Shunt-responsive parkinsonism and reversible white matter lesions in patients with idiopathic NPH

Akiguchi, Ichiro; Ishii, Mitsuaki; Watanabe, Yûko; Watanabe, Toshiyuki; Kawasaki, Toshisuke; Yano, Hideo; Shiino, Akihiko; Shirakashi, Yoshitomo; Kawamoto, Yuko

doi:10.1007/s00415-008-0928-1

Cited by 70 publications

(60 citation statements)

References 39 publications

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“…Nevertheless, the finding that some of the clinical symptoms associated with INPH recover after shunt placement implies that the abnormalities observed in the areas of white matter with low FA values should be at least partially reversible. A recent study demonstrated that periventricular white matter lesions observed through MRI and/or CT scans could be reversed by shunt operation in some shunt-responsive INPH patients [46]. In combination with the results of the present study, the neuropathological finding of reversible white matter lesions in INPH patients might be related to interstitial oedema, which is detected by high MD values.…”

Section: Discussionsupporting

confidence: 82%

White matter involvement in idiopathic normal pressure hydrocephalus: a voxel-based diffusion tensor imaging study

et al. 2011

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The aim of this study was to characterise the white matter damage involved in idiopathic normal pressure hydrocephalus (INPH) using diffusion tensor imaging (DTI) and the relationship between this damage and clinical presentation. Twenty patients with INPH, 20 patients with Alzheimer's disease and 20 patients with idiopathic Parkinson's disease (as disease control groups) were enrolled in this study. Mean diffusivity (MD) and fractional anisotropy (FA) were determined using DTI, and these measures were analysed to compare the INPH group with the control groups and with certain clinical correlates. On average, the supratentorial white matter presented higher MD and lower FA in the INPH group than in the control groups. In the INPH group, the mean hemispheric FA correlated with some of the clinical measures, whereas the mean hemispheric MD did not. On a voxel-based statistical map, white matter involvement with high MD was localised to the periventricular regions, and white matter involvement with low FA was localised to the corpus callosum and the subcortical regions. The total scores on the Frontal Assessment Battery were correlated with the FA in the frontal and parietal subcortical white matter, and an index of gait disturbance was correlated with the FA in the anterior limb of the left internal capsule and under the left supplementary motor area. DTI revealed the presence of white matter involvement in INPH. Whereas white matter regions with high MD were not related to symptom manifestation, those with low FA were related to motor and cognitive dysfunction in INPH.

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Section: Discussionsupporting

confidence: 82%

White matter involvement in idiopathic normal pressure hydrocephalus: a voxel-based diffusion tensor imaging study

et al. 2011

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“…We selected frequently used neuropsychological tests for patients with iNPH in order to evaluate the comprehensive cognitive function (8,9). The MMSE and HDS-R were performed as global measurements to estimate the cognitive function.…”

Section: Neuropsychological Examinationsmentioning

confidence: 99%

Subclinical Declines in the Verbal Fluency and Motor Regulation of Patients with AVIM (Asymptomatic Ventriculomegaly with Features of Idiopathic NPH on MRI): A Case-controlled Study

et al. 2013

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Objective We previously reported that, on brain MRI, iNPH features were observed in approximately 1% of asymptomatic elderly community dwellers. This phenomenon is designated asymptomatic ventriculomegaly with features of iNPH on MRI (AVIM). The aim of the present study was to clarify whether a subclinical decline in the neuropsychological function is present in patients with AVIM. Methods We examined eight subjects with AVIM, six subjects with possible iNPH and 21 elderly controls. Neuropsychological tests were used, including the mini-mental state examination (MMSE), the Hasegawa dementia scale-revised (HDS-R), the frontal assessment battery (FAB), the trail making test A&B and semantic and letter verbal fluency tests. Results When comparing the individuals with AVIM with the control subjects, significant differences were found in the scores achieved on the semantic verbal fluency tests and Luria's motor series (fist-edge-palm), a subtest of the FAB. Conclusion The present study suggests that individuals with AVIM demonstrate a slight subclinical decline in the cognitive function and motor regulation, which may represent a prodromal stage of iNPH.

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“…Since the NeMo Tool reports results as distributions over a population of CN, small differences in ROI location should not unduly influence the results. The NeMo results indicated that the fiber tracts passing through these regions connect to cortical and subcortical structures which have been implicated as loci of abnormal brain function in NPH (Akiguchi et al, 2008;Gleichgerrcht et al, 2009;Otani et al, 2004;Saito et al, 2011). Both the anterior and posterior masks showed reduced connections only ipsi-laterally.…”

Section: Interpretation Of the Nemo Resultsmentioning

confidence: 94%

The Network Modification (NeMo) Tool: Elucidating the Effect of White Matter Integrity Changes on Cortical and Subcortical Structural Connectivity

et al. 2013

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Accurate prediction of brain dysfunction caused by disease or injury requires the quantification of resultant neural connectivity changes compared with the normal state. There are many methods with which to assess anatomical changes in structural or diffusion magnetic resonance imaging, but most overlook the topology of white matter (WM) connections that make up the healthy brain network. Here, a new neuroimaging software pipeline called the Network Modification (NeMo) Tool is presented that associates alterations in WM integrity with expected changes in neural connectivity between gray matter regions. The NeMo Tool uses a large reference set of healthy tractograms to assess implied network changes arising from a particular pattern of WM alteration on a region-and network-wise level. In this way, WM integrity changes can be extrapolated to the cortices and deep brain nuclei, enabling assessment of functional and cognitive alterations. Unlike current techniques that assess network dysfunction, the NeMo tool does not require tractography in pathological brains for which the algorithms may be unreliable or diffusion data are unavailable. The versatility of the NeMo Tool is demonstrated by applying it to data from patients with Alzheimer's disease, fronto-temporal dementia, normal pressure hydrocephalus, and mild traumatic brain injury. This tool fills a gap in the quantitative neuroimaging field by enabling an investigation of morphological and functional implications of changes in structural WM integrity.

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Shunt-responsive parkinsonism and reversible white matter lesions in patients with idiopathic NPH

Abstract: iNPH often appears as a shunt-responsive type of parkinsonism and reversible white matter lesions among the geriatric population.

Cited by 70 publications

References 39 publications

White matter involvement in idiopathic normal pressure hydrocephalus: a voxel-based diffusion tensor imaging study

White matter involvement in idiopathic normal pressure hydrocephalus: a voxel-based diffusion tensor imaging study

Subclinical Declines in the Verbal Fluency and Motor Regulation of Patients with AVIM (Asymptomatic Ventriculomegaly with Features of Idiopathic NPH on MRI): A Case-controlled Study

The Network Modification (NeMo) Tool: Elucidating the Effect of White Matter Integrity Changes on Cortical and Subcortical Structural Connectivity

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