Challenges in diagnosing normal pressure hydrocephalus: Evaluation of the diagnostic guidelines

Andersson, Jens; Rosell, Michelle; Kockum, Karin; Söderström, Lars; Laurell, Katarina

doi:10.1016/j.ensci.2017.04.002

Cited by 39 publications

(35 citation statements)

References 30 publications

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“…In 2017, Andersson et al 18 evaluated the aforementioned guidelines and found remarkable discrepancies between these and the neurologists. Overall, this paper stated that the Japanese guidelines were more concordant with the professionals, which can be partially explained by the comparative lack of specificity that marks the International Guidelines - neither radiological nor clinical criteria are particular enough, with only one symptom of the classical triad being sufficient for “possible” disease, whereas at least two are necessary according to the Japanese guidelines.…”

Section: Idiopathic Normal-pressure Hydrocephalus (Inph)mentioning

confidence: 99%

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Normal-pressure hydrocephalus: A critical review

Oliveira

Nitrini

Román

2019

Dement. neuropsychol.

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ABSTRACT. Normal-pressure hydrocephalus (NPH) is a potentially reversible syndrome characterized by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia and urinary incontinence. A critical review of the concept, pathophysiology, diagnosis, and treatment of both idiopathic and secondary NPH was conducted. We searched Medline and PubMed databases from January 2012 to December 2018 using the keywords “normal-pressure hydrocephalus” / “idiopathic normal-pressure hydrocephalus” / “secondary normal-pressure hydrocephalus” / “NPH” / “ventriculoperitoneal shunt”. The initial search produced 341 hits. After careful selection, a total of 54 articles were chosen and additional relevant studies were included during the process of writing this article. NPH is an important cause of potentially reversible dementia, frequent falls and recurrent urinary infections in the elderly. The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors and often requiring expert assessment to minimize unsuccessful surgical treatments. Recent advances resulting from the use of non-invasive MRI methods for quantifying cerebral blood flow, in particular arterial spin-labeling (ASL), and the frequent association of NPH and obstructive sleep apnea (OSA), offer new avenues to understand and treat NPH.

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Section: Idiopathic Normal-pressure Hydrocephalus (Inph)mentioning

confidence: 99%

“…Furthermore, this study emphasized the need to review the current guidelines in order to produce a common, more objective, diagnostic system. 18 …”

Section: Idiopathic Normal-pressure Hydrocephalus (Inph)mentioning

confidence: 99%

Normal-pressure hydrocephalus: A critical review

Oliveira

Nitrini

Román

2019

Dement. neuropsychol.

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“…In a recent publication, we compared diagnoses according to the two guidelines and a senior consultant in neurology, respectively. A higher agreement was found between the Japanese guidelines and the neurologist (kappa = 0.69) than between the American-European guidelines and the neurologist (kappa = 0.44) [27]. We concluded that one widely recognized, diagnostic system is needed in order to compare different studies.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of idiopathic normal pressure hydrocephalus: A prospective, population-based study

et al. 2019

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Background Idiopathic normal pressure hydrocephalus (iNPH) causing gait impairment, dementia and urinary incontinence among the elderly, is probably under-diagnosed and under-treated. Despite being known since the 1960s, there is still a lack of prospective, population-based studies on the prevalence of iNPH. Such studies are warranted to minimize selection bias and estimate the true prevalence of the disease. Methods The prevalence of iNPH was determined in a randomly selected sample of residents, aged 65 years and older, in the Swedish county of Jämtland. Out of 1,000 individuals invited to participate, 673 (67.3%) completed a questionnaire with seven questions on iNPH symptoms. A subgroup, with and without self-reported symptoms, participated in clinical and radiological evaluations and were diagnosed according to international guidelines. Measurement of cerebrospinal fluid opening pressure was not performed as it was considered too invasive. Results Those who reported at least two symptoms in the questionnaire (n = 117) and 51 randomly selected individuals with 0–1 symptom participated in further examinations. Out of them, 25 individuals received the diagnosis probable iNPH according to American-European guidelines (except for the criterion of CSF opening pressure) corresponding to a prevalence of 3.7%. The prevalence of iNPH was four times higher among those aged 80 years and older (8.9%) than among those aged 65–79 years (2.1%) (p <0.001). The difference in prevalence between men (4.6%) and women (2.9%) was not significant (p = 0.24). When iNPH was diagnosed according to the Japanese guidelines the prevalence was 1.5% Conclusions In this prospective, population-based study the prevalence of iNPH was 3.7% among individuals 65 years and older, and more common in the higher age group, 80 years and above. INPH should be increasingly recognized since it is a fairly common condition and an important cause of gait impairment and dementia among the elderly that can be effectively treated by shunt surgery.

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“…Normal pressure hydrocephalus (NPH) is a chronic condition among adults which is characterized by the clinical triad of gait disturbances, memory deficits and urinary incontinence, as well as radiological evidence of ventriculomegaly with disproportionally effaced superior frontal sulci and reduced callosal angle [1]. Despite the fact that it is known that NPH can be secondary to traumatic brain injuries, intracranial hemorrhages and infections, the majority of cases are idiopathic (iNPH), and their pathophysiology remaining puzzling.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Brain Positron Emission Tomography with Different Tracers in the Evaluation of Patients with Idiopathic Normal Pressure Hydrocephalous

Mattoli

Treglia

Calcagni

et al. 2020

IJMS

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Idiopathic normal pressure hydrocephalus (iNPH) is the only form of dementia that can be cured by surgery. Its diagnosis relies on clinical and radiological criteria. Identifying patients who can benefit from surgery is challenging, as other neurological diseases can be concomitant or mimic iNPH. We performed a systematic review on the role of positron emission tomography (PET) in iNPH. We retrieved 35 papers evaluating four main functional aspects with different PET radiotracers: (1) PET with amyloid tracers, revealing Alzheimer’s disease (AD) pathology in 20–57% of suspected iNPH patients, could be useful in predictions of surgical outcome. (2) PET with radiolabeled water as perfusion tracer showed a global decreased cerebral blood flow (CBF) and regional reduction of CBF in basal ganglia in iNPH; preoperative perfusion parameters could predict surgical outcome. (3) PET with 2-Deoxy-2-[18F]fluoroglucose ([18F]FDG ) showed a global reduction of glucose metabolism without a specific cortical pattern and a hypometabolism in basal ganglia; [18F]FDG PET may identify a coexisting neurodegenerative disease, helping in patient selection for surgery; postsurgery increase in glucose metabolism was associated with clinical improvement. (4) Dopaminergic PET imaging showed a postsynaptic D2 receptor reduction and striatal upregulation of D2 receptor after treatment, associated with clinical improvement. Overall, PET imaging could be a useful tool in iNPH diagnoses and treatment response.

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Challenges in diagnosing normal pressure hydrocephalus: Evaluation of the diagnostic guidelines

Cited by 39 publications

References 30 publications

Normal-pressure hydrocephalus: A critical review

Normal-pressure hydrocephalus: A critical review

Prevalence of idiopathic normal pressure hydrocephalus: A prospective, population-based study

Usefulness of Brain Positron Emission Tomography with Different Tracers in the Evaluation of Patients with Idiopathic Normal Pressure Hydrocephalous

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