Poor Cognitive Outcome in Shunt-Responsive Idiopathic Normal Pressure Hydrocephalus

Koivisto, Anne M.; Alafuzoff, Irina; Savolainen, Sakari; Sutela, Anna; Rummukainen, Jaana; Kurki, Mitja; Jääskeläinen, Juha E.; Soininen, Hilkka; Rinne, Jaakko; Leinonen, Ville

doi:10.1227/neu.0b013e31827414b3

Cited by 90 publications

(74 citation statements)

References 41 publications

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“…Brain biopsy clearly has a value when predicting the risk of concomitant and further AD [6]. Also, if the shunt response is diluting in shunted NPH patients, especially when cognitive decline is progressing despite a functioning shunt, a brain biopsy taken earlier can help in the prediction and diagnosis of later dementia [25]. …”

Section: Discussionmentioning

confidence: 99%

Prospective Flutemetamol Positron Emission Tomography and Histopathology in Normal Pressure Hydrocephalus

et al. 2013

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Backgound/Objective: To determine the level of association between uptake of the amyloid positron emission tomography (PET) imaging agent [¹⁸F]flutemetamol and the level of amyloid-ß measured by immunohistochemical and histochemical staining in a frontal cortical region biopsy site. Methods: Seventeen patients with probable normal pressure hydrocephalus (NPH) underwent prospective [¹⁸F]flutemetamol PET and subsequent frontal cortical brain biopsy during ventriculoperitoneal shunting. Tissue amyloid-ß was evaluated using the monoclonal antibody 4G8, thioflavin S and Bielschowsky silver stain. Results: Four of the 17 patients (23.5%) had amyloid-ß pathology based on the overall pathology read and also showed increased [¹⁸F]flutemetamol uptake. [¹⁸F]Flutemetamol standardized uptake values from the biopsy site were significantly associated with biopsy specimen amyloid-ß levels (Pearson's r = 0.67; p = 0.006). There was also good correlation between the biopsy specimen amyloid-ß level and uptake of [¹⁸F]flutemetamol in the region contralateral to the biopsy site (r = 0.67; p = 0.006), as well as with composite cortical [¹⁸F]flutemetamol uptake (r = 0.65; p = 0.008). The blinded visual read showed a high level of agreement between all readers (κ = 0.88). Two of 3 readers were in full agreement on all images; 1 reader disagreed on 1 of the 17 NPH cases. Blinded visual assessments of PET images by 1 reader were associated with 100% sensitivity to the overall pathology read, and assessments by the 2 others were associated with 75% sensitivity (overall sensitivity by majority read was 75%); specificity of all readers was 100%. Conclusions: [¹⁸F]Flutemetamol detects brain amyloid-ß in vivo and shows promise as a valuable tool to study and possibly facilitate diagnosis of Alzheimer's disease both in patients with suspected NPH and among the wider population.

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Section: Discussionmentioning

confidence: 99%

Prospective Flutemetamol Positron Emission Tomography and Histopathology in Normal Pressure Hydrocephalus

et al. 2013

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“…These symptoms are also common in other neurodegenerative disorders, such as vascular dementia (VD), Alzheimer's (AD) and Parkinson's disease. The differential diagnosis is challenging, especially because iNPH patients often have other accompanying neurodegenerative diseases [22,26].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of radiological markers in idiopathic normal pressure hydrocephalus

et al. 2015

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“…9,12,21,32,35,78,119 Studies show an improvement in neurocognitive measures after treatment, including verbal memory, psychomotor scores, mental tracking speed, attention, independent living, and caregiver scores. 62,77 Postshunting cognitive changes can precede functional recovery and may be sensitive and early markers of NPH outcome. The durability of the improvement is influenced by many factors such as shunt survival and complications, and distinguishing worsening due to progressive iNPH or other comorbidities such as vascular dementia and Alzheimer disease.…”

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confidence: 99%

An update on research priorities in hydrocephalus: overview of the third National Institutes of Health-sponsored symposium “Opportunities for Hydrocephalus Research: Pathways to Better Outcomes”

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Walker

et al. 2015

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abbreviatioNs CPC = choroid plexus cauterization; DTI = diffusion tensor imaging; ETV = endoscopic third ventriculostomy; HCRN = Hydrocephalus Clinical Research Network; ICP = intracranial pressure; iNPH = idiopathic NPH; LPA = lysophosphatidic acid; NIH = National Institutes of Health; NPC = neural precursor cell; NPH = normal pressure hydrocephalus; NSC = neural stem cell; PreOL = precursor oligodendroglia; RCT = randomized controlled trial; SVZ = subventricular zone; TNF = tumor necrosis factor; VP = ventriculoperitoneal; VZ = ventricular zone. . International experts gave plenary talks, and extensive group discussions were held for each of the major themes.The conference emphasized patient-centered care and translational research, with the main objective to arrive at a consensus on priorities in hydrocephalus that have the potential to impact patient care in the next 5 years. The current state of hydrocephalus research and treatment was presented, and the following priorities for research were recommended for each theme. 1) Causes of Hydrocephalus-CSF absorption, production, and related drug therapies; pathogenesis of human hydrocephalus; improved animal and in vitro models of hydrocephalus; developmental and macromolecular transport mechanisms; biomechanical changes in hydrocephalus; and age-dependent mechanisms in the development of hydrocephalus. 2) Diagnosis of Hydrocephalus-implementation of a standardized set of protocols and a shared repository of technical information; prospective studies of multimodal techniques including MRI and CSF biomarkers to test potential pharmacological treatments; and quantitative and cost-effective CSF assessment techniques. 3) Treatment of Hydrocephalus-improved bioengineering efforts to reduce proximal catheter and overall shunt failure; external or implantable diagnostics and support for the biological infrastructure research that informs these efforts; and evidencebased surgical standardization with longitudinal metrics to validate or refute implemented practices, procedures, or tests. 4) Outcome in Hydrocephalus-development of specific, reliable batteries with metrics focused on the hydrocephalic 1427

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Poor Cognitive Outcome in Shunt-Responsive Idiopathic Normal Pressure Hydrocephalus

Cited by 90 publications

References 41 publications

Prospective Flutemetamol Positron Emission Tomography and Histopathology in Normal Pressure Hydrocephalus

Prospective Flutemetamol Positron Emission Tomography and Histopathology in Normal Pressure Hydrocephalus

Feasibility of radiological markers in idiopathic normal pressure hydrocephalus

An update on research priorities in hydrocephalus: overview of the third National Institutes of Health-sponsored symposium “Opportunities for Hydrocephalus Research: Pathways to Better Outcomes”

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