Abnormal cortical thickening and thinning in idiopathic normal-pressure hydrocephalus

Kyunghun Kang,Jaehwan Han,Shin Young Jeong,Uicheul Yoon,Jong-Min Lee,Sang-Woo Lee,Yong-Hyun Lim

doi:10.1038/s41598-020-78067-x

Abstract

We investigated differences in cortical thickness between idiopathic normal-pressure hydrocephalus (INPH) patients and healthy controls. We also explored whether a relationship exists between cortical thinning and gait disturbance in INPH patients. Forty-nine INPH patients and 26 healthy controls were imaged with MRI, including 3-dimensional volumetric images, for automated surface-based cortical thickness analysis across the entire brain. Compared with age- and gender-matched healthy controls, unexpectedly, INPH patients showed statistically significant cortical thickening mainly in areas located in the high convexity of the frontal, parietal, and occipital regions. Additionally, cortical thinning mainly in temporal and orbitofrontal regions was observed in the INPH group relative to the control group. The Gait Status Scale (GSS) scores were negatively correlated with cortical thickness in the medial orbital part of the superior frontal gyrus, gyrus rectus, superior temporal gyrus, temporal pole, and insula. A distinctive pattern of cortical thickness changes was found in INPH patients. We cautiously suggest that cortical thickening in INPH can result from reactive gliosis. Further, our results support the hypothesis that cortical thinning in INPH can result from neuronal degeneration. In addition, cortical thinning can play an important role in gait disturbances in INPH patients.

Highlights

We investigated differences in cortical thickness between idiopathic normal-pressure hydrocephalus (INPH) patients and healthy controls
We investigated differences in cortical thickness utilizing automated surface-based cortical thickness analysis in two groups: INPH patients who had a positive response to the CSF tap test (CSFTT) and healthy controls
The final sample for analysis was 49 INPH patients who had a positive response to the CSFTT and 26 age- and gender-matched healthy controls

Summary

Introduction

We investigated differences in cortical thickness between idiopathic normal-pressure hydrocephalus (INPH) patients and healthy controls. We explored whether a relationship exists between cortical thinning and gait disturbance in INPH patients. Idiopathic normal-pressure hydrocephalus (INPH) is a rare disorder in neurology associated with an unknown underlying pathology causing cerebral ventricle e nlargement[1]. It is associated with unchanged cerebrospinal fluid (CSF) pressure along with cognitive impairment, gait disturbance, and urinary d ysfunction[1]. AD pathology comorbidity adversely affects shunt surgery outcomes and contributes to INPH s ymptomatology[7] It is well-known that cortical thinning patterns are associated with AD p athology[8]. An investigation of the relationship between cortical atrophy and gait performance in INPH patients has not been reported

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Conclusion