How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study

Lundin, Fredrik; Ulander, Martin; Svanborg, Eva; Wikkelsø, Carsten; Leijon, Göran

doi:10.1016/j.clineuro.2012.05.009

Cited by 12 publications

(8 citation statements)

References 33 publications

(33 reference statements)

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“…Furthermore, previous brain MRE studies on Alzheimer's disease and multiple sclerosis illustrated that decreased brain tissue stiffness is associated with neurodegenerative changes [20, 33, 34]. Similarly, in this study we hypothesize that the decreased stiffness in the frontal lobe and deep GM/WM may be attributed to the underlying neurodegenerative process resulting from NPH or reduced blood flow [13, 24, 35, 36]. Increased pressure in these areas, producing elevated stiffness, due to ventricle enlargement may also contribute to a limited measurable reduction in stiffness.…”

Section: Methodssupporting

confidence: 60%

“…Several groups have shown that there is a strong correlation between surgical outcomes of shunt placement and patient's response to high-volume lumbar tap [5, 8-13]. However, several factors including time intervals between CSF taps, CSF leaks, and the subjective nature of both the diagnosis and therapeutic response may result in ambiguity in the interpretation of the results.…”

Section: Introductionmentioning

confidence: 99%

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MR Elastography Demonstrates Increased Brain Stiffness in Normal Pressure Hydrocephalus

Fattahi

Arani

Perry

et al. 2015

AJNR Am J Neuroradiol

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Introduction Normal pressure hydrocephalus (NPH) is a reversible neurologic disorder characterized by a triad of cognitive impairment, gait abnormality and urinary incontinence that is commonly treated with ventriculoperitoneal shunt placement. However, there are multiple overlapping symptoms which often make it difficult to differentiate NPH from other types of dementia and improved diagnostic techniques would help patient management. MR elastography (MRE) is a novel diagnostic tool that could potentially identify patients with NPH. The purpose of this study was to assess brain stiffness changes in NPH patients compared with age- and sex-matched cognitively normal individuals. Methods MRE was performed on 10 NPH patients and 21 age- and sex-matched volunteers with no known neurologic disorders. Image acquisition was conducted on a 3T MRI scanner. Shear waves with 60Hz vibration frequency were transmitted into the brain by a pillow-like passive driver. A novel postprocessing technique resistant to noise and edge artifacts was implemented to determine regional brain stiffness. The Wilcoxon rank sum test and linear regression were used for statistical analysis. Results A significant increase in stiffness was observed in the cerebrum (p = 0.001), occipital lobe (p = 0.0002), parietal lobe (p= 0.001), and the temporal lobe (p = 0.02) in the NPH group compared with normal controls. However, no significant difference was noted in other regions of the brain including the frontal lobe (p = 0.07), deep gray and white matter (p = 0.43), or the cerebellum (p = 0.20). Conclusion This study demonstrates increased brain stiffness in NPH patients compared to age- and sex-matched normal controls which motivates future studies investigating the use of MRE for NPH diagnosis and efficacy of shunt therapy.

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Section: Methodssupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

MR Elastography Demonstrates Increased Brain Stiffness in Normal Pressure Hydrocephalus

Fattahi

Arani

Perry

et al. 2015

AJNR Am J Neuroradiol

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“…They speculated that the patients are caught in the role of being cared for and are not able or motivated to change their habits in spite of improved performance. 19 This can also be true for the caregivers; the slow development of iNPH symptoms, in many cases over several years, gives rise to very gradual changes in the roles of family members. At the time of surgery these new roles may well have become firmly established and may be perceived as the normal way of living.…”

Section: Caregiver Burdenmentioning

confidence: 99%

Improvement in social function and health-related quality of life after shunt surgery for idiopathic normal-pressure hydrocephalus

Petersen

Hellström²,

Wikkelsø³

et al. 2014

JNS

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Object To investigate the impact of shunt surgery on the activity, participation, autonomy, and health-related quality of life (HRQOL) of patients with idiopathic normal-pressure hydrocephalus (iNPH) as well as the effect on caregiver burden. Methods Thirty-seven patients (median age 70 years, range 50–89 years) with iNPH were evaluated before and 6 months after surgery. Symptoms and signs were assessed by the iNPH scale, activities of daily living (ADL) with the Functional Independence Measure (FIM) and Assessment of Motor and Process Skills (AMPS), autonomy and participation with Impact on Participation and Autonomy (IPA), and caregiver burden with the Caregiver Burden Scale (CBS). HRQOL was evaluated with the EQ-5D (EuroQol Group–5 Dimension health survey). Results Twenty-four patients (65%) improved clinically (iNPH scale score) and 31 (86%) improved their HRQOL after surgery, almost to the same level as found in the normal population. The patients became more independent in physical and cognitive activities, and participation and autonomy improved. The caregiver burden was decreased among caregivers to male patients but remained unchanged on the overall group level. Conclusions After shunt surgery, patients with iNPH showed improvement in most aspects of social life, they became more independent, and their quality of life returned to nearly normal.

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“…In our study the majority of these dimensions remained impaired or even worsened. It has been suggested that post‐operative changes in the cerebrospinal fluid hydrodynamics cause hearing loss in some patients with NPH and they have also been reported to have effects on sleeping . However, sleep disordered breathing might also be connected with NPH and could also explain our observation.…”

Section: Discussionmentioning

confidence: 57%

Health‐related quality‐of‐life outcome in patients with idiopathic normal‐pressure hydrocephalus – a 1‐year follow‐up study

Junkkari

Häyrinen

Rauramaa

et al. 2016

Euro J of Neurology

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Less than half of the patients with iNPH experienced clinically significant favorable HRQoL outcome, partly explained by the patient's characteristics and comorbidities. The HRQoL approach reveals aspects that are important for the patient's well-being, but may also improve the quality of the outcome assessment of cerebrospinal fluid shunting. Study results may help clinicians to estimate which patients will benefit shunt surgery.

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How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study

Cited by 12 publications

References 33 publications

MR Elastography Demonstrates Increased Brain Stiffness in Normal Pressure Hydrocephalus

MR Elastography Demonstrates Increased Brain Stiffness in Normal Pressure Hydrocephalus

Improvement in social function and health-related quality of life after shunt surgery for idiopathic normal-pressure hydrocephalus

Health‐related quality‐of‐life outcome in patients with idiopathic normal‐pressure hydrocephalus – a 1‐year follow‐up study

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