Postshunt cognitive and functional improvement in idiopathic normal pressure hydrocephalus. 2011

Heather Katzen, and Lisa D Ravdin, and Stephanie Assuras, and Roberto Heros, and Michael Kaplitt, and Theodore H Schwartz, and Matthew Fink, and Bonnie E Levin, and Norman R Relkin
Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA. hkatzen@med.miami.edu

BACKGROUND Improvement in gait after shunt placement has been well documented in idiopathic normal pressure hydrocephalus (iNPH); however, controversy remains regarding the extent and pattern of postsurgical cognitive changes. Conflicting findings may be explained by variability in both test selection and follow-up intervals across studies. Furthermore, most investigations lack a control group, making it difficult to disentangle practice effects from a true treatment effect. OBJECTIVE To examine postshunt changes in a sample of well-characterized iNPH participants compared with a group of age- and education-matched healthy control subjects. METHODS We identified 12 participants with iNPH undergoing shunt placement and 9 control participants. All participants were evaluated with comprehensive neuropsychological testing and standardized gait assessment at baseline and were followed up for 6 months. RESULTS Repeated-measures analysis of variance revealed a significant group- (iNPH and control) by-time (baseline and 6 months) interaction for Trailmaking Test B: (P < .003) and Symbol Digit Modalities (P < .02), with greater improvement in iNPH participants relative to control subjects. In addition, the iNPH group showed greater improvement in gait (P < .001) and caregivers reported improved activities of daily living (P < .01) and reduced caregiver distress (P < .01). CONCLUSIONS This study demonstrates improvements in mental tracking speed and sustained attention 6 months after shunt placement in iNPH. The present investigation is the first study to use a controlled design to show that cognitive improvement in iNPH is independent of practice effects. Furthermore, these findings indicate functional and quality-of-life improvements for both the shunt responder and their caregiver.

UI MeSH Term Description Entries
D009483 Neuropsychological Tests Tests designed to assess neurological function associated with certain behaviors. They are used in diagnosing brain dysfunction or damage and central nervous system disorders or injury. Aphasia Tests,Cognitive Test,Cognitive Testing,Cognitive Tests,Memory for Designs Test,Neuropsychological Testing,AX-CPT,Behavioral Assessment of Dysexecutive Syndrome,CANTAB,Cambridge Neuropsychological Test Automated Battery,Clock Test,Cognitive Function Scanner,Continuous Performance Task,Controlled Oral Word Association Test,Delis-Kaplan Executive Function System,Developmental Neuropsychological Assessment,Hooper Visual Organization Test,NEPSY,Neuropsychologic Tests,Neuropsychological Test,Paced Auditory Serial Addition Test,Repeatable Battery for the Assessment of Neuropsychological Status,Rey-Osterrieth Complex Figure,Symbol Digit Modalities Test,Test of Everyday Attention,Test, Neuropsychological,Tests, Neuropsychological,Tower of London Test,Neuropsychologic Test,Test, Cognitive,Testing, Cognitive,Testing, Neuropsychological,Tests, Cognitive
D011788 Quality of Life A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral, social environment as well as health and disease. HRQOL,Health-Related Quality Of Life,Life Quality,Health Related Quality Of Life
D002557 Cerebrospinal Fluid Shunts Tubes inserted to create communication between a cerebral ventricle and the internal jugular vein. Their emplacement permits draining of cerebrospinal fluid for relief of hydrocephalus or other condition leading to fluid accumulation in the ventricles. Cerebrospinal Fluid Shunt,Shunt, Cerebrospinal Fluid,Shunts, Cerebrospinal Fluid
D003072 Cognition Disorders Disorders characterized by disturbances in mental processes related to learning, thinking, reasoning, and judgment. Overinclusion,Disorder, Cognition,Disorders, Cognition
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006850 Hydrocephalus, Normal Pressure A form of compensated hydrocephalus characterized clinically by a slowly progressive gait disorder (see GAIT DISORDERS, NEUROLOGIC), progressive intellectual decline, and URINARY INCONTINENCE. Spinal fluid pressure tends to be in the high normal range. This condition may result from processes which interfere with the absorption of CSF including SUBARACHNOID HEMORRHAGE, chronic MENINGITIS, and other conditions. (From Adams et al., Principles of Neurology, 6th ed, pp631-3) Hakim Syndrome,Normal Pressure Hydrocephalus,Hakim's Syndrome,Hydrocephalus, Normal-Pressure,NPH (Normal Pressure Hydrocephalus),Hakim Syndromes,Hakim's Syndromes,Hakims Syndrome,NPHs (Normal Pressure Hydrocephalus),Syndrome, Hakim,Syndrome, Hakim's,Syndromes, Hakim,Syndromes, Hakim's
D000203 Activities of Daily Living The performance of the basic activities of self care, such as dressing, ambulation, or eating. ADL,Chronic Limitation of Activity,Limitation of Activity, Chronic,Activities, Daily Living,Activity, Daily Living,Daily Living Activities,Daily Living Activity,Living Activities, Daily,Living Activity, Daily
D020233 Gait Disorders, Neurologic Gait abnormalities that are a manifestation of nervous system dysfunction. These conditions may be caused by a wide variety of disorders which affect motor control, sensory feedback, and muscle strength including: CENTRAL NERVOUS SYSTEM DISEASES; PERIPHERAL NERVOUS SYSTEM DISEASES; NEUROMUSCULAR DISEASES; or MUSCULAR DISEASES. Ambulation Disorders, Neurologic,Charcot Gait,Charcot's Gait,Duck Gait,Gait Disorder, Sensorimotor,Gait Dysfunction, Neurologic,Gait, Athetotic,Gait, Broadened,Gait, Drop Foot,Gait, Festinating,Gait, Frontal,Gait, Hemiplegic,Gait, Hysterical,Gait, Reeling,Gait, Rigid,Gait, Scissors,Gait, Shuffling,Gait, Spastic,Gait, Stumbling,Gait, Unsteady,Gait, Widebased,Locomotion Disorders, Neurologic,Marche a Petit Pas,Neurologic Ambulation Disorders,Neurologic Locomotion Disorders,Rapid Fatigue of Gait,Sensorimotor Gait Disorder,Ambulation Disorder, Neurologic,Athetotic Gait,Broadened Gait,Charcot Gaits,Charcots Gait,Drop Foot Gait,Festinating Gait,Foot Gait, Drop,Frontal Gait,Gait Disorder, Neurologic,Gait Disorders, Sensorimotor,Gait Dysfunctions, Neurologic,Gait, Charcot,Gait, Charcot's,Gait, Duck,Gaits, Charcot,Hemiplegic Gait,Hysterical Gait,Locomotion Disorder, Neurologic,Neurologic Ambulation Disorder,Neurologic Gait Disorder,Neurologic Gait Disorders,Neurologic Gait Dysfunction,Neurologic Gait Dysfunctions,Neurologic Locomotion Disorder,Reeling Gait,Rigid Gait,Scissors Gait,Sensorimotor Gait Disorders,Shuffling Gait,Shuffling Gaits,Spastic Gait,Stumbling Gait,Unsteady Gait,Widebased Gait

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