Idiopathic Normal-Pressure Hydrocephalus Syndrome: Is It Understood? The Comprehensive Idiopathic Normal-Pressure Hydrocephalus Theory (CiNPHT)

Ammar, Ahmed; Abbas, Faisal; Issawi, Wisam Al; Fakhro, Fatima; Batarfi, Layla; Hendam, Ahmed T; Hasen, Mohammed; Shawarby, Mohammed; Jehani, Hosam Al

doi:10.1007/978-3-319-61304-8_5

Cited by 10 publications

(5 citation statements)

References 34 publications

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“…Pathophysiologically, it is not clear why the callosal angle may be narrower in tap test responders. In iNPH, it has been hypothesized that a vicious circle of a circulatory disturbance of the CNS and deceleration of its absorption leads to enlargement of the ventricles [ 3 , 36 ]. So, an impaired glymphatic transport might play a role [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Callosal Angle Sub-Score of the Radscale in Patients with Idiopathic Normal Pressure Hydrocephalus Is Associated with Positive Tap Test Response

Pyrgelis

Paraskevas

Constantinides

et al. 2022

JCM

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The aim of the present study was the implementation of the composite imaging “Radscale” in patients with idiopathic normal pressure hydrocephalus (iNPH) and the evaluation of its score, as well as absolute stroke volume and peak flow velocity of cerebrospinal fluid (CSF) in aqueduct as indicators of a positive response following a tap test. Forty-five patients with iNPH were included. Clinical evaluation involved the 10 m timed walk test before and every 24 h for 3 consecutive days after evacuative lumbar puncture (LP). Neuropsychological evaluation comprised a mini mental state examination (MMSE), frontal assessment battery (FAB), 5-word test (5WT) and CLOX drawing test 1 and 2, which were carried out before and 48 h after LP. The tap test’s response was defined as a ≥20% improvement in gait and/or a ≥10% improvement in neuropsychological tests. All scores of neuropsychological and clinical variables, except for immediate 5WT and CLOX-1, differed significantly before and 48 h after LP. Improvement in time and steps of a 10 m timed walk test differed significantly between female and male patients. Out of 45 total patients, 19 were tap test responders and 26 non-responders. The total score of Radscale and CSF flow parameters did not differ between responders and non-responders. However, “Callosal angle” sub-score differed significantly between these two groups. A greater “callosal angle” sub-score, meaning more acute callosal angle, was associated with a positive tap test response, rendering it a useful measurement in the stratification of iNPH patients that will potentially respond to CSF shunting.

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Section: Discussionmentioning

confidence: 99%

Callosal Angle Sub-Score of the Radscale in Patients with Idiopathic Normal Pressure Hydrocephalus Is Associated with Positive Tap Test Response

Pyrgelis

Paraskevas

Constantinides

et al. 2022

JCM

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“…Some of them suggest that increased venous resistance is the initial “hit”, while others correlate ischemic white matter lesions to deceleration of CSF flow through the extracellular spaces, resulting in a “back-pressure” effect, leading to ventricular enlargement [ 15 ]. The common denominator of these studies seems to be the fact that iNPH is caused by a vicious circle of CSF circulation disruption that leads to a deceleration of its absorption and enlargement of the ventricles [ 5 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal Fluid Biomarkers in iNPH: A Narrative Review

et al. 2022

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Idiopathic normal pressure hydrocephalus (iNPH) is a neurological syndrome characterized by the clinical triad of gait disorder, cognitive impairment and urinary incontinence. It has attracted interest because of the possible reversibility of symptoms, especially with timely treatment. The main pathophysiological theory is based on a vicious circle of disruption in circulation of cerebrospinal fluid (CSF) that leads to the deceleration of its absorption. Data regarding CSF biomarkers in iNPH are contradictory and no definite CSF biomarker profile has been recognized as in Alzheimer’s disease (AD), which often co-exists with iNPH. In this narrative review, we investigated the literature regarding CSF biomarkers in iNPH, both the established biomarkers total tau protein (t-tau), phosphorylated tau protein (p-tau) and amyloid peptide with 42 amino acids (Aβ42), and other molecules, which are being investigated as emerging biomarkers. The majority of studies demonstrate differences in CSF concentrations of Aβ42 and tau-proteins (t-tau and p-tau) among iNPH patients, healthy individuals and patients with AD and vascular dementia. iNPH patients present with lower CSF Aβ42 and p-tau concentrations than healthy individuals and lower t-tau and p-tau concentrations than AD patients. This could prove helpful for improving diagnosis, differential diagnosis and possibly prognosis of iNPH patients.

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“…A previous autopsy-based study confirmed that severe hypertensive and arteriosclerotic vasculopathy with multiple lacunar infarcts was found in a patient with iNPH ( 47 ). Atherosclerosis causes ischemic-hypoxic damage to brain vessels and parenchyma, resulting in extensive changes in metabolism, blood-brain barrier function, and cerebrospinal fluid hydrodynamics ( 48 ). This contributes to demyelination and ventriculomegaly in patients with iNPH, as seen using magnetic resonance imaging ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Vascular risk factors for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

Cai,

Yang,

Gao

et al. 2023

Front. Neurol.

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ObjectiveIdiopathic normal-pressure hydrocephalus (iNPH) is a treatable cause of dementia; however, its etiology and pathogenesis remain poorly understood. The objective of this study was to investigate the prevalence and impact of vascular risk factors in patients with iNPH compared to a control cohort to better understand the potential mechanisms and preventive measures.MethodsWe systematically searched PubMed, Web of Science, Embase, and the Cochrane Library (from inception to December 20, 2022) for studies reporting vascular risk factors for the development of iNPH. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using random-effects models.ResultsAfter screening 1,462 articles, 11 case-control studies comprising 1,048 patients with iNPH and 79,668 cognitively unimpaired controls were included in the meta-analysis. Our data showed that hypertension (N = 991, OR = 2.30, 95% CI 1.64 to 3.23, I2= 64.0%), diabetes mellitus (DM) (N = 985, OR = 3.12, 95% CI 2.29 to 4.27, I2= 44.0%), coronary heart disease (CHD; N = 880, OR = 2.34, 95% CI 1.33 to 4.12, I2= 83.1%), and peripheral vascular disease (N = 172, OR = 2.77, 95% CI 1.50 to 5.13, I2= 0.0%) increased the risk for iNPH, while overweight was a possible factor (N = 225, OR = 2.01, 95% CI 1.34 to 3.04, I2= 0.0%) based on the sensitivity analysis. Smoking and alcohol consumption were not associated with iNPH.ConclusionsOur study suggested that hypertension, DM, CHD, peripheral vascular disease, and overweight were associated with iNPH. These factors might be involved in the pathophysiological mechanisms promoting iNPH. These findings require further investigation in future studies.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, CRD42022383004.

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Idiopathic Normal-Pressure Hydrocephalus Syndrome: Is It Understood? The Comprehensive Idiopathic Normal-Pressure Hydrocephalus Theory (CiNPHT)

Cited by 10 publications

References 34 publications

Callosal Angle Sub-Score of the Radscale in Patients with Idiopathic Normal Pressure Hydrocephalus Is Associated with Positive Tap Test Response

Callosal Angle Sub-Score of the Radscale in Patients with Idiopathic Normal Pressure Hydrocephalus Is Associated with Positive Tap Test Response

Cerebrospinal Fluid Biomarkers in iNPH: A Narrative Review

Vascular risk factors for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

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