Serial Tap Test of patients with idiopathic normal pressure hydrocephalus: impact on cognitive function and its meaning

Rocha, Samanta Fabricio Blattes da; Kowacs, Pedro André; Souza, Ricardo Krause Martinez de; Pedro, Matheus Kahakura Franco; Ramina, Ricardo; Teive, Hélio Afonso Ghizoni

doi:10.1186/s12987-021-00254-3

Cited by 12 publications

(7 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar results were seen in the study of Ryan Gallagher et al [9] on 40 patients who used MoCa score for evaluating the mental function. It was also seen in the study of Samanta Fabricio et al [16] on 61 patients with significant improvement after the first puncture in MMSE (p = 0.031).…”

Section: Mri Csf Flow Studies Showed An Important Role Not Only In Th...supporting

confidence: 61%

Accuracy of MRI CSF Flowmetry in the Diagnosis of Normal Pressure Hydrocephalus

Zakaria

Hafez

Elsamman

et al. 2022

Open Access Maced J Med Sci

View full text Add to dashboard Cite

BACKGROUND: Normal pressure hydrocephalus (NPH) is one of the few treatable causes of dementia. NPH is diagnosed using the clinical triad of: Gait disturbance, progressive mental deterioration, urinary urgency, or incontinence in association with radiological findings suggestive of NPH, for example, ventriculomegaly, disproportionately enlarged subarachnoid space hydrocephalus, and narrow callosal angles. AIM: The purpose of the present study was to assess the accuracy of MRI cine phase flow studies as a non-invasive modality in the diagnosis, and also for the prediction of improvement of symptoms suggestive of NPH without the need for CSF tapping. METHODS: Twenty-six patients suffering clinically from the triad of NPH, or at least two of them; attending our neurology, psychiatry, and neurosurgery clinics in Cairo University Hospitals, with ages ranging between 50 and 85 years, randomly chosen regarding sex or other comorbidities. All patients underwent a regular MRI in addition to CSF flowmetry studies to correlate the MRI findings that reveal NPH with their known clinical features. Careful clinical assessment was performed to detect severity of symptoms, and patients were classified accordingly, and a disability score was provided. After CSF tapping, patients were reassessed clinically after 6–8 h to detect improvement of symptoms, and the degree of improvement was compared to the result of CSF flow study. RESULTS: CSF flow studies, particularly stroke volume across the aqueduct of Sylvius, provide the highest significance in diagnosing hyperdynamic circulation evident by many radiological studies in cases of NPH. This was also found to be a good prognostic factor which correlates well with the improvement of symptoms following CSF tapping. However, its use to exclude suspicious cases of NPH seems unreliable, that is, not a good negative predictor. Findings of MRI CSF flow studies also show significance in detecting brain atrophic changes, especially peak systolic velocity, which usually accompany or mimic the clinical picture of NPH. CONCLUSION: MRI CSF flow studies are an excellent aid as an adjuvant non-invasive technique in selection of suspicious cases as it shows significance in detecting hyperdynamic circulation, especially high stroke volume results in cases of NPH. Both CSF tapping and CSF flowmetry findings “low stroke volume values” were not found to be a good negative predictor for clinical improvement after shunting.

show abstract

Section: Mri Csf Flow Studies Showed An Important Role Not Only In Th...supporting

confidence: 61%

Accuracy of MRI CSF Flowmetry in the Diagnosis of Normal Pressure Hydrocephalus

Zakaria

Hafez

Elsamman

et al. 2022

Open Access Maced J Med Sci

View full text Add to dashboard Cite

show abstract

“…Cognitive function changes appear later compared with other iNPH symptoms, such as gait disturbance ( 14 ). Considering that the MMSE score changes due to TT are not considerably large, it might be insufficient to evaluate cognitive function during a time period of 7 days after TT ( 30 , 35 , 36 ). However, MMSE score changes between “before TT” and 7 days after are useful in predicting the level of improvement at 12 months after shunt surgery.…”

Section: Discussionmentioning

confidence: 99%

Tap Test Can Predict Cognitive Improvement in Patients With iNPH—Results From the Multicenter Prospective Studies SINPHONI-1 and –2

et al. 2021

View full text Add to dashboard Cite

Background: We analyzed the predictive value of the tap test (TT) on the outcome of cerebrospinal fluid (CSF) shunting in patients with idiopathic normal pressure hydrocephalus (iNPH) and cognitive impairment up to 12 months postoperatively.Methods: We analyzed the data of two prospective multicenter studies on ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS) use in iNPH patients. We selected patients with Mini-Mental State Examination (MMSE) scores ≤ 26 points as study subjects. We used a multivariate logistic regression model to obtain the optimal threshold of MMSE scores after TT to predict the score improvement at 12 months following shunting and that helped to control for confounding factors such as age and MMSE scores before TT. We used logistic regression models to identify variables with age-adjusted odds ratio (A-OR) and multivariate-adjusted OR (M-OR).Results: For an improvement of ≥3 points in the MMSE score cutoff 7 days following TT in VPS and LPS cohort studies, the MMSE scores improved by 6 points after 12 months. The VPS cohort had sensitivity, specificity, and area under the curve (AUC) of 69.2, 73.7, and 0.771%, respectively; however, for the LPS cohort, they were 86.2, 90.9, and 0.906%, respectively. For MMSE scores that improved by ≥3 points in patients after the TT, the possibility of an improvement by 6 points at 12 months following CSF shunt had A-OR 7.77 and M-OR 6.3 times for the VPS, and A-OR 62.3 and M-OR 59.6 times for the LPS cohort.Conclusion: CSF shunting contributes to improved cognitive function in iNPH patients. Furthermore, MMSE score evaluation at the TT can sensitively predict improvement in postoperative MMSE scores following LPS intervention.Clinical Trial Registration: SINPHONI-1 (ClinicalTrials.gov, no. NCT00221091), first posted: September 22, 2005.SINPHONI-2 [University Hospital Medical Information Network (UMIN) Clinical Trials no. UMIN000002730], the posted: February 1, 2010.

show abstract

“…Improvements of cognitive functions associated with frontosubcortical structures and circuits, such as attentional and executive functions, have regularly been reported for iNPH patients following shunt placement (del Mar Matarín et al, 2007; Hellström et al, 2008; Peterson et al, 2016) and LP (da Rocha et al, 2021; Laidet et al, 2015; Wikkelsø et al, 1982). Ameliorations of the assessed functions might be facilitated by reinforced processing speed, a physiological reflection of the signal transmission capacity of white-matter fibers and thereby a prerequisite of higher cognitive abilities (Penke et al, 2010; Salthouse, 1992; Silva & Lee, 2023).…”

Section: Discussionmentioning

confidence: 94%

Phasic alertness and working memory improvements following lumbar puncture in iNPH patients differ from other age-associated cognitive syndromes.

Löbig¹,

Südmeyer²,

Werheid³

2024

Psychology & Neuroscience

View full text Add to dashboard Cite

Objective: Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbances, urinary incontinence, and cognitive impairment. Occurring in older age, iNPH is often mimicked by other neurological conditions. While the pattern of cognitive deficits is known to differ from other age-associated cognitive syndromes (AACS), there is no recommended standard test set for iNPH to date. In this study, we evaluate whether tests of attention and working memory differ between iNPH and AACS. Method: A total of 50 patients with suspected iNPH (23 iNPH, 27 AACS) receiving lumbar puncture (LP) in a neurological acute clinic were consecutively included in the study over 4 years. In a prospective study design, patients completed the Wechsler Memory Scale–Revised (WMS-R) digit spans, symbol digit modalities test (SDMT), and the Test of Attentional Performance (TAP) alertness subtest prior to and following LP. Subsequent group assignment (iNPH vs. AACS) was based on neurological assessment. Between-group comparisons were analyzed using Mann–Whitney rank sum test, and within-group change was analyzed using the Wilcoxon signed rank test. Results: In the iNPH group, post-LP improvements were found for the TAP index of phasic alertness (p = .005) and WMS-R digit span backward (p = .008). Both groups improved in SDMT score while between-group comparisons of this variable revealed a significant difference. Conclusions: Improvements of phasic alertness and working memory hold diagnostic value to differentiate iNPH from AACS. Test–retest effects in the AACS group SDMT results impede differentiation and need to be discussed.

show abstract

Serial Tap Test of patients with idiopathic normal pressure hydrocephalus: impact on cognitive function and its meaning

Cited by 12 publications

References 43 publications

Accuracy of MRI CSF Flowmetry in the Diagnosis of Normal Pressure Hydrocephalus

Accuracy of MRI CSF Flowmetry in the Diagnosis of Normal Pressure Hydrocephalus

Tap Test Can Predict Cognitive Improvement in Patients With iNPH—Results From the Multicenter Prospective Studies SINPHONI-1 and –2

Phasic alertness and working memory improvements following lumbar puncture in iNPH patients differ from other age-associated cognitive syndromes.

Contact Info

Product

Resources

About