Comparisons of the data between pre- and post-tap tests showed significant improvements with small to medium effect sizes for left step length, right step time, stride length and time, cadence, and gait speed. Gait speed showed the largest percentage change among temporospatial gait variables. Within-group and interaction effects were found in some variables but no between-group effect was found. Tap test responders showed significant improvements in right step length and time, stride length and time, cadence, and gait speed while non-responders did not. Some individuals with iNPH showed clinically important improvements in temporospatial gait variables after the tap test, particularly in step/stride length and time, cadence, who could be classified by gait speed. However, gait-related balance variables did not change. Therefore, additional treatments should focus on improving such variables.

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Section: Discussionsupporting

confidence: 90%

Clinical improvements in temporospatial gait variables after a spinal tap test in individuals with idiopathic normal pressure hydrocephalus

Bovonsunthonchai,

Witthiwej,

Vachalathiti

et al. 2024

Sci Rep

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“…Idiopathic normal pressure hydrocephalus (INPH) is a potentially reversible syndrome characterized clinically by ventricular enlargement (enlarged ventricles), cognitive impairment, gait disorders, and urinary incontinence ( Williams and Relkin, 2013 ; Chunyan et al, 2021 ; Nakajima et al, 2021 ). Alzheimer’s disease (AD) shares common features with INPH in clinical appearances, laboratories, and imaging, such as executive dysfunction, impairment in attention and short-term memory in cognition ( Chunyan et al, 2021 ). INPH and AD are both likely to happen in the elderly population but INPH is a reversible neurological disease ( Yamada et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

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

Li,

Liu,

Tai

et al. 2023

Front. Aging Neurosci.

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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.

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“…The most common form of hydrocephalus in ‘adults’ is iNPH ( Williams and Malm, 2016 ), which is often confused with AD due to similarities in symptoms ( Graff-Radford, 2014 ; Yamada et al, 2016 ). Although the cognitive impairment can be confused between the NPH and AD, gait dysfunction is a primary differentiating feature, which is present in NPH but not in AD ( He D. et al, 2021 ; He M. et al, 2021 ; Chunyan et al, 2021 ; Davis et al, 2021 ; Hnin et al, 2021 ; Jeong et al, 2021 ; Kuruvithadam et al, 2021 ; Morel et al, 2021 ; Nikaido et al, 2021 ; Tang et al, 2021 ; Yamada et al, 2021 ; Maier et al, 2022 ; Nikaido et al, 2022 ; Sun et al, 2022 ; Suzuki et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

TRPV4 mRNA is elevated in the caudate nucleus with NPH but not in Alzheimer’s disease

et al. 2022

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Symptoms of normal pressure hydrocephalus (NPH) and Alzheimer’s disease (AD) are somewhat similar, and it is common to misdiagnose these two conditions. Although there are fluid markers detectable in humans with NPH and AD, determining which biomarker is optimal in representing genetic characteristics consistent throughout species is poorly understood. Here, we hypothesize that NPH can be differentiated from AD with mRNA biomarkers of unvaried proximity to telomeres. We examined human caudate nucleus tissue samples for the expression of transient receptor potential cation channel subfamily V member 4 (TRPV4) and amyloid precursor protein (APP). Using the genome data viewer, we analyzed the mutability of TRPV4 and other genes in mice, rats, and humans through matching nucleotides of six genes of interest and one house keeping gene with two factors associated with high mutation rate: 1) proximity to telomeres or 2) high adenine and thymine (A + T) content. We found that TRPV4 and microtubule associated protein tau (MAPT) mRNA were elevated in NPH. In AD, mRNA expression of TRPV4 was unaltered unlike APP and other genes. In mice, rats, and humans, the nucleotide size of TRPV4 did not vary, while in other genes, the sizes were inconsistent. Proximity to telomeres in TRPV4 was <50 Mb across species. Our analyses reveal that TRPV4 gene size and mutability are conserved across three species, suggesting that TRPV4 can be a potential link in the pathophysiology of chronic hydrocephalus in aged humans (>65 years) and laboratory rodents at comparable ages.

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Gait characteristics and effects of the cerebrospinal fluid tap test in probable idiopathic normal pressure hydrocephalus

Cited by 3 publications

References 19 publications

Clinical improvements in temporospatial gait variables after a spinal tap test in individuals with idiopathic normal pressure hydrocephalus

Clinical improvements in temporospatial gait variables after a spinal tap test in individuals with idiopathic normal pressure hydrocephalus

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

TRPV4 mRNA is elevated in the caudate nucleus with NPH but not in Alzheimer’s disease

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