Association between Cognitive Impairment and Gait Disturbance in Patients with Idiopathic Normal Pressure Hydrocephalus

Miyoshi, Noriko; Kazui, Hiroaki; Oginö, Kazuhíde; Ishikawa, Masatsune; Miyake, Hiroji; Takahashi, Hiromasa; Ikejiri, Yoshitaka; Takeda, Masatoshi

doi:10.1159/000085858

Cited by 83 publications

(57 citation statements)

References 64 publications

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“…However, the involvement of the CST in gait disturbance in patients with iNPH has been controversial in previous studies. 18,25,26 In contrast, a recent hypothesis for gait disturbance in patients with iNPH is frontal lobe dysfunction 27,28 and/or malfunction of the cortex-basal ganglia-thalamus-cortex circuit, including the supplementary motor cortex. 29 On the other hand, the origin of dementia in patients with iNPH is also unknown.…”

Section: Discussionmentioning

confidence: 99%

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White Matter Alteration in Idiopathic Normal Pressure Hydrocephalus: Tract-Based Spatial Statistics Study

Hattori¹,

Ito²,

Aoki³

et al. 2011

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

“…30 These features resemble those seen in frontal disorders 31,32 and are sometimes characterized as frontal and subcortical deficits. 33 To date, frontal lobe dysfunction 27,30,34 or prefrontal lobe discon-nection or both 35 have been proposed to be involved in the pathogenesis of dementia in patients with iNPH.…”

Section: Discussionmentioning

confidence: 99%

White Matter Alteration in Idiopathic Normal Pressure Hydrocephalus: Tract-Based Spatial Statistics Study

Hattori¹,

Ito²,

Aoki³

et al. 2011

AJNR Am J Neuroradiol

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“…This malfunction greatly affects the supplementary motor cortex, resulting in the gait disturbances characteristic of patients with NPH. 33,40,44,47 Numerous similarities in pathogenesis between iNPH and AD or other subcortical vascular dementias have been reported. 6,23,52-54 Symptoms of iNPH resemble those observed in disorders arising from diseases of the frontal lobe.…”

Section: Discussionmentioning

confidence: 99%

The role of diffusion tensor imaging and fractional anisotropy in the evaluation of patients with idiopathic normal pressure hydrocephalus: a literature review

Siasios

Kapsalaki²,

Fountas³

et al. 2016

FOC

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OBJECTIVE Diffusion tensor imaging (DTI) for the assessment of fractional anisotropy (FA) and involving measurements of mean diffusivity (MD) and apparent diffusion coefficient (ADC) represents a novel, MRI-based, noninvasive technique that may delineate microstructural changes in cerebral white matter (WM). For example, DTI may be used for the diagnosis and differentiation of idiopathic normal pressure hydrocephalus (iNPH) from other neurodegenerative diseases with similar imaging findings and clinical symptoms and signs. The goal of the current study was to identify and analyze recently published series on the use of DTI as a diagnostic tool. Moreover, the authors also explored the utility of DTI in identifying patients with iNPH who could be managed by surgical intervention. METHODS The authors performed a literature search of the PubMed database by using any possible combinations of the following terms: “Alzheimer's disease,” “brain,” “cerebrospinal fluid,” “CSF,” “diffusion tensor imaging,” “DTI,” “hydrocephalus,” “idiopathic,” “magnetic resonance imaging,” “normal pressure,” “Parkinson's disease,” and “shunting.” Moreover, all reference lists from the retrieved articles were reviewed to identify any additional pertinent articles. RESULTS The literature search retrieved 19 studies in which DTI was used for the identification and differentiation of iNPH from other neurodegenerative diseases. The DTI protocols involved different approaches, such as region of interest (ROI) methods, tract-based spatial statistics, voxel-based analysis, and delta-ADC analysis. The most studied anatomical regions were the periventricular WM areas, such as the internal capsule (IC), the corticospinal tract (CST), and the corpus callosum (CC). Patients with iNPH had significantly higher MD in the periventricular WM areas of the CST and the CC than had healthy controls. In addition, FA and ADCs were significantly higher in the CST of iNPH patients than in any other patients with other neurodegenerative diseases. Gait abnormalities of iNPH patients were statistically significantly and negatively correlated with FA in the CST and the minor forceps. Fractional anisotropy had a sensitivity of 94% and a specificity of 80% for diagnosing iNPH. Furthermore, FA and MD values in the CST, the IC, the anterior thalamic region, the fornix, and the hippocampus regions could help differentiate iNPH from Alzheimer or Parkinson disease. Interestingly, CSF drainage or ventriculoperitoneal shunting significantly modified FA and ADCs in iNPH patients whose condition clinically responded to these maneuvers. CONCLUSIONS Measurements of FA and MD significantly contribute to the detection of axonal loss and gliosis in the periventricular WM areas in patients with iNPH. Diffusion tensor imaging may also represent a valuable noninvasive method for differentiating iNPH from other neurodegenerative diseases. Moreover, DTI can detect dynamic changes in the WM tracts after lumbar drainage or shunting procedures and could help identify iNPH patients who may benefit from surgical intervention.

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“…36B) The impairment of attention, psychomotor speed, literal fluency, and executive function is disproportionately severe, whereas the impairment of memory and orientation is disproportionately mild in patients with iNPH compared with Alzheimer's disease. 80,88) Clumsiness and writing difficulty were also noted. 105) The impairment of verbal memory and psychomotor speed of iNPH appears more likely to respond to shunt surgery, 120) whereas overall cognitive impairments in severe cases tend not to improve after shunt surgery.…”

Section: Characteristics Of Gait Disturbancementioning

confidence: 99%

“…42,80,112) Pressure setting is particularly important due to the low brain compliance with narrow acceptable ICP range. PVs are useful for controlling postoperative complications.…”

Section: Long-term Managementmentioning

confidence: 99%

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus Guidelines From the Guidelines Committee of Idiopathic Normal Pressure Hydrocephalus, the Japanese Society of Normal Pressure Hydrocephalus

Ishikawa

Hashimoto

Kuwana

et al. 2008

Neurol. Med. Chir.(Tokyo)

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202

184

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With the rapid aging of Japanese society, medical care of the elderly has become an important social issue. Among various disorders manifesting dementia, gait disturbance, and urinary incontinence in the elderly population, normal pressure hydrocephalus (NPH), especially of idiopathic type (iNPH), is becoming noteworthy. The Guidelines for management of iNPH in Japan are created in compliance with the evidence-based medicine methods and published in 2004. This English version is made to show the diagnosis and treatment of iNPH with reference to the socio-medical background in Japan and to promote the international research on iNPH. They propose three diagnostic levels; possible, probable, and definite. They indicate the diagnostic importance of high convexity tightness and dilated sylvian fissure with mild to moderate ventriculomegaly on coronal magnetic resonance imaging. The cerebrospinal fluid tap test is regarded as an important diagnostic test because of its simplicity to perform and high predictability of the shunt efficacy. The use of programmable valves at shunt surgeries is recommended. Flowcharts for diagnosis, preoperative assessment, and prevention for complications of shunt surgery are made to promote a wide use of them.

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Association between Cognitive Impairment and Gait Disturbance in Patients with Idiopathic Normal Pressure Hydrocephalus

Cited by 83 publications

References 64 publications

White Matter Alteration in Idiopathic Normal Pressure Hydrocephalus: Tract-Based Spatial Statistics Study

White Matter Alteration in Idiopathic Normal Pressure Hydrocephalus: Tract-Based Spatial Statistics Study

The role of diffusion tensor imaging and fractional anisotropy in the evaluation of patients with idiopathic normal pressure hydrocephalus: a literature review

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus Guidelines From the Guidelines Committee of Idiopathic Normal Pressure Hydrocephalus, the Japanese Society of Normal Pressure Hydrocephalus

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