Premium
P4–140: Neuropsychologic deficits in normal pressure hydrocephalus
Author(s) -
Kastury Leah L.,
Golomb James,
Kluger Alan,
Boksay Istvan,
Wisoff Jeffrey,
Weiner Howard,
George Ajax,
Ferris Steven,
Reisberg Barry
Publication year - 2006
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2006.05.1879
Subject(s) - ventriculomegaly , dementia , medicine , normal pressure hydrocephalus , neuropsychology , hydrocephalus , audiology , pediatrics , cognition , psychology , disease , physical medicine and rehabilitation , psychiatry , pregnancy , fetus , genetics , biology
Background: Idiopathic Normal Pressure Hydrocephalus (iNPH) is a potentially treatable form of dementia and progressive gait impairment where symptoms are believed to be caused by the subcortical disruption of white matter tracts. Although Alzheimer’s disease (AD) is frequently co-morbid in iNPH, differences in affected brain tissue may result in differing neuropsychologic presentations. Objective: To contrast neuropsychological impairment between iNPH patients and matched non-NPH control subjects (normal, MCI or AD). Method: Within 13 years, 279 iNPH patients were evaluated at the NYU Silberstein Aging-and-Dementia Research Center. iNPH was diagnosed if patients exhibited sulcal disproportionate ventriculomegaly on CT/MRI and a prominent dyspraxic gait disorder without alternative neurologic explanation. Neither cognitive status nor incontinence was considered in making the diagnosis. Controls included research subjects with neither a gait disorder nor hydrocephalic ventriculomegaly who received diagnoses of either normal, MCI or AD. All iNPH patients underwent a neuropsychologic test battery (see table) before shunt surgery. Cases were excluded for impaired English language competency, a Global Deterioration Score (GDS) 4, or education 12 years. iNPH cases were paired with control subjects using a matching algorithm that first ensured exact correspondence for gender, GDS and Functional Assessment Staging score, and then minimized differences in age and years of education. Univariate analyses of variance were conducted with WAIS vocabulary score as a covariate to adjust for potential language and IQ influences. Results: Most iNPH cases exhibited global cognitive impairment (60.4% dementia, 31.8% MCI). No significant group differences were observed for age (mean 74.2yrs) or education (mean 15.3yrs). Significant mean neuropsychologic differences were observed only for Digit-Symbol Substitution, Perceptual Speed, Digit-Span Backward, Finger-Tapping Speed, and Trail-Making Part B (see table). Conclusion: To our knowledge, this is the first large scale study investigating neuropsychologic function in iNPH. The findings indicate that, relative to controls, iNPH patients exhibit neuropsychological deficits in selective attention, executive function, concentration, and motor functioning, but not in areas of language, constructional praxis, and verbal recent memory. These results support the concept that in iNPH, unlike normal aging or AD, patients exhibit a “subcortical dementia” syndrome with disproportionate deficits on non-cortically mediated tasks.