Ventricular dilation: association with gait and cognition.
OBJECTIVE
Normal pressure hydrocephalus is characterized by gait impairment, cognitive impairment, and urinary incontinence, and is associated with disproportionate ventricular dilation. Here we report the distribution of ventricular volume relative to sulcal cerebrospinal fluid (CSF) volume, and the association of increasing ventricular volume relative to sulcal CSF volume with a cluster of gait impairment, cognitive impairment, and urinary incontinence in a stroke-free cohort of elderly persons from the general population.


METHODS
Data are based on 858 persons (35.4% men; age range, 66-92 years) who participated in the Age, Gene/Environment Susceptibility-Reykjavik Study. Gait was evaluated with an assessment of gait speed. Composite scores representing speed of processing, memory, and executive function were constructed from a neuropsychological battery. Bladder function was assessed with a questionnaire. Magnetic resonance brain imaging was followed by semiautomated segmentation of intracranial CSF volume. White matter hyperintensity (WMH) volume was assessed with a semiquantitative scale. For the analysis of ventricular dilation relative to the sulcal spaces, ventricular volume was divided by sulcal CSF volume (VV/SV).


RESULTS
Disproportion between ventricular and sulcal CSF volume, defined as the highest quartile of the VV/SV z score, was associated with gait impairment (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.3) and cognitive impairment (OR, 1.8; 95% CI, 1.1-3.0). We did not find an association between the VV/SV z score and bladder dysfunction.


CONCLUSIONS
The prevalence and severity of gait impairment and cognitive impairment increases with ventricular dilation in persons without stroke from the general population, independent of WMH volume.
Department of Radiology, Leiden University Medical Center, The Netherlands.
Walter M
WM
Palm
Jane S
JS
Saczynski
J
J
van der Grond
Sigurdur
S
Sigurdsson
Olafur
O
Kjartansson
Palmi V
PV
Jonsson
Gudny
G
Eiriksdottir
Vilmundur
V
Gudnason
Faiza
F
Admiraal-Behloul
Lenore J
LJ
Launer
Mark A
MA
van Buchem
D000368:Aged; D000369:Aged, 80 and over; D002555:Cerebrospinal Fluid / Q000502:physiology; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D020233:Gait Disorders, Neurologic / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000473:pathology*; D020547:Lateral Ventricles / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D012720:Severity of Illness Index