Incidental findings of typical iNPH imaging signs in asymptomatic subjects with subclinical cognitive decline
Abstract Background The etiology of idiopathic normal pressure hydrocephalus (iNPH) remains unclear. Little is known about the pre-symptomatic stage. This study aimed to investigate the association of neuropsychological data with iNPH-characteristic imaging changes compared to normal imaging and uns...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-08-01
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| Series: | Fluids and Barriers of the CNS |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12987-021-00268-x |
| _version_ | 1818362683188051968 |
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| author | Doortje C. Engel Lukas Pirpamer Edith Hofer Reinhold Schmidt Cornelia Brendle |
| author_facet | Doortje C. Engel Lukas Pirpamer Edith Hofer Reinhold Schmidt Cornelia Brendle |
| author_sort | Doortje C. Engel |
| collection | DOAJ |
| description | Abstract Background The etiology of idiopathic normal pressure hydrocephalus (iNPH) remains unclear. Little is known about the pre-symptomatic stage. This study aimed to investigate the association of neuropsychological data with iNPH-characteristic imaging changes compared to normal imaging and unspecific atrophy in a healthy population. Methods We extracted data from the community-dwelling Austrian Stroke Prevention Family Study (ASPS-Fam) database (2006–2010). All subjects underwent a baseline and identical follow-up examination after 3–5 years with MR imaging and an extensive neuropsychological test battery (Trail Making Test B, short physical performance balance, walking speed, memory, visuo-practical skills, composite scores of executive function and g-factor). We categorized the subjects into “iNPH”-associated, non-specific “atrophy,” and “normal” based on the rating of different radiological cerebrospinal fluid (CSF) space parameters. We noted how the categories developed over time. We assessed the association of the image categories with the neuropsychological data, different demographic, and lifestyle parameters (age, sex, education, alcohol intake, arterial hypertension, hypercholesterolemia), and the extent of white matter hyperintensities. We investigated whether neuropsychological data associated with the image categories were independent from other parameters as confounders. Results One hundred and thirteen subjects, aged 50–70 years, were examined. The imaging category “iNPH” was only present at follow-up. A third of subjects with “atrophy” at baseline changed to the category “iNPH” at follow-up. More white matter hyperintensities (WMH) were present in later “iNPH” subjects. Subjects with “iNPH” performed worse than “normal” subjects on executive function (p = 0.0118), memory (p = 0.0109), and Trail Making Test B (TMT-B. p < 0.0001). Education, alcohol intake, diabetes, arterial hypertension, and hypercholesterolemia had no effect. Age, number of females, and the extent of white matter hyperintensities were higher in “iNPH” than in “normal” subjects but did not significantly confound the neuropsychological results. Conclusions Apparent asymptomatic subjects with “iNPH” imaging characteristics presented with subclinical cognitive decline and showed worse executive function, memory, and TMT-B results than “normal” subjects. WMH seem to play a role in the etiology before ventriculomegaly. Clinical screening of individuals with incidental iNPH-characteristic imaging and conspicuous results sof these neurocognitive tests needs further validation. |
| first_indexed | 2024-12-13T21:36:28Z |
| format | Article |
| id | doaj.art-90ea7b2ef9c8447ea558796e42a19103 |
| institution | Directory Open Access Journal |
| issn | 2045-8118 |
| language | English |
| last_indexed | 2024-12-13T21:36:28Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Fluids and Barriers of the CNS |
| spelling | doaj.art-90ea7b2ef9c8447ea558796e42a191032022-12-21T23:30:39ZengBMCFluids and Barriers of the CNS2045-81182021-08-0118111010.1186/s12987-021-00268-xIncidental findings of typical iNPH imaging signs in asymptomatic subjects with subclinical cognitive declineDoortje C. Engel0Lukas Pirpamer1Edith Hofer2Reinhold Schmidt3Cornelia Brendle4Department of Neurosurgery, University Hospital of TuebingenClinical Division of Neurogeriatrics, Department of Neurology, Medical University of GrazClinical Division of Neurogeriatrics, Department of Neurology, Medical University of GrazClinical Division of Neurogeriatrics, Department of Neurology, Medical University of GrazDepartment of Neuroradiology, University Hospital of TuebingenAbstract Background The etiology of idiopathic normal pressure hydrocephalus (iNPH) remains unclear. Little is known about the pre-symptomatic stage. This study aimed to investigate the association of neuropsychological data with iNPH-characteristic imaging changes compared to normal imaging and unspecific atrophy in a healthy population. Methods We extracted data from the community-dwelling Austrian Stroke Prevention Family Study (ASPS-Fam) database (2006–2010). All subjects underwent a baseline and identical follow-up examination after 3–5 years with MR imaging and an extensive neuropsychological test battery (Trail Making Test B, short physical performance balance, walking speed, memory, visuo-practical skills, composite scores of executive function and g-factor). We categorized the subjects into “iNPH”-associated, non-specific “atrophy,” and “normal” based on the rating of different radiological cerebrospinal fluid (CSF) space parameters. We noted how the categories developed over time. We assessed the association of the image categories with the neuropsychological data, different demographic, and lifestyle parameters (age, sex, education, alcohol intake, arterial hypertension, hypercholesterolemia), and the extent of white matter hyperintensities. We investigated whether neuropsychological data associated with the image categories were independent from other parameters as confounders. Results One hundred and thirteen subjects, aged 50–70 years, were examined. The imaging category “iNPH” was only present at follow-up. A third of subjects with “atrophy” at baseline changed to the category “iNPH” at follow-up. More white matter hyperintensities (WMH) were present in later “iNPH” subjects. Subjects with “iNPH” performed worse than “normal” subjects on executive function (p = 0.0118), memory (p = 0.0109), and Trail Making Test B (TMT-B. p < 0.0001). Education, alcohol intake, diabetes, arterial hypertension, and hypercholesterolemia had no effect. Age, number of females, and the extent of white matter hyperintensities were higher in “iNPH” than in “normal” subjects but did not significantly confound the neuropsychological results. Conclusions Apparent asymptomatic subjects with “iNPH” imaging characteristics presented with subclinical cognitive decline and showed worse executive function, memory, and TMT-B results than “normal” subjects. WMH seem to play a role in the etiology before ventriculomegaly. Clinical screening of individuals with incidental iNPH-characteristic imaging and conspicuous results sof these neurocognitive tests needs further validation.https://doi.org/10.1186/s12987-021-00268-xIdiopathic normal pressure hydrocephalusNeuropsychological testingTrail Making Test-BTight high convexityEvans’ indexShort physical performance balance test |
| spellingShingle | Doortje C. Engel Lukas Pirpamer Edith Hofer Reinhold Schmidt Cornelia Brendle Incidental findings of typical iNPH imaging signs in asymptomatic subjects with subclinical cognitive decline Fluids and Barriers of the CNS Idiopathic normal pressure hydrocephalus Neuropsychological testing Trail Making Test-B Tight high convexity Evans’ index Short physical performance balance test |
| title | Incidental findings of typical iNPH imaging signs in asymptomatic subjects with subclinical cognitive decline |
| title_full | Incidental findings of typical iNPH imaging signs in asymptomatic subjects with subclinical cognitive decline |
| title_fullStr | Incidental findings of typical iNPH imaging signs in asymptomatic subjects with subclinical cognitive decline |
| title_full_unstemmed | Incidental findings of typical iNPH imaging signs in asymptomatic subjects with subclinical cognitive decline |
| title_short | Incidental findings of typical iNPH imaging signs in asymptomatic subjects with subclinical cognitive decline |
| title_sort | incidental findings of typical inph imaging signs in asymptomatic subjects with subclinical cognitive decline |
| topic | Idiopathic normal pressure hydrocephalus Neuropsychological testing Trail Making Test-B Tight high convexity Evans’ index Short physical performance balance test |
| url | https://doi.org/10.1186/s12987-021-00268-x |
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