Article
Normal pressure hydrocephalus: neuropsychological assessment, gait analysis and molecular pattern to predict shunt response
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Authors
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Marco Fontanella
- Department of Neuroscience, Division of Neurosurgery, University of Brescia, Italy
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Karol Migliorati
- Department of Neuroscience, Division of Neurosurgery, University of Brescia, Italy
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Giannantonio Spena
- Department of Neuroscience, Division of Neurosurgery, University of Brescia, Italy
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Pier Paolo Panciani
- Department of Neuroscience, Division of Neurosurgery, University of Brescia, Italy
| Published: | June 2, 2015 |
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Outline
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Objective: The diagnosis of idiopathic normal pressure hydrocephalus (iNPH) is challenging and it's based on clinical features that may mimic other neurological diseases. Invasive cerebrospinal fluid (CSF) removal and infusion tests are generally used to predict shunt response. Nowadays, the rate of positive shunt response is lower than 75%, even though all the selection criteria to surgery are met.
Aim of the study was to create a new score for iNPH in order to predict shunt response joining together biochemical pattern, neuropsychological assessment and gait analysis.
Method: We enrolled 115 patients with clinical and radiological features of iNPH. Patients meeting Marmarou diagnostic criteria underwent CSF removal or infusion test to predict shunt response. Neuropsichological tests (Story Recall Test-MMSE-Trail making test and Semantic Verbal Fluency test) and gait analysis (using a specific inertial sensor to achieve digital and reproducible data) were used to address surgery. Moreover, we collected CSF from all patients to detect the level of Tau, P-Tau and β-amyloid.
The shunted patients were evaluated after one, four and twelve months. The patients who showed an increase higher than 5 points in the iNPH scale score were considered shunt-responder. Statistical analysis (t-student and logistic regression) was performed to compare the population of shunt-responder and shunt non-responder patients. Pre-operative neuropsychological data, gait analysis and molecular pattern were considered in a multivariate analysis.
Results: According to the European criteria the diagnosis of iNPH was made in 75 patients. Afterwards, surgery was performed in 53 patients. Among these, 42 (79,2%) resulted shunt-responder and 11 (20,8%) non-responder.
We observed significant statistical difference between the 2 groups in 3 gait parameters (speed, stride length and double support time) and in 2 of the 3 dosed proteins (pTAU and β-amyloid). The multivariate analysis has allowed us to develop a new score, able to quantify the probability of response to shunt.
Conclusions: We speculate that our score may be useful in predicting the response to shunt.
