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Risk of idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia

Published online by Cambridge University Press:  11 November 2015

Yuta Yoshino ,
Taku Yoshida ,
Takaaki Mori ,
Shigeru Hirota ,
Junichi Iga  and
Shu-ichi Ueno
Yuta Yoshino*
Affiliation:
Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
Taku Yoshida
Affiliation:
Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
Takaaki Mori
Affiliation:
Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
Shigeru Hirota
Affiliation:
Department of Psychiatry, Futaiwa Hospital, 4-160-1, Wakayama, Yawatahama, Ehime 796-8035, Japan
Junichi Iga
Affiliation:
Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
Shu-ichi Ueno
Affiliation:
Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
*
Correspondence should be addressed to: Yuta Yoshino, Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan. Phone: +81-89-960-5315; Fax: +81-89-960-5317. Email: [email protected].
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Abstract

Background:

The mean age of inpatients with schizophrenia has gradually increased in Japan and the risk of fracture in older schizophrenia patients is elevated. One possible cause may be idiopathic normal pressure hydrocephalus (iNPH). The present study aimed to evaluate the prevalence and symptoms of iNPH in older inpatients with schizophrenia.

Methods:

We prospectively examined older inpatients with schizophrenia (N = 21, mean age = 70.5 ± 5.9) in a psychiatric ward. We evaluated iNPH symptoms using the idiopathic Normal-Pressure Hydrocephalus Grading Scale (iNPHGS), Timed Up-and-Go test (TUG), Gait Status Scale (GSS), Mini-Mental State Examination (MMSE), and Neuropsychiatric Inventory (NPI). We also evaluated symptoms of schizophrenia using the Brief Psychiatric Rating Scale (BPRS) and Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). We conducted cerebrospinal fluid (CSF) tap tests for patients with possible-iNPH.

Results:

In total, three (14.3%) patients were diagnosed with possible iNPH: age, GS-Gait, GS-Cognition, TUG, 10-meter walking test, GSS, and DIEPSS were significantly increased in these compared to patients without iNPH; however, GS-Urine, MMSE, NPI, and BPRS did not differ significantly. Probable iNPH was diagnosed for two (9.5%) patients because of positive CSF tap tests.

Conclusion:

The prevalence of possible and probable iNPH in older patients with schizophrenia was much higher than that reported for older people without mental illness. Of the symptoms evaluated with the tests employed, only gait disturbances, particularly walking speed, distinguished schizophrenia patients with iNPH. These findings suggest that we should pay more attention to the possibility of iNPH in older patients with schizophrenia.

Keywords

schizophrenianormal pressure hydrocephaluscerebrospinal fluid tap test
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 5 , May 2016 , pp. 863 - 868
Copyright
Copyright © International Psychogeriatric Association 2015 

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References

Apostolova, L. G. et al. (2012). Hippocampal atrophy and ventricular enlargement in normal aging, mild cognitive impairment (MCI), and Alzheimer Disease. Alzheimer Disease and Associated Disorders, 26, 17–27. doi: 10.1097/WAD.0b013e3182163b62.CrossRefGoogle ScholarPubMed
Bergsneider, M., Black, P. M., Klinge, P., Marmarou, A. and Relkin, N. (2005). Surgical management of idiopathic normal-pressure hydrocephalus. Neurosurgery, 57 (Suppl. 3), S29–S39.CrossRefGoogle ScholarPubMed
Brean, A. and Eide, P. K. (2008). Prevalence of probable idiopathic normal pressure hydrocephalus in a Norwegian population. Acta Neurologica Scandinavica, 118, 48–53. doi: 10.1111/j.1600-0404.2007.00982.x.CrossRefGoogle Scholar
Casmiro, M., D’Alessandro, R., Cacciatore, F. M., Daidone, R., Calbucci, F. and Lugaresi, E. (1989). Risk factors for the syndrome of ventricular enlargement with gait apraxia (idiopathic normal pressure hydrocephalus): a case-control study. Journal of Neurology, Neurosurgery & Psychiatry, 52, 847–852.Google Scholar
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
DeLisi, L. E., Sakuma, M., Tew, W., Kushner, M., Hoff, A. L. and Grimson, R. (1997). Schizophrenia as a chronic active brain process: a study of progressive brain structural change subsequent to the onset of schizophrenia. Psychiatry Research, 74, 129–140.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Hakim, S. and Adams, R. D. (1965). The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. Journal of the Neurological Sciences, 2, 307–327.Google Scholar
Hamlat, A., Adn, M., Sid-ahmed, S., Askar, B. and Pasqualini, E. (2006). Theoretical considerations on the pathophysiology of normal pressure hydrocephalus (NPH) and NPH-related dementia. Medical Hypotheses, 67, 115–123. doi: 10.1016/j.mehy.2006.01.029.Google Scholar
Hashimoto, M., Ishikawa, M., Mori, E. and Kuwana, N. (2010). Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study. Cerebrospinal Fluid Research, 7, 18. doi: 10.1186/1743-8454-7-18.Google Scholar
Inada, T. (2009). DIEPSS: A Second-Generation Rating Scale for Antipsychotic-Induced Extrapyramidal Symptoms: drug-Induced Extrapyramidal Symptoms Scale. Tokyo, Japan: Seiwa Shoten.Google Scholar
Iseki, C. et al. (2009). Asymptomatic ventriculomegaly with features of idiopathic normal pressure hydrocephalus on MRI (AVIM) in the elderly: a prospective study in a Japanese population. Journal of the Neurological Sciences, 277, 54–57. doi: 10.1016/j.jns.2008.10.004.CrossRefGoogle Scholar
Ishikawa, M., Hashimoto, M., Mori, E., Kuwana, N. and Kazui, H. (2012). The value of the cerebrospinal fluid tap test for predicting shunt effectiveness in idiopathic normal pressure hydrocephalus. Fluids and Barriers of the CNS, 9, 1. doi: 10.1186/2045-8118-9-1.Google Scholar
Kahlon, B., Sundbärg, G. and Rehncrona, S. (2002). Comparison between the lumbar infusion and CSF tap tests to predict outcome after shunt surgery in suspected normal pressure hydrocephalus. Journal of Neurology, Neurosurgery & Psychiatry, 73, 721–726.Google Scholar
Kubo, Y. et al. (2008). Validation of grading scale for evaluating symptoms of idiopathic normal-pressure hydrocephalus. Dementia and Geriatric Cognitive Disorders, 25, 37–45. doi: 10.1159/000111149.CrossRefGoogle ScholarPubMed
Marmarou, A. et al. (2005). Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patients. Journal of Neurosurgery, 102, 987–997.Google Scholar
Maurizi, C. P. (1987). The pathophysiology of enlarged ventricles in normal pressure communicating hydrocephalus and schizophrenia: a possible therapeutic role for melatonin. Medical Hypotheses, 23, 61–66.CrossRefGoogle ScholarPubMed
Mishra, B. R., Sarkar, S., Mishra, S., Praharaj, S. K., Mahapatra, P. and Sinha, V. K. (2011). Antipsychotic sensitivity in normal pressure hydrocephalus. General Hospital Psychiatry, 33, e11–e13. doi: 10.1016/j.genhosppsych.2010.09.014.Google Scholar
Miyoshi, N. et al. (2002). Association between cognitive impairment and gait disturbance in patients with idiopathic normal pressure hydrocephalus. Dementia and Geriatric Cognitive Disorders, 20, 71–76. doi: 10.1159/000085858.Google Scholar
Mori, E. et al. (2012). Guidelines for management of idiopathic normal pressure hydrocephalus: second edition. Neurologia medico-chirurgica (Tokyo), 52, 775–809.Google Scholar
Oshima, I., Mino, Y. and Inomata, Y. (2007). How many long-stay schizophrenia patients can be discharged in Japan? Psychiatry and Clinical Neurosciences, 61, 71–77. doi: 10.1111/j.1440-1819.2007.01613.x.CrossRefGoogle ScholarPubMed
Papanastasiou, E. (2013). The prevalence and mechanisms of metabolic syndrome in schizophrenia: a review. Therapeutic Advances in Psychopharmacology, 3, 33–51. doi: 10.1177/2045125312464385.CrossRefGoogle ScholarPubMed
Podsiadlo, D. and Richardson, S. (1991). The timed “Up & Go:” a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142–148.Google Scholar
Pratt, N., Roughead, E. E., Salter, A. and Ryan, P. (2012). Choice of observational study design impacts on measurement of antipsychotic risks in the elderly: a systematic review. BMC Medical Research Methodology, 12, 72. doi: 10.1186/1471-2288-12-72.Google Scholar
Raftopoulos, C. et al. (1994). Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study. Neurosurgery, 35, 397–404.Google Scholar
Rhoades, H. M. and Overall, J. E. (1988). The semistructured BPRS interview and rating guide. Psychopharmacology Bulletin, 24, 101–104.Google ScholarPubMed
Schultz, S. K., Miller, D. D., Oliver, S. E., Arndt, S., Flaum, M. and Andreasen, N. C. (1997). The life course of schizophrenia: age and symptom dimensions. Schizophrenia Research, 23, 15–23. doi: 10.1016/S0920-9964(96)00087-4.Google Scholar
Shprecher, D., Schwalb, J. and Kurlan, R. (2008). Normal pressure hydrocephalus: diagnosis and treatment. Current Neurology and Neuroscience Reports, 8, 371–376.Google Scholar