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S32

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)

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