Upper limb dysfunction and activities in daily living in idiopathic normal pressure hydrocephalus

Abstract

Background Idiopathic normal pressure hydrocephalus (iNPH) is a neurodegenerative disease with a characteristic symptom triad of gait disturbance, cognitive decline, and incontinence. Recently, also dysfunctions in upper limbs have been described in iNPH and reported to improve after shunt surgery. We aim to describe the role of upper limb motor function in the clinical assessment of iNPH patients and its influence on activities of daily living (ADL). Methods Seventy-five consecutive patients with probable iNPH were studied pre-operatively and at 3 and 12 months after shunt surgery. The pre-operative evaluation included lumbar drainage of cerebrospinal fluid (tap test). Motor functions were assessed in upper and lower limbs with Grooved Pegboard Test (GPT), Box & Block Test (BBT), Total Score of Gait (TSG), and balance test. ADL was assessed with Barthel’s index and cognition in accordance with the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Results Patients showed improvement in all motor tests and ADL at 3 months after shunt surgery. The improvement remained stable during the 12-month post-operative follow-up. The motor function tests correlated with each other and with ADL. Conclusions A 3-month follow-up period after shunt surgery is adequate to show improvement in motor tasks, and a positive outcome will last for at least 12 months. A shunt-responsive dysfunction of upper limb motor performance plays a major role in ADL of iNPH patients. Therefore, we suggest an evaluation of upper limb motor performance to be included in routine evaluation of iNPH patients.

Computer-based Eye-tracking Analysis of King-Devick Test Differentiates Persons With Idiopathic Normal Pressure Hydrocephalus From Cognitively Unimpaired

“…We may speculate that these changes could also explain the changes observed in iNPH. Psychomotor slowing and attention impairment play a greater role in iNPH than in AD,34 and are also observed in other functions, such as gait 35. Therefore, it would be reasonable to investigate differences between iNPH and AD by further examining the reading ability and oculomotor function.…”

The effect of shunt surgery on corticospinal excitability in idiopathic normal pressure hydrocephalus: a transcranial magnetic stimulation study

“…2 Neurosurgery, Neurocenter, Kuopio University Hospital, Kuopio, Finland. 3 Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland. 4 Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.…”

“…Typically, impairment in gait is the initial and the most prominent symptom [ 1 ]. Recently, also upper limb motor dysfunction has been strongly associated with the symptomatology of iNPH [ 3 ].…”

Longitudinal neuropsychological trajectories in idiopathic normal pressure hydrocephalus: a population–based study

“…Gait disturbance is the most frequent symptom in iNPH present in 90–100% of diagnosed cases followed by worsened cognition (56–98%), and incontinence (60–92%) [ 2 , 11 ]. Although gait disturbances are hallmark signs of iNPH, upper motor dysfunction is a part of the syndrome as well [ 12 , 13 ]. One prominent cognitive dysfunction in iNPH is poor executive functioning [ 14 , 15 ].…”