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13 results

  • 7 - Other Dementias

  • from Part I - Foundations: What Do We Need to Know about Optimal Aging?
  • Robert P. Friedland
  • Book:
    Unaging
    Published online:
    15 September 2022
    Print publication:
    20 October 2022, pp 117-125

  • Summary

    There are several other important causes of dementia in younger and older persons. Normal pressure hydrocephalus is a condition with altered absorption of spinal fluid leading to cognitive losses, gait disturbances, and poor control of urination. It may be successfully treated with surgery. Creutzfeldt-Jakob disease is a rapidly fatal progressive condition caused by a potentially transmissible form of a prion, an abnormally folded protein. Bovine spongiform encephalopathy is another prion disease associated with eating infected cows. It is now recognized that small and large head injuries are bad for the brain and can cause serious cognitive and motor deficits, and progressive untreatable dementia. Repeated blows without visible immediate effect can lead to brain degeneration. A critical way to maintain cognitive reserve is to avoid all kinds of blows to the head. Excess consumption of alcohol is very damaging to brain function and can lead to dementia, as well as nerve damage and injury to several other parts of the body, such as the liver, heart and intestines. It is recommended that men should not consume more than two doses of alcohol a day and women not more than one.

  • Effect of Lumbar Drainage on Cortical Excitability in Normal Pressure Hydrocephalus

  • Aakash Agrawal, Amitabh Bhattacharya, Nitish Kamble, Ravi Yadav, Pramod Kumar Pal
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 48 / Issue 2 / March 2021
    Published online by Cambridge University Press:
    03 August 2020, pp. 253-258
    • Article
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  • Background:

    Idiopathic normal pressure hydrocephalus (iNPH) is characterized by the clinical triad of gait disturbance, urinary incontinence, and memory impairment with normal cerebrospinal fluid (CSF) pressure. Transcranial magnetic stimulation (TMS) has been used to assess the corticospinal motor pathways in patients with iNPH with conflicting results.

    Methods:

    Our study included 11 patients with iNPH and 13 healthy controls. All the subjects underwent TMS and resting motor threshold (RMT), central motor conduction time (CMCT), short-interval intracortical inhibition (SICI), intracortical facilitation, and silent period (SP) were recorded in the upper limb. Besides, RMT and CMCT in lower limb were also recorded. Cognitive assessments were done using mini-mental status examination, Montreal cognitive assessment (MoCA), and Addenbrooke’s cognitive evaluation III (ACE III). Same parameters were recorded 24 h of CSF (lumbar puncture, LP) drainage.

    Results:

    Mean age of the iNPH patients was 69.00 ± 6.71 years with age at onset being 66.64 ± 7.10 years. Duration of disease was 1.80 ± 1.25 years. A significant difference was noted in CMCT for the lower limb (CMCT-LL), SICI, and ipsilateral SP between pre-LP NPH and controls. Also, there was a significant difference in MoCA and ACE III between pre-LP NPH and controls. A significant reduction was observed in lower limb RMT between pre- and post-LP NPH patients. Post LP, there was a reduction in the lower limb CMCT and improvement in SICI.

    Conclusion:

    A significant prolongation of CMCT-LL was observed in NPH patients. Lumbar CSF drainage in them resulted in a significant reduction in lower limb RMT thereby suggesting an increase in cortical excitability.

  • Two Novel Psychomotor Tasks in Idiopathic Normal Pressure Hydrocephalus

  • Maria A. Rossetti, Irene Piryatinsky, Fayeza S. Ahmed, Petra M. Klinge, Norman R. Relkin, Stephen Salloway, Lisa D. Ravdin, Einat Brenner, Paul F. Malloy, Bonnie E. Levin, Michael Broggi, Rebecca Gavett, James S. Maniscalco, Heather Katzen
  • Journal:
    Journal of the International Neuropsychological Society / Volume 22 / Issue 3 / March 2016
    Published online by Cambridge University Press:
    28 January 2016, pp. 341-349

  • Objective: Idiopathic normal pressure hydrocephalus (INPH) is a neurological disorder presenting with gait, cognitive, and bladder symptoms in the context of ventricular enlargement. Although gait is the primary indicator for treatment candidacy and outcome, additional monitoring tools are needed. Line Tracing Test (LTT) and Serial Dotting Test (SDT), two psychomotor tasks, have been introduced as potential outcome measures but have not been widely studied. This preliminary study examined whether LTT and SDT are sensitive to motor dysfunction in INPH and determined if accuracy and time are important aspects of performance. Methods: Eighty-four INPH subjects and 36 healthy older adults were administered LTT and SDT. Novel error scoring procedures were developed to make scoring practical and efficient; interclass correlation showed good reliability of scoring procedures for both tasks (0.997; p<.001). Results: The INPH group demonstrated slower performance on SDT (p<.001) and made a greater number of errors on both tasks (p<.001). Combined Time/Error scores revealed poorer performance in the INPH group for original-LTT (p<.001), modified-LTT (p≤.001) and SDT (p<.001). Conclusions: These findings indicate LTT and SDT may prove useful for monitoring psychomotor skills in INPH. While completion time reflects impaired processing speed, reduced accuracy may suggest planning and self-monitoring difficulties, aspects of executive functioning known to be compromised in INPH. This is the first study to underscore the importance of performance accuracy in INPH and introduce practical/reliable error scoring for these tasks. Future work will establish reliability and validity of these measures and determine their utility as outcome tools. (JINS, 2016, 22, 341–349)

  • Risk of idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia

  • Yuta Yoshino, Taku Yoshida, Takaaki Mori, Shigeru Hirota, Junichi Iga, Shu-ichi Ueno
  • Journal:
    International Psychogeriatrics / Volume 28 / Issue 5 / May 2016
    Published online by Cambridge University Press:
    11 November 2015, pp. 863-868
  • 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.

  • 8 - Incontinence and lower urinary tract symptoms in normal pressure hydrocephalus

  • from Section 2 - Pathophysiology
  • Edited by Daniele Rigamonti, The Johns Hopkins University School of Medicine
  • Book:
    Adult Hydrocephalus
    Published online:
    05 February 2014
    Print publication:
    06 February 2014, pp 80-90

  • Summary

    This chapter focuses on aspects of hydrocephalus that are common to all ages with a particular emphasis on the aging brain and the so called normal pressure hydrocephalus (NPH) syndrome, which is a chronic disease that likely evolved over a period of years. It has been clear for decades that the rate of ventricular dilatation and the state of brain maturation have a significant impact on the pathology, and possibly the pathogenesis of brain damage. Idiopathic NPH has been distinguished from chronic adult hydrocephalus associated with prior meningitis, brain trauma, or subarachnoid hemorrhage. The initial displacement may be at the expense of the subarachnoid compartment, the venous compartment, and the extracellular compartment with negligible damage to brain cells. Blood flow hypoperfusion leads to hypoxic-ischemic changes in the white matter, physical stretching compromises axon integrity, and retarded turnover of the cerebrospinal fluid (CSF) alters the extracellular microenvironment.

  • Epilogue

  • Edited by Daniele Rigamonti, The Johns Hopkins University School of Medicine
  • Book:
    Adult Hydrocephalus
    Published online:
    05 February 2014
    Print publication:
    06 February 2014, pp 304-304

  • Summary

    This chapter reviews the types of shunt complications, their likelihood, and some clinical examples. Cerebrospinal fluid (CSF) shunting and particularly ventriculoperitoneal shunting is a common procedure used to treat a variety of CSF flow dynamic pathologies including obstructive, communicating, and normal pressure hydrocephalus (NPH) from a variety of etiologies. There are several types of specific long-term complications associated with shunting procedures in addition to those more likely seen in the NPH population in particular. These include underdrainage of CSF, overdrainage of CSF, mechanical failures of the hardware such as alterations in valve resistance over time, malposition of the tubing, and frank breakage, CSF leak, subdural hemorrhage or hygroma, seizure, and infection. Underdrainage conditions arise when shunt systems develop increased resistance across the valve over time, disconnection or kinking of the system components, or migration of the tubing out of an appropriate position for proper drainage and/or reabsorption.

  • 17 - Hydrocephalus shunts

  • from Section 4 - Treatment and outcomes
  • Edited by Daniele Rigamonti, The Johns Hopkins University School of Medicine
  • Book:
    Adult Hydrocephalus
    Published online:
    05 February 2014
    Print publication:
    06 February 2014, pp 190-206

  • Summary

    The recently updated Japanese guidelines draw attention to a specific MRI pattern of disproportionately enlarged subarachnoid space hydrocephalus (DESH), believed to be pathognomonic of idiopathic normal pressure hydrocephalus (iNPH). This chapter discusses why establishing the diagnosis of NPH remains a challenge fifty years after its classic description. The original diagnosis of NPH relied upon the presence of mild dementia, gait, and urinary difficulties (Hakim's triad) seen in association with ventriculomegaly on pneumo-encephalogram. More sensitive cognitive evaluation of iNPH patients requires specific tests for the assessment of subcortical frontal lobe deficits such as the Rey Auditory Verbal Learning Test, Stroop test, Grooved Pegboard, Trail Making A and B Test, and digit span test. This diagnostic test provides information about cerebrospinal fluid (CSF) dynamics and predicts outcome. It consists in either removal of CSF accompanied by pre and post functional evaluation, or an infusion (bolus or continuous) test.

  • 15 - Cerebrospinal fluid biomarkers in idiopathic normal pressure hydrocephalus

  • from Section 3 - Diagnosis
  • Edited by Daniele Rigamonti, The Johns Hopkins University School of Medicine
  • Book:
    Adult Hydrocephalus
    Published online:
    05 February 2014
    Print publication:
    06 February 2014, pp 164-174

  • Summary

    This chapter provides an overview of incontinence and lower urinary tract symptoms in normal pressure hydrocephalus (NPH), and covers areas including dementia and incontinence, differential diagnosis, physiology and pathophysiology, symptoms, evaluation, and treatment. The relationship between gait disturbances, dementia, and incontinence has profound importance because of the potential heightened risk of falls. In the central nervous system, there are two main areas involved in the motor control and reciprocal coordination of lower urinary tract function. Our understanding of lower urinary tract dysfunction in NPH is limited by a lack of detailed knowledge of the supraspinal pathways involved in the control of micturition. Urodynamic studies may be the most important investigative procedures performed in patients with significant urinary symptoms and idiopathic NPH (iNPH), as the results will help identify etiologies and guide treatments. Patients may be treatment refractory to standard doses or may require higher than recommended doses or combination therapies.

  • 12 - Imaging of the cerebrospinal fluid circulation

  • from Section 3 - Diagnosis
  • Edited by Daniele Rigamonti, The Johns Hopkins University School of Medicine
  • Book:
    Adult Hydrocephalus
    Published online:
    05 February 2014
    Print publication:
    06 February 2014, pp 121-138

  • Summary

    Several theories have been proposed to explain the pathophysiology of gait dysfunction in normal pressure hydrocephalus (NPH). The variety of potential targets includes midbrain compression or atrophy, cortical dysfunction, cortical-subcortical or intracortical circuit abnormalities, postural disturbance, dopamine signaling abnormalities, and regional cerebral blood flow (rCBF) depression. This chapter presents objective measures of gait dysfunction that have been used clinically, and highlights some of the major theories postulated to explain gait dysfunction in NPH. Gait dysfunction in NPH has characteristic features that include a slow pace, short stride length, wide stance, and low foot-floor elevation. Objective measures of gait can be used to quantify the pattern of walking and step-taking, focusing on walking speed, stride length, cadence, equilibrium, and posture. Recognition of cortical involvement in locomotion stems from multiple research efforts evaluating gait in healthy individuals and those with cognitive disturbances.

  • 24 - Management of hydrocephalus with associated cerebrospinal fluid pathologies

  • from Section 5 - Associated conditions
  • Edited by Daniele Rigamonti, The Johns Hopkins University School of Medicine
  • Book:
    Adult Hydrocephalus
    Published online:
    05 February 2014
    Print publication:
    06 February 2014, pp 275-290

  • Summary

    This chapter describes many of the techniques and protocols that can be used to minimize the risk of shunt failure, focusing on the surgical procedure at each anatomic location for proximal and distal catheter placement. It includes the extended discussions of ventricular and lumbar proximal catheters, and peritoneal, atrial, pleural, and other distal catheters. Valves can be divided into four different categories: differential pressure valves, flow-regulated valves, antisiphon valves, and adjustable valves. Antisiphon valves are used to prevent the siphoning of cerebrospinal fluid (CSF) into the distal compartment. Antisiphon devices (ASDs) are primarily used in management of normal pressure hydrocephalus (NPH) patients in the adult population to prevent the formation of subdural hematomas and hygromas, and in the management of hydrocephalus in the pediatric population to prevent the slit ventricle syndrome and proximal catheter obstruction.

  • 25 - Normal Pressure Hydrocephalus

  • from SECTION III - SPECIFIC NEUROLOGICAL CONDITIONS
    • By Oliver W. Hayes, Ingham Regional Medical Center Sparrow Hospital/MSU Emergency Medicine Residency Program Lansing, Michigan, Lara Kunschner, Department of Neurology Allegheny General Hospital Pittsburgh, Pennsylvania
  • Edited by Sid M. Shah, Michigan State University, Kevin M. Kelly, Drexel University, Philadelphia
  • Book:
    Principles and Practice of Emergency Neurology
    Published online:
    06 August 2009
    Print publication:
    18 February 2003, pp 260-262

  • Summary

    Normal pressure hydrocephalus (NPH) is clinical syndrome of dementia, gait disturbance, and urinary incontinence that progresses over a period of weeks to years. Urinary incontinence, a late symptom, occurs in less than 50% of patients. If untreated, NPH progresses resulting in an inability to stand, akinetic rigidity, and withdrawn behavior. The differential diagnosis includes Parkinson's disease, bifrontal brain disease due to tumor, metastases, cerebral infarction, aqueductal stenosis, metabolic encephalopathy, and Alzheimer's disease. When NPH is suspected clinically, computerized tomography (with contrast enhancement) reveals ventriculomegaly, minimal or absence of cortical atrophy, periventricular lucencies, and nearly normal-sized subarachnoid space. Magnetic resonance imaging (MRI) is the study of choice to evaluate ventriculomegaly and functional imaging of cerebrospinal fluid (CSF) flow. The role of the emergency physician is to consider the diagnosis of NPH in patients with dementia and gait disturbance and to initiate appropriate referral.