Poor Cognitive Outcome in Shunt-Responsive Idiopathic Normal Pressure Hydrocephalus
Poor Cognitive Outcome in Shunt-Responsive Idiopathic Normal Pressure Hydrocephalus
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DOI：
10.1227/neu.0b013e31827414b3
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发表时间：
2013-01-01
期刊：
影响因子：
4.8
通讯作者：
Leinonen, Ville
中科院分区：
文献类型：
--
作者：
Koivisto, Anne M.;Alafuzoff, Irina;Leinonen, Ville
背景技术背景：特发性正常压力脑积水（iNPH）导致认知功能下降，可以通过分流缓解，但长期结果研究很少。目的：阐明分流反应性iNPH患者的长期认知状况。随访数据（库奥皮奥大学医院NPH登记处）对146名通过临床和放射学检查、24小时脑室内压监测诊断为iNPH的患者进行了研究，分析额叶皮质活检和对分流的反应是否有痴呆的迹象。使用精神障碍诊断和统计手册第四版和指定的记忆障碍标准。中位随访时间为4.8年。结果：随访结束时，146名iNPH患者中有117名（80%）出现认知功能下降，67名（46%）出现临床痴呆。最常见的临床诊断是阿尔茨海默病和血管性痴呆。在146例iNPH患者的多变量分析中，记忆缺陷作为分流前的首发症状（比值比[OR] 18.3; 95%置信区间[CI] 1.9-175），男性（OR 3.29; 95%CI 1.11-9.73）、年龄（OR 1.17岁; 95%CI 1.07-1.28）和随访时间（OR 1.20年; 95%CI 1.02-1.40）预测痴呆。有趣的是，在临床、神经放射学或脑活检评价中，8例（5%）iNPH患者患有痴呆，而没有任何其他神经退行性疾病的体征。这些患者最初表现出完整的三联征，步态障碍是最常见的初始症状，其次是认知功能恶化。新的发现是（a）最初对脑脊液分流有反应的iNPH中痴呆的显著风险，（B）认知障碍最常见于iNPH相关痴呆，其次是并发退行性脑病，和（c）患有与iNPH相关的痴呆且无合并症的亚组。
BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) causes cognitive decline that can be alleviated by shunting, but long-term outcome studies are scarce.OBJECTIVE: To elucidate the long-term cognitive condition of shunt-responsive iNPH patients.METHODS: The follow-up data (Kuopio University Hospital NPH Registry) of 146 patients diagnosed with iNPH by clinical and radiological examination, 24-hour intraventricular pressure monitoring, frontal cortical biopsy, and response to the shunt were analyzed for signs of dementia. The Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, and specified memory disorder criteria were used. Median follow-up was 4.8 years.RESULTS: At the end of follow-up, 117 (80%) of the 146 iNPH patients had cognitive decline and 67 (46%) had clinical dementia. The most common clinical diagnoses were Alzheimer disease and vascular dementia. In multivariate analysis of the 146 iNPH patients, memory deficit as a first symptom before shunt (odds ratio [OR] 18.3; 95% confidence interval [CI] 1.9-175), male sex (OR 3.29; 95% CI 1.11-9.73), age (OR 1.17 year; 95% CI 1.07-1.28), and follow-up time (OR 1.20 year; 95% CI 1.02-1.40) predicted dementia. Interestingly, 8 (5%) iNPH patients had dementia without any signs of other neurodegenerative diseases in clinical, neuroradiological, or brain biopsy evaluation. These patients initially presented a full triad of symptoms, with gait disturbance being the most frequent initial symptom followed by deterioration in cognition.CONCLUSION: The novel findings were (a) a significant risk of dementia in iNPH initially responsive to cerebrospinal fluid shunt, (b) cognitive impairment most commonly due to iNPH-related dementia followed by concurrent degenerative brain disease, and (c) a subgroup with dementia related to iNPH without comorbidities.