Abstract
Background: Idiopathic normal pressure hydrocephalus (iNPH) is a common disease in elderly adults. Patients with iNPH are generally characterized by progressive gait impairment, cognitive deficits, and urinary urgency and/or incontinence. A number of radiographic studies have shown that iNPH patients have enlarged ventricles and altered brain morphology; however, few studies have focused on the relationships between altered brain structure and gait dysfunction due to iNPH. Thus, this study aimed to evaluate the abnormalities of white matter (WM) correlated with gait impairment in iNPH patients and to gain a better understanding of its underlying pathology.Methods: Fifteen iNPH patients (five women, 10 men) were enrolled in this study, and each patient’s demographic and gait indices were collected. First, we performed a correlation analysis between the demographic and gait indices. Then, all gait indices were grouped according to the number of WM hyperintensities (WMH) among each WM tract (JHU WM tractography atlas), to perform comparative analysis.Results: Considering sex and illness duration as covariates, correlation analysis showed a significantly negative correlation between step length (r = −0.80, p = 0.001), pace (r = −0.84, p = 2.96e-4), and age. After removing the effects of age, sex, and illness duration, correlation analysis showed negative correlation between step length (r = −0.73, p = 0.007), pace (r = −0.74, p = 0.005), and clinical-grade score and positive correlation between 3-m round trip time (r = 0.66, p = 0.021), rising time (r = 0.76, p = 0.004), and clinical-grade score. Based on WMH of each white matter tract, gait indices showed significant differences (p < 0.05/48, corrected by Bonferroni) between fewer WMH patients and more WMH in the middle cerebellar peduncle, left medial lemniscus, left posterior limb of the internal capsule (IC), and right posterior limb of the IC.Conclusions: Our results indicated that iNPH patients exhibited gait-related WM abnormalities located in motor and sensory pathways around the ventricle, which is beneficial to understand the underlying pathology of iNPH.
Highlights
Idiopathic normal pressure hydrocephalus is a common reversible syndrome characterized by progressive gait impairment, cognitive deficits, urinary urgency and/or incontinence, ventricular enlargement, and normal mean intracranial pressure, which typically occurs in the elderly (>60 years; Adams et al, 1965; Hebb and Cusimano, 2001)
According to the guidelines for the management of Idiopathic normal pressure hydrocephalus (iNPH), the tap test is effective in detecting abnormal cerebrospinal fluid (CSF) hydrodynamics and predicting the effectiveness of ventriculoperitoneal shunting (Marmarou et al, 2005; Ishikawa et al, 2008; Mori et al, 2012); it has some potential risk as an invasive procedure
All patients were from the Department of Neurology of Zhongshan Hospital and diagnosed as probable iNPH which is consistent with the Japanese iNPH Guidelines more than one symptom in the clinical triad; above-mentioned clinical symptoms cannot be completely explained by other neurological or non-neurological disease; preceding diseases possibly causing ventricular dilation are not obvious; CSF pressure of 200 mm H2O or less and normal CSF content; improvement of symptoms after CSF tap test
Summary
Idiopathic normal pressure hydrocephalus (iNPH) is a common reversible syndrome characterized by progressive gait impairment, cognitive deficits, urinary urgency and/or incontinence, ventricular enlargement, and normal mean intracranial pressure, which typically occurs in the elderly (>60 years; Adams et al, 1965; Hebb and Cusimano, 2001). Cerebrospinal fluid (CSF) shunting and drainage aid in improving or reversing symptoms of iNPH in the early period (Mirzayan et al, 2010); accurate diagnosis and appropriate treatment of early iNPH is important. In-depth pathological investigations and identification of specific biomarkers of iNPH are important for accurate diagnosis and treatment. Patients with iNPH are generally characterized by progressive gait impairment, cognitive deficits, and urinary urgency and/or incontinence. This study aimed to evaluate the abnormalities of white matter (WM) correlated with gait impairment in iNPH patients and to gain a better understanding of its underlying pathology
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