Abstracts of the Hydrocephalus 2008 Congress / Clinical Neurology and Neurosurgery 110S (2008), S1S41
O.118 Cognitive and motor improvement after shunting in
normal pressure hydrocephalus: A real change or merely the learning effect after repeated test? E. Solana 1 , M.A. Poca 2 , J. Sahuquillo 2 , A. Muns 3 , C. Junqu 1 and Neurotraumatology Research Unint, Vall dHebron University Hospital, Barcelona, Spain; 2 Department of Neurosurgery, Neurosurgery and Neurotraumatology Research Unint, Vall dHebron University Hospital, Barcelona, Spain; 3 Department of Psychiatry and Clinical Psychophysiology, University of Barcelona and Institut dInvestigations Biomdiques August Pi-Sunyer, Barcelona, Spain
patients after CSF removal is related to enhanced activity in medial parts
of frontal motor areas considered crucial for motor planning. Regarding cognitive functioning, longer recuperation times seems to be needed before signicant effects arise.
1 Neurosurgery
The test-retest method is commonly used in the management of patients
with normal pressure hydrocephalus (NPH). However, interpretation of improved results in subsequent evaluations is controversial, because higher scores could reect a real change in cognitive abilities or could be simply the result of a learning effect. Objective and Methods: To determine the effect of testing-retesting in NPH patients, we analyzed changes in ve neuropsychological tests (Toulouse-Pieron, Trail Making A, Grooved Pegboard, Word Fluency and Bingleys Memory tests) and several motor abilities (motor performance test, length of step and walking speed) in a series of 32 NPH patients who underwent the same battery on 4 consecutive days. The results were compared with those obtained in 30 healthy volunteers who underwent the same procedure. Results: NPH patients showed no statistically signicant differences in any of the neuropsychological or motor tests performed on 4 consecutive days. In contrast, healthy volunteers showed statistically signicant improvement in the Toulouse-Pieron, Trail Making A, and Grooved Pegboard tests (P< 0.001) but not in the remaining tests. Conclusions: No learning effect was found in NPH patients in any of the neuropsychological or motor tests evaluated. Clinical improvement after retesting in NPH patients reects real changes and this strategy can therefore be used both in diagnosis and in the evaluation of surgical outcomes. Supported by Grant FIS:PI07/0681 to M.A. Poca.
O.119 What enhanced cortical activity occurs in the INPH
brain after CSF drainage in conjunction with improved performance? N. Lenfeldt 1 , A. Larsson 2 , L. Nyberg 3 , M. Andersson 1 , J. Malm 1 Neuroscience, Ume, Sweden; 2 Radiation Sciences, Ume, Sweden; 3 Integrative Medical Biology, Ume, Sweden
1 Clinical
Objective: This study used functional MRI (fMRI) to investigate the
changes in cortical activity that accompanies improved motor and cognitive performance after long-term external lumbar drainage (ELD) of CSF in patients with INPH. Methods: Eighteen INPH patients and ten matched controls were included in the study, and data from eleven INPH patients were analysed both before and after the ELD. Their average drain volume was 400 ml/3d. Brain activation was investigated using fMRI protocols taxing motor performance (nger tapping and reaction time) and cognitive functioning (memory and attention) before and after ELD. Behavioural data were compared at a signicance level of 0.05, whereas functional MRI data were analysed by statistical parametric mapping including a conjunction analysis of areas enhancing in activity after ELD and areas activated in controls (p< 0.005, uncorrected). Results: Right-hand nger tapping improved from 104 to 117 (p= 0.02). Left-hand nger tapping showed a tendency to improve (p= 0.12). Righthand reaction time improved from 1630 ms to 1409 ms and left-hand reaction time from 1760 ms to 1467 (both p-values = 0.01). Signicant improvements in motor performance were accompanied by bilateral increased activation in the supplementary motor area. Cognitive functions did also improve, but not signicantly so, and hence the cortical cognitive enhancement areas could not be determined. Conclusions: The results suggest that motor function recovery in INPH
O.120 Cognitive and biochemical prole of patients suffering
from idiopathic normal pressure hydrocephalus A. Tarnaris 1 , M.D. Chapman 3 , E. Pullen 2 , A. Toma 1 , A. Petzold 3 , N.D. Kitchen 1 , L. Cipolotti 2 , L. Lemieux 4 , G. Keir 3 , L.D. Watkins 1 1 Victor Horsley department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; 2 Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK; 3 Department of Neuroimmunology, Institute of Neurology, London, UK; 4 Department of Clinical and Experimental Epilepsy, Institute of Neurology, London, UK and MRI Unit, National Society for Epilepsy, Chalfont St Peter, UK Introduction: It is still not clearly established whether the cognitive decits of iNPH is caused by a disturbance in CSF dynamics or an underlying metabolic disturbance. Objective: To identify any possible associations between biochemical markers, the neuroimaging characteristics and cognitive decits of patients undergoing investigations for possible iNPH. Methods: In 10 patients with iNPH a CSF sample obtained during a lumbar puncture was analysed for several biochemical markers (lactate, 8-isoprostane, VEGF, neurolament heavy protein (NF(h)), GFAP, Ab1-42 and tau). All patients underwent a battery of neuropsychological testing and imaging as part of their selection process for possible CSF diversion surgical procedure. Volumetric analysis of imaging was carried out measuring the ventricular (VV), intracranial (ICV), periventricular (PVL), deep white matter hyperintensities (DWMH) and white matter (WM) volumes. Results: There was a signicant positive correlation (R=0.648, p=0.043) between the levels of VEGF and the VV/ICV ratio. There was a signicant positive correlation of the levels of GFAP and the VV/DWMH ratio (R=0.828, p=0.006). A signicant negative correlation was observed between the levels of NF(h) and the VV/ICV ratio (R=-0.657, p=0.039) and the white matter volume (R=-0.778, p=0.023). The mean levels of GFAP were signicantly higher in the patients who performed normally in the trail making test B, than the patients who had below normal performance (p=0.001). No correlation was found between the cranial volumes and the cognitive prole of the above patients. Conclusion: The positive correlation of the VEGF levels with the severity of ventriculomegaly may indicate that this is due to the transmantle pressure gradient; this response may not be due to hypoxia but represent an attempt of neuroregeneration. GFAP correlates strongly with the amount of DWMH suggesting a degree of irreversible damage being represented by these two markers. However, higher levels of GFAP appeared in patients whose frontal executive functions were normal meaning that the cognitive disturbance might be due to some other underlying cause. Neuronal degeneration as measured by the neurolament levels are negatively correlated with the volume of the white matter in these patients. The negative correlation with the ventriculomegaly may indicating a dilution effect for NF(h). The negative association of the volumetry and cognitive proles of these patients may suggest a direct biochemical disturbance being responsible for the cognitive decit observed.
O.121 CSF and blood ows in mild cognitive impairment and
Alzheimer disease. Differential diagnosis with normal pressure hydrocephalus? S. Stoquart-El Sankari, C. Gondry-Jouet, D. Mbayo, O. Godefroy, O. Baldent University Hospital, Amiens, France Phase-contrast magnetic resonance imaging (PC-MRI) is a noninvasive reliable technique which enables quantication of cerebrospinal uid (CSF)