The CSF lipid profile in patients with probable idiopathic normal pressure hydrocephalus differs from control but does not differ between shunt responders and non-responders

Abstract

Abstract Idiopathic normal pressure hydrocephalus (iNPH) is a common form of hydrocephalus in the elderly, characterized by enlarged ventricles combined with clinical symptoms presenting as gait impairment, urinary incontinence, and dementia. iNPH may be difficult to differentiate clinically from other neurodegenerative disorders, and up to 80% of cases may remain unrecognized and thus untreated. Consequently, there is a pressing demand for biomarkers that can confirm the diagnosis of iNPH. In this exploratory study, CSF was sampled from the lumbar compartment of 21 control individuals and 19 probable iNPH patients and analysed by an untargeted mass spectroscopy-based platform to reveal a complete CSF lipid profile in these samples. 244 lipids from 17 lipid classes were detected in CSF. Various lipid classes, and select individual lipids, were reduced in the CSF obtained from patients with probable iNPH, whereas a range of lipids belonging to the class of triacylglycerols was elevated. We detected no difference in the CSF lipid profile between probable iNPH patients with and without clinical improvement following CSF shunting. In conclusion, the lipidomic profile of the CSF in patients with probable iNPH therefore may serve as a thought after biomarker of the pathology, which may be employed to complement the clinical diagnosis.