Abstract
We often encounter idiopathic normal-pressure hydrocephalus (iNPH) and mild cognitive impairment (MCI) in the same patient. Four iNPH patients whose gait improved following placement of a lumbar-peritoneal shunt (LPS) and whose cognitive function improved after administration of donepezil are reported. LPS is useful for improvement of gait disturbance in iNPH, and donepezil is used to treat impaired memory in dementia of Alzheimer’s type (DAT). These four patients showed improvements in gait disturbances postoperatively, and just after donepezil administration, improvements in cognitive symptoms were recognized in the memory tests of the Mini-Mental State Examination (MMSE). The four patients (two males and two females) ranged in age from 72 to 81 years (mean age: 77 years). In all patients, disproportionately enlarged subarachnoid-space hydrocephalus (DESH) was recognized on imaging examinations, and improvements after the tap test were considered to be indications for surgery. The improvements in the Timed Up and Go Test (TUG) were from 25% to 36%. The patients’ mean MMSE score was 27 points preoperatively, 27 points at 1 week after LPS placement, and 30 points at 3 months after LPS placement. Treatment with donepezil appeared to be effective for residual cognitive impairments after LPS placement.
Highlights
Idiopathic normal-pressure hydrocephalus is a pathological condition attributable to impaired cerebrospinal fluid absorption that gives rise mainly to a gait disturbance as well as to cognitive disorders and urination disorders in the absence of any preceding disease, such as subarachnoid hemorrhage or meningitis, and it is commonly seen in the elderly and slowly progresses
The diagnosis of Idiopathic normal-pressure hydrocephalus (iNPH) was made in cases in which there was disproportionately enlarged subarachnoid-space hydrocephalus (DESH), which is seen as enlargement of the subarachnoid space of the basal cistern of the brain and Sylvian fissure, in addition to enlargement of the cerebral ventricles and narrowing of the subarachnoid space of the upper fornix area and longitudinal fissure of the cerebrum on CT and MRI scans (SINPHONI) [1], in which Parkinson’s disease and dementia with Lewy bodies had been ruled out by myocardial scintigraphy [6], and that exhibited manifestations such as a gait disturbance, memory impairment, and incontinence
Four iNPH patients whose gait disturbances improved after lumbar-peritoneal shunt (LPS) placement and whose cognitive functions improved after administration of donepezil were described
Summary
Idiopathic normal-pressure hydrocephalus (iNPH) is a pathological condition attributable to impaired cerebrospinal fluid absorption that gives rise mainly to a gait disturbance as well as to cognitive disorders and urination disorders in the absence of any preceding disease, such as subarachnoid hemorrhage or meningitis, and it is commonly seen in the elderly and slowly progresses. It is a syndrome in which it is possible to achieve an improvement in symptoms by placing an appropriate shunt [1]. Four patients who showed improvements of gait disturbances and cognitive functions after LPS placement and donepezil administration are described
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