Abstract
Awareness of the importance of chronic adult hydrocephalus has been raised again with the recent emergence of epidemiological studies. It is estimated that between 5 and 10% of patients suffering from dementia might, in fact, have chronic hydrocephalus. Although, surgical diversion of the cerebrospinal fluid (CSF) represents the only known procedure able to treat the symptoms of this condition, the selection of surgical patients has always been problematic. In the last 40 years, we have become wiser in using appropriate diagnostic tests for the selection of these patients; however, the area of biological markers has so far been overlooked in this condition, in contrast to that for other neurodegenerative disorders and dementias. Biomarkers are biological substances that may be used to indicate either the onset or the presence, and the progression of a clinical condition, being closely linked to its pathophysiology. In such a setting they might assist in the more appropriate selection of patients for shunt surgery. In this article, we have reviewed research carried out in the last 25 years regarding the identification of serum and CSF biomarkers for chronic hydrocephalus, discussed the potential for each one, and finally discussed the limitations for use, as well as future directions and possibilities in this field. It is concluded that tumour-necrosis factor, tau protein, lactate, sulfatide and neurofilament triple protein are the most promising CSF markers for chronic hydrocephalus. At present however, none of these meet the criteria required to justify a change clinical practice. In the future, collaborative multi-centre projects will be needed to obtain more substantial data that overcome the problems that arise from small individual and uncoordinated studies.
Highlights
Chronic communicating hydrocephalus in adults is recognised as one of the causes for reversible dementia, with an occurrence of 1–10% among patients with a diagnosis of dementia [1,2]
Nooijen et al reported higher lactate levels in the normal pressure hydrocephalus (NPH) group when compared to controls, and significantly higher values when compared with Alzheimer's dementia (AD) (p = 0.0005, n = 36) and vascular dementia (p
The results showed a significant increase in the levels of thiobarbituric acid-reactive material (TBAR), total and soluble SH groups, as well as a decrease in the number of protein thiol groups between the NPH and the control group
Summary
Chronic communicating hydrocephalus in adults is recognised as one of the causes for reversible dementia, with an occurrence of 1–10% among patients with a diagnosis of dementia [1,2]. The term chronic hydrocephalus of adult-onset (CAH) encompasses a variety of conditions that include normal pressure hydrocephalus (NPH) of the idiopathic or secondary variety (depending on whether there is a known cause such as trauma, subarachnoid haemorrhage, meningitis, and tumour), communicating hydrocephalus due to a disturbance of CSF dynamics, non-tumoural aqueductal stenosis, and compensated arrested hydrocephalus. Biomarkers can assist us in this task as they provide an insight to the changes of the cerebral milieu associated with the condition. In order for their use to be established in routine clinical practice, they should demonstrate high sensitivity and specificity. Extensive research has already been carried out to document the hydrocephalus-induced changes in the composition of cerebrospinal fluid (CSF) [16]
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