Recovery in hydrocephalic dementia after shunt operation.

Gustafson, Lars; Hagberg, Bo

doi:10.1136/jnnp.41.10.940

Cited by 75 publications

(41 citation statements)

References 31 publications

(41 reference statements)

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“…We found signifi cant improvement in verbal memory and recall and psychomotor speed and motor precision after shunt surgery, but performance on the Stroop Color-Word test did not improve, suggesting that impairment of some executive functions may not be relieved by shunt. This corroborates fi ndings that frontal lobe executive functions may be impaired early in NPH patients, with irreversible damage to the frontostriatal pathways [4,5,27] . Improvement in another task of executive function, the Trail making B test (which relies more on sequencing and task switching), was seen in fewer than half of our patients, albeit the Trail making test is not specifi c for frontal lobe dysfunction [28] .…”

Section: Discussionsupporting

confidence: 76%

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Baseline Neuropsychological Profile and Cognitive Response to Cerebrospinal Fluid Shunting for Idiopathic Normal Pressure Hydrocephalus

Thomas¹,

McGirt²,

Woodworth³

et al. 2005

Dement Geriatr Cogn Disord

124

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Objective: To evaluate neurocognitive changes and predict neurocognitive outcome after ventriculoperitoneal shunting for idiopathic normal pressure hydrocephalus (INPH). Background: Reports of neurocognitive response to shunting have been variable and studies that predict cognitive outcomes after shunting are limited. We reviewed our experience with cognitive outcomes for INPH patients who were selected for shunting based on abnormal cerebrospinal fluid (CSF) pressure monitoring and positive response in any of the NPH symptoms following large volume CSF drainage. Methods: Forty-two INPH patients underwent neurocognitive testing and Folstein Mini-Mental State Examination (MMSE) prior to shunting. Neurocognitive testing or MMSEwere performed at least 3 months after shunt insertion. Significant improvement in a neurocognitive subtest was defined as improvement by one standard deviation (1 SD) for the patient’s age, sex and education level. Significant improvement in overall neurocognitive outcome was defined as a 4-point improvement in MMSE or improvement by 1 SD in 50% of the administered neurocognitive subtests. Nonparametric tests were used to assess changes. Predictors of outcome were assessed via logistic regression analysis. Results: Twenty-two patients (52.3%) showed overall neurocognitive improvement, and significant improvement was seen in tests of verbal memory and psychomotor speed. Predictive analysis showed that patients scoring more than 1 SD below mean at baseline on verbal memory immediate recall were fourfold less likely to show overall cognitive improvement, and sixfold less likely if also associated with visuoconstructional deficit or executive dysfunction. Verbal memory scores at baseline were higher in patients who showed overall cognitive improvement. Conclusions: Shunting INPH patients on the basis of CSF pressure monitoring and drainage response shows a significant rate of cognitive improvement, and baseline neurocognitive test scores may distinguish patients likely to respond to shunt surgery from those who will not.

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Section: Discussionsupporting

confidence: 76%

“…[2] . NPH may account for up to 5% of causes of dementia [3] , and the cognitive defi cits are of 'frontosubcortical' type [4][5][6] . There is decline in active retrieval of memory, executive functions and complex information processing; visuospatial perception and visuoconstructive skills may also be affected [3,7] .…”

Section: Introductionmentioning

confidence: 99%

Baseline Neuropsychological Profile and Cognitive Response to Cerebrospinal Fluid Shunting for Idiopathic Normal Pressure Hydrocephalus

Thomas¹,

McGirt²,

Woodworth³

et al. 2005

Dement Geriatr Cogn Disord

124

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“…This agrees with Gustafson and Hagberg's findings [9], who noted a pronounced postoperative improvement from a marked dysfunction in "spatioperceptual performance" preoperatively .…”

Section: Discussionsupporting

confidence: 84%

“…Furthermore, there is no consensus regarding diagnostic criteria and preoperative tests, although there have been several attempts to identify such factors. For instance, known cause or short history are stressed by some authors as potent predictors [3,9,11,151. Bgirgesen and Gjerris [6] have recently shown that a combination of clinical features, computed tomography (CT) findings, recording of intraventricular pressure, and measurement of conductance to outflow of cerebrospinal fluid (C,,,) may result in an improved success rate following shunting.…”

mentioning

confidence: 99%

Prognosis of dementia in normal‐pressure hydrocephalus after a shunt operation

Thomsen¹,

Børgesen²,

Bruhn³

et al. 1986

Annals of Neurology

132

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Forty patients who had normal-pressure hydrocephalus were examined neuropsychologically before and 12 months after a ventriculoatrial shunt operation. Comparison of the preoperative and postoperative test results showed that cognitive functions improved in 16 patients, were unchanged in 19, and deteriorated in 5. Moreover, we found that the outcome of the operation depended on patient selection criteria. When three or more of the following preoperative signs were present (known cause, short history, low cerebrospinal fluid outflow, small sulci and/or periventricular hypodensity indicated by computed tomography), an improvement in cognitive function was seen in 80% of the patients after a shunt operation.

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“…30 The duration of preoperative symptoms has been reported to be a significant factor in the prognosis of NPH. 16,30 Patients with sNPH present with a shorter duration of preoperative symptoms, because the presence of a known etiology can lead to an earlier investigation and detection of NPH symptoms. Similarly, Thomsen et al reported that patients with NPH of a known cause had a better outcome than patients with iNPH, and that disease duration of less than 12 months was an important factor for successful outcome.…”

Section: 5mentioning

confidence: 99%

Revisiting secondary normal pressure hydrocephalus: does it exist? A review

Daou

Klinge

Tjoumakaris

et al. 2016

FOC

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OBJECTIVE There are several etiologies that can lead to the development of secondary normal pressure hydrocephalus (sNPH). The aim of this study was to evaluate the etiology, diagnosis, treatment, and outcome in patients with sNPH and to highlight important differences between the separate etiologies. METHODS A comprehensive review of the literature was performed to identify studies conducted between 1965 and 2015 that included data regarding the etiology, treatment, diagnosis, and outcome in patients with sNPH. Sixty-four studies with a total of 1309 patients were included. The inclusion criteria of this study were articles that were written in English, included more than 2 patients with the diagnosis of sNPH, and contained data regarding the etiology, diagnosis, treatment, or outcome of NPH. The most common assessment of clinical improvement was based on the Stein and Langfitt grading scale or equivalent improvement on other alternative ordinal grading scales. RESULTS The main etiologies of sNPH were subarachnoid hemorrhage (SAH) in 46.5%, head trauma in 29%, intracranial malignancies in 6.2%, meningoencephalitis in 5%, and cerebrovascular disease in 4.5% of patients. In 71.9% of patients the sNPH was treated with ventriculoperitoneal shunt placement, and 24.4% had placement of a ventriculoatrial shunt. Clinical improvement after shunt placement was reported in 74.4% and excellent clinical improvement in 58% of patients with sNPH. The mean follow-up period after shunt placement was 13 months. Improvement was seen in 84.2% of patients with SAH, 83% of patients with head trauma, 86.4% of patients with brain tumors, 75% of patients with meningoencephalitis, and 64.7% of patients with NPH secondary to stroke. CONCLUSIONS Secondary NPH encompasses a diverse group of clinical manifestations associated with a subset of patients with acquired hydrocephalus. The most common etiologies of sNPH include SAH and traumatic brain injury. Secondary NPH does indeed exist, and should be differentiated from idiopathic NPH based on outcome and on clinical, pathophysiological, and epidemiological characteristics, but should not be considered as a separate entity.

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Recovery in hydrocephalic dementia after shunt operation.

Cited by 75 publications

References 31 publications

Baseline Neuropsychological Profile and Cognitive Response to Cerebrospinal Fluid Shunting for Idiopathic Normal Pressure Hydrocephalus

Baseline Neuropsychological Profile and Cognitive Response to Cerebrospinal Fluid Shunting for Idiopathic Normal Pressure Hydrocephalus

Prognosis of dementia in normal‐pressure hydrocephalus after a shunt operation

Revisiting secondary normal pressure hydrocephalus: does it exist? A review

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