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A population-based study on neuropsychological and morphological signs of idiopathic normal pressure hydrocephalus
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper.
2022 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is typically manifested in people over 65 years. The condition of gait disturbances, incontinence, and cognitive dysfunction can be reversed in up to 80% of the cases by ventricular shunting. Neuropsychological testing and standardized brain imaging of signs of iNPH are essential to detect and define the progression. The aims of this thesis were to develop a radiological iNPH scale, examine how morphological features relate to symptoms of iNPH, investigate if dual-task testing (e.g., walking and talking) is helpful in detecting iNPH, and monitor developing symptoms over two years.

METHOD: The studies include 168 participants (median [range] age 73 [66–92]) at baseline (2014/2015) and 104 participants (age 75 [68–91]) at follow-up (2016/2017) from the general population. Neuropsychological tests of executive functions, memory, and motor performance, and computed tomography (CT) for brain imaging were used.

RESULTS: Seven morphological features were combined into a scoring scale for iNPH. The total score correlated with clinical symptoms (r = -0.40, p <.001). All core symptoms were associated to wider temporal horns (TH) (p <.01). Participants with iNPH stopped walking to talk more frequently (p = .044). Participants who developed iNPH during the study worsened more on declarative memory (ES -0.37).

DISCUSSION: The Radscale was related to symptoms of iNPH and the TH to all main clinical features. Difficulties walking while recalling a previous event, worsened declarative memory, and expanding ventricular space surrounding the hippocampus were noticeable signs of iNPH. Memory functions are important to recognize in iNPH.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University , 2022. , s. 86
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2200
Nyckelord [en]
idiopathic normal pressure hydrocephalus, cognition, dual-task, ageing, temporal horns, morphology, memory, executive function
Nationell ämneskategori
Neurologi
Forskningsämne
neurologi
Identifikatorer
URN: urn:nbn:se:umu:diva-201142ISBN: 978-91-7855-889-6 (tryckt)ISBN: 978-91-7855-890-2 (digital)OAI: oai:DiVA.org:umu-201142DiVA, id: diva2:1712333
Disputation
2022-12-15, Hörsalen Snäckan, Östersund sjukhus, Östersund, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2022-11-24 Skapad: 2022-11-21 Senast uppdaterad: 2022-12-02Bibliografiskt granskad
Delarbeten
1. Dual-Task Performance in Older Adults With and Without Idiopathic Normal Pressure Hydrocephalus
Öppna denna publikation i ny flik eller fönster >>Dual-Task Performance in Older Adults With and Without Idiopathic Normal Pressure Hydrocephalus
2022 (Engelska)Ingår i: Frontiers in Aging Neuroscience, ISSN 1663-4365, E-ISSN 1663-4365, Vol. 14, artikel-id 904194Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Two of the main features of idiopathic normal pressure hydrocephalus (iNPH) are disturbed gait and cognition. These features are typically investigated separately, but here we combined walking with a cognitive task to investigate if older adults with iNPH were more susceptible to dual-task interference on walking than those without iNPH. In total, 95 individuals from the general population participated in our study. Of these, 20 were classified as Possible iNPH (median [interquartile range, IQR] 80 years [75–82.5]) and 75 as Unlikely iNPH (74 years [72–78]). Conversation, 10-m walking, semantic and phonemic verbal fluency were performed either combined or independently. “Stopping walking while talking” was noted. Pairwise comparisons and multiple logistic regression analyses were used. We found that the Possible iNPH group was older, stopped walking more frequently during the conversation, and had a slower single-task pace. The dual-task pace was slower for both groups. Only single-task walking pace could predict Possible iNPH when adjusted for age. We could establish a dual-task cost on gait performance in this sample of older adults from the general population, but the cost was not exclusive for individuals with Possible iNPH. To further assess the value of dual-task testing in iNPH, including observations of stopping walking while talking, a study of a clinical iNPH material with more severe symptoms would be valuable.

Ort, förlag, år, upplaga, sidor
Frontiers Media S.A., 2022
Nyckelord
idiopathic normal pressure hydrocephalus, cognition, dual-task, ageing
Nationell ämneskategori
Neurologi
Forskningsämne
neurologi; klinisk psykologi
Identifikatorer
urn:nbn:se:umu:diva-201140 (URN)10.3389/fnagi.2022.904194 (DOI)000810184900001 ()35707704 (PubMedID)2-s2.0-85132248019 (Scopus ID)
Forskningsfinansiär
Knut och Alice Wallenbergs StiftelseUmeå universitetUppsala universitetRegion Jämtland Härjedalen
Tillgänglig från: 2022-11-21 Skapad: 2022-11-21 Senast uppdaterad: 2022-11-25Bibliografiskt granskad
2. Wide temporal horns are associated with cognitive dysfunction, as well as impaired gait and incontinence
Öppna denna publikation i ny flik eller fönster >>Wide temporal horns are associated with cognitive dysfunction, as well as impaired gait and incontinence
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2020 (Engelska)Ingår i: Scientific Reports, E-ISSN 2045-2322, Vol. 10, nr 1, artikel-id 18203Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The association between morphology of the brain and symptoms of suspected idiopathic normal pressure hydrocephalus (iNPH) is largely unknown. We investigated how ventricular expansion (width of the temporal horns [TH], callosal angle [CA], and Evans' index [EI]) related to symptom severity in suspected iNPH. Participants (n=168; 74.9 years +/- SD 6.7; 55% females) from the general population underwent neurological examination, computed tomography, and neuropsychological testing. Multiple linear regression analysis revealed that wide TH was independently associated with all examined iNPH symptoms (p<0.01) except for fine-motor performance, whereas a narrow CA only was associated to specific motor and cognitive functions (p<0.05). TH and EI correlated significantly with incontinence (r(s) 0.17 and r(s) 0.16; p<0.05). In conclusion, wide TH was significantly associated with most iNPH-symptoms. This finding potentially reflects the complex nature of the hippocampus, however further studies are needed to demonstrate functional connectivity.

Ort, förlag, år, upplaga, sidor
Nature Publishing Group, 2020
Nationell ämneskategori
Neurologi
Identifikatorer
urn:nbn:se:umu:diva-177175 (URN)10.1038/s41598-020-75381-2 (DOI)000586495800004 ()33097796 (PubMedID)2-s2.0-85093977166 (Scopus ID)
Tillgänglig från: 2020-12-01 Skapad: 2020-12-01 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
3. The idiopathic normal-pressure hydrocephalus Radscale: a radiological scale for structured evaluation
Öppna denna publikation i ny flik eller fönster >>The idiopathic normal-pressure hydrocephalus Radscale: a radiological scale for structured evaluation
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2018 (Engelska)Ingår i: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 25, nr 3, s. 569-576Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background and purpose: Despite the important role of imaging in diagnosing idiopathic normal‐pressure hydrocephalus (iNPH), a structured overall assessment of radiological signs is still lacking. The purpose of this study was to construct a radiological scale, composed of morphological signs of iNPH, and compare it with clinical symptoms.

Methods: In this prospective, population‐based study of iNPH, 168 individuals (93 females) [mean age 75 (range 66–92) years] underwent computed tomography of the brain and a neurological examination with assessment of clinical symptoms according to Hellström's iNPH scale. Two radiologists, blinded to clinical data, independently evaluated and measured eight radiological parameters, i.e. Evans’ index, callosal angle, size of temporal horns, narrow high‐convexity sulci, dilated Sylvian fissures, focally dilated sulci, peri‐ventricular hypodensities and bulging of the lateral ventricular roof.

Results: In a linear regression model, all parameters except ventricular roof bulging were significantly associated with clinical iNPH symptoms. The seven remaining parameters were summarized into a total iNPH Radscale score ranging from 0 to 12. There was a significant correlation (r = 0.55, < 0.001) between the total iNPH Radscale score and clinical symptoms. The inter‐rater agreement for the included radiological parameters was high (intraclass correlation, 0.74–0.97).

Conclusion: The iNPH Radscale may become a valuable diagnostic screening tool, allowing a structured radiological assessment. A high iNPH Radscale score together with clinical symptoms should raise suspicion of iNPH, motivating further evaluation for shunt surgery.

Nyckelord
computed tomography, neurologic gait disorders, normal pressure hydrocephalus, memory disorders
Nationell ämneskategori
Radiologi och bildbehandling
Identifikatorer
urn:nbn:se:umu:diva-145580 (URN)10.1111/ene.13555 (DOI)000425631500025 ()29281156 (PubMedID)2-s2.0-85042358989 (Scopus ID)
Tillgänglig från: 2018-03-22 Skapad: 2018-03-22 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
4. Longitudinal neuropsychological trajectories of idiopathic normal pressure hydrocephalus: a populationbased study
Öppna denna publikation i ny flik eller fönster >>Longitudinal neuropsychological trajectories of idiopathic normal pressure hydrocephalus: a populationbased study
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(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nyckelord
idiopathic normal pressure hydrocephalus, cognition, ageing, morphology, memory, executive function, longitudinal, life-span
Nationell ämneskategori
Neurologi
Forskningsämne
neurologi
Identifikatorer
urn:nbn:se:umu:diva-201159 (URN)
Tillgänglig från: 2022-11-22 Skapad: 2022-11-22 Senast uppdaterad: 2022-11-25

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