The Neuropsychology of Patients With Clinically Diagnosed Idiopathic Normal Pressure Hydrocephalus

Hellström, Per; Edsbagge, Mikael; Archer, Trevor; Tisell, Magnus; Tullberg, Mats; Wikkelsø, Carsten

doi:10.1227/01.neu.0000306100.83882.81

Cited by 83 publications

(61 citation statements)

References 46 publications

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“…The symptoms and signs in INPH are generally recognised as being of subcortical origin 4. Damage to myelin and axons, and signs of arteriosclerosis in these areas have been described 5 6.…”

Section: Introductionmentioning

confidence: 99%

Reduced thalamic N-acetylaspartate in idiopathic normal pressure hydrocephalus: a controlled 1H-magnetic resonance spectroscopy study of frontal deep white matter and the thalamus using absolute quantification

Lundin

Tisell

Leinhard

et al. 2011

Journal of Neurology, Neurosurgery & Psychiatry

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“…The symptoms and signs in INPH are generally recognised as being of subcortical origin 4. Damage to myelin and axons, and signs of arteriosclerosis in these areas have been described 5 6.…”

Section: Introductionmentioning

confidence: 99%

Reduced thalamic N-acetylaspartate in idiopathic normal pressure hydrocephalus: a controlled 1H-magnetic resonance spectroscopy study of frontal deep white matter and the thalamus using absolute quantification

Lundin

Tisell

Leinhard

et al. 2011

Journal of Neurology, Neurosurgery & Psychiatry

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“…Our findings should be seen in light of reports that patients with iNPH and concurrent hypertension or DM have more severe symptoms than those without. 38 Among the strengths of this study are the size and representativeness of the population-based sample. All participants were systematically selected from the general population, i.e., participants were not scanned because of symptoms or suspicions of iNPH, and we identified cases with HVe without considering clinical data.…”

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confidence: 99%

Vascular factors in suspected normal pressure hydrocephalus

et al. 2016

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Objective: We examined clinical and imaging findings of suspected idiopathic normal pressure hydrocephalus (iNPH) in relation to vascular risk factors and white matter lesions (WMLs), using a nested case-control design in a representative, population-based sample.Methods: From a population-based sample, 1,235 persons aged 70 years or older were examined with CT of the brain between 1986 and 2000. We identified 55 persons with hydrocephalic ventricular enlargement, i.e., radiologic findings consistent with iNPH. Among these, 26 had clinical signs that fulfilled international guideline criteria for probable iNPH. These cases were labeled suspected iNPH. Each case was matched to 5 controls from the same sample, based on age, sex, and study cohort. Data on risk factors were obtained from clinical examinations and the Swedish Hospital Discharge Register. History of hypertension, diabetes mellitus (DM), smoking, overweight, history of coronary artery disease, stroke/TIA, and WMLs on CT were examined. Risk factors associated with iNPH with a p value ,0.1 in x 2 tests were included in conditional logistic regression models. Idiopathic normal pressure hydrocephalus (iNPH) is probably more common than previously supposed. We have recently reported that 5.9% of persons older than 80 years have this disorder. 1 Treatment with shunt surgery improves symptoms in more than 80% of patients. 2 Despite this, iNPH is underdiagnosed and undertreated.1,3 Furthermore, little is known about the underlying disease mechanisms. It is important to learn more about risk factors for the disease in order to understand pathophysiologic mechanisms and suggest preventive measures. Vascular risk factors, such as hypertension, diabetes, and ischemic heart disease, have previously been associated with iNPH in hospital-based, case-control studies.4-9 Also, cerebral white matter lesions (WMLs), which are associated with small vessel disease and white matter ischemia, 10 are common in iNPH. 11,12 It has therefore been suggested that vascular mechanisms may be related to the development of iNPH. However, previous studies on risk factors have not been population-based. Furthermore, there are no previous epidemiologic investigations regarding WMLs in iNPH.

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“…Although alteration in neurological and neuropsychological capacities – including level of vigilance – in patients suffering from iNPH has been well documented (8), the real impact of the disease on arousal after general anesthesia or in the critical care setting is unknown. Lack of data concerning this issue might be due to both old age and poor medical condition of the population of patients suffering from the disease.…”

Section: Discussionmentioning

confidence: 99%

Hakim–Adams Syndrome: An Unusual Cause of Reversible Postoperative Coma

Saleh¹,

Bouex

2016

Front. Med.

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We report the case of a 72-year-old patient presenting in our ICU with persistent postoperative coma in a context of recent unexplored neurological dysfunction. Detailed medical history taking from the patient’s family revealed he recently suffered from gait instability, urinary incontinence, and slight cognitive impairment. These constituted the clinical triad of normal pressure hydrocephalus syndrome. The presence of normal cerebrospinal fluid (CSF) pressure and distinctive radiological findings confirmed the diagnosis of normal pressure hydrocephalus or Hakims–Adams syndrome. After CSF volume subtraction (soustraction), the patient recovered a normal level of consciousness and was successfully weaned from mechanical ventilation. Normal pressure hydrocephalus should be included in the differential diagnosis of delayed postoperative arousal, especially in the elderly.

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The Neuropsychology of Patients With Clinically Diagnosed Idiopathic Normal Pressure Hydrocephalus

Abstract: The neuropsychological deficits in INPH are widely distributed, interrelated, associated with neurological signs, and aggravated by vascular comorbidity.

Cited by 83 publications

References 46 publications

Reduced thalamic N-acetylaspartate in idiopathic normal pressure hydrocephalus: a controlled 1H-magnetic resonance spectroscopy study of frontal deep white matter and the thalamus using absolute quantification

Reduced thalamic N-acetylaspartate in idiopathic normal pressure hydrocephalus: a controlled 1H-magnetic resonance spectroscopy study of frontal deep white matter and the thalamus using absolute quantification

Vascular factors in suspected normal pressure hydrocephalus

Hakim–Adams Syndrome: An Unusual Cause of Reversible Postoperative Coma

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