Wide temporal horns are associated with cognitive dysfunction, as well as impaired gait and incontinence

Abstract

The association between morphology of the brain and symptoms of suspected idiopathic normal pressure hydrocephalus (iNPH) is largely unknown. We investigated how ventricular expansion (width of the temporal horns [TH], callosal angle [CA], and Evans’ index [EI]) related to symptom severity in suspected iNPH. Participants (n = 168; 74.9 years ± SD 6.7; 55% females) from the general population underwent neurological examination, computed tomography, and neuropsychological testing. Multiple linear regression analysis revealed that wide TH was independently associated with all examined iNPH symptoms (p < 0.01) except for fine-motor performance, whereas a narrow CA only was associated to specific motor and cognitive functions (p < 0.05). TH and EI correlated significantly with incontinence (rs 0.17 and rs 0.16; p < 0.05). In conclusion, wide TH was significantly associated with most iNPH-symptoms. This finding potentially reflects the complex nature of the hippocampus, however further studies are needed to demonstrate functional connectivity.

Application of Evans Index in Normal Pressure Hydrocephalus Patients: A Mini Review

“…It is difficult to characterize the gait and cognition of patients with NPH. VV measurements can better indicate the current and future gait and cognitive status of NPH patients than the EI (Crook et al, 2020 ), and no significant relationship between the EI and impaired cognition or gait has been described (Lilja-Lund et al, 2020 ). More importantly, a study including 36 iNPH patients who responded to CSF drainage and subsequently underwent ventriculoperitoneal shunt surgery showed that higher EI is a predictor of long-term cognitive improvement in NPH patients after surgery; however, there is no appropriate EI threshold to help clinicians accurately predict the surgical effect on NPH patients.…”

Dual-Task Performance in Older Adults With and Without Idiopathic Normal Pressure Hydrocephalus

“…Previous studies have shown that phonemic fluency is more related to the PFC, and semantic fluency to the hippocampi ( Glikmann-Johnston et al, 2015 ). Inferior performance on a more hippocampi-dependent task in iNPH is intriguing as widening of the temporal horns surrounding the hippocampi has been associated with all main symptoms of iNPH ( Lilja-Lund et al, 2020 ). Furthermore, a study using verbal fluency during walking to evaluate the effects of tap-testing in iNPH revealed improvements in semantic fluency post-tap but not in phonemic fluency, possibly indicating that semantic fluency is sensitive to iNPH ( Allali et al, 2017a ).…”

“…The participants were recruited from an epidemiological study on iNPH among inhabitants of Jämtland Härjedalen, Sweden, aged 65 years or older ( Kockum et al, 2018 ; Andersson et al, 2019 ; Lilja-Lund et al, 2020 ). The final sample consisted of 95 individuals with and without symptoms of iNPH.…”

“…Idiopathic normal pressure hydrocephalus (iNPH) is a disorder affecting older adults with the hallmark symptoms of gait disturbances, cognitive decline, and incontinence ( Hakim and Adams, 1965 ; Mori et al, 2012 ). Radiological characteristics include disproportionately enlarged subarachnoid-space hydrocephalus (DESH) ( Kitagaki et al, 1998 ), wide temporal horns ( Lilja-Lund et al, 2020 ), and a narrow callosal angle ( Virhammar et al, 2014 ). Untreated, iNPH reduces life expectancy, autonomy, and health-related quality of life ( Petersen et al, 2014 ; Andrén et al, 2020 ).…”

Temporal Horn Enlargements Predict Secondary Hydrocephalus Diagnosis Earlier than Evans’ Index

“…When untreated, marked enlargement of the temporal horns disrupts neurogenesis in the dentate gyrus from multipotent, self-renewing progenitor cells of neurons and glial cells, can impair cognitive functions, such as learning and memory abnormalities, and contribute to executive dysfunction. Temporal horn enlargements can also cause seizures (temporal lobe epilepsy) and favour contralateral homonymous hemianopia and contralateral hemiparesis (indirectly, by compressing the internal capsule) [10][11][12]. Persistent temporal horn dilatations were previously reported to cause flattening of the hippocampal formations, due to neural tissue loss [2].…”