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Hydrocephalus, Intracranial Pressure and Neurocognition

脑积水、颅内压和神经认知

基本信息

批准号：
7097900
负责人：
DAVID MARTIN FRIM
金额：
$ 28.29万
依托单位：
UNIVERSITY OF CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2003
资助国家：
美国
起止时间：
2003-09-30 至 2008-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7097900
关键词：
behavioral /social science research tag cerebral ventricles cerebrospinal fluid clinical research hydrocephalus implant intracranial pressure magnetic resonance imaging neuropsychological tests neuropsychology neurosurgery patient monitoring device

项目摘要

DESCRIPTION (provided by applicant): Hydrocephalus, a build-up of cerebrospinal fluid (CSF) in the intracranial space, is a disease that can cause significant neurological injury. Although the associated life-threatening intracranial hypertension can be well treated by diversion of cerebrospinal fluid to an absorptive surface outside of the brain, the short- and longterm cognitive effects of elevated intracranial pressure and altered cerebrospinal fluid pressure dynamics are incompletely understood. The overall objective of this proposal is to determine the cognitive effects of changes in intracranial pressure and altered CSF pressure dynamics in a population of hydrocephalics. In addition, these studies may help to determine the pressures needed to optimize cognitive outcome in the treatment of hydrocephalus. Specifically, the aims of the proposal are: (1) to determine the acute changes in cognitive function associated with graded increases in ICP seen after manipulations of novel programmable CSF shunting valves; (2) to determine the changes in cognitive function caused by the lowering of intracranial pressure (ICP) at the time of treatment of malfunctioning shunts; (3) to determine the cognitive deficits and post-treatment improvement in the sub-population of hydrocephalics with aqueductal stenosis who are treated by an internal CSF bypass procedure; and (4) to determine the shunting pressure dynamic that optimizes cognitive function when comparing the two most commonly used shunting valve systems: those that siphon and those that do not. We propose enrolling hydrocephalic patients as subjects for a series of studies addressing the above specific aims. Cerebrospinal fluid pressure dynamics will be measured using telemonitoring technology for the non-invasive measurement of ICP which is implanted in-line in the CSF shunting system as part of the standard clinical care of the hydrocephalic patient. Treatment outcome determination will be based on specific neuropsychological tests of higher cortical function. With this approach in the hydrocephalus model, we will be able to examine the effects of ICP changes on neurocognition, presumably determining which cognitive functions are ICP "sensitive" or ICP "resistant". At the study conclusion, derived data should also practically affect the surgical choice of shunting products.

描述（由申请人提供）：脑积水是脑脊液（CSF）在颅内积聚的一种疾病，可导致严重的神经损伤。虽然相关的危及生命的颅内高压可以通过将脑脊液转移到大脑外的吸收表面来得到很好的治疗，但颅内压升高和脑脊液压力动态改变的短期和长期认知影响尚不完全清楚。该提案的总体目标是确定脑积水人群中颅内压变化和脑脊液压力动态变化的认知影响。此外，这些研究可能有助于确定在脑积水治疗中优化认知结果所需的压力。具体来说，该提案的目的是：（1）确定在操作新型可编程脑脊液分流阀后与ICP分级增加相关的认知功能的急剧变化； (2) 确定分流器故障治疗时颅内压（ICP）降低引起的认知功能变化； (3) 确定接受脑脊液内搭桥手术治疗的伴有导水管狭窄的脑积水患者亚群的认知缺陷和治疗后改善情况； (4) 在比较两种最常用的分流阀系统（虹吸式和非虹吸式）时，确定优化认知功能的分流压力动态。我们建议招募脑积水患者作为针对上述具体目标的一系列研究的受试者。脑脊液压力动态将使用远程监测技术进行测量，用于无创测量 ICP，该技术被在线植入脑脊液分流系统中，作为脑积水患者标准临床护理的一部分。治疗结果的确定将基于高级皮质功能的特定神经心理学测试。通过脑积水模型中的这种方法，我们将能够检查 ICP 变化对神经认知的影响，大概确定哪些认知功能是 ICP“敏感”或 ICP“抵抗”。根据研究结论，派生数据实际上也会影响分流产品的手术选择。