Postshunt cognitive and functional improvement in idiopathic normal pressure hydrocephalus.
BACKGROUND
Improvement in gait after shunt placement has been well documented in idiopathic normal pressure hydrocephalus (iNPH); however, controversy remains regarding the extent and pattern of postsurgical cognitive changes. Conflicting findings may be explained by variability in both test selection and follow-up intervals across studies. Furthermore, most investigations lack a control group, making it difficult to disentangle practice effects from a true treatment effect.


OBJECTIVE
To examine postshunt changes in a sample of well-characterized iNPH participants compared with a group of age- and education-matched healthy control subjects.


METHODS
We identified 12 participants with iNPH undergoing shunt placement and 9 control participants. All participants were evaluated with comprehensive neuropsychological testing and standardized gait assessment at baseline and were followed up for 6 months.


RESULTS
Repeated-measures analysis of variance revealed a significant group- (iNPH and control) by-time (baseline and 6 months) interaction for Trailmaking Test B: (P < .003) and Symbol Digit Modalities (P < .02), with greater improvement in iNPH participants relative to control subjects. In addition, the iNPH group showed greater improvement in gait (P < .001) and caregivers reported improved activities of daily living (P < .01) and reduced caregiver distress (P < .01).


CONCLUSIONS
This study demonstrates improvements in mental tracking speed and sustained attention 6 months after shunt placement in iNPH. The present investigation is the first study to use a controlled design to show that cognitive improvement in iNPH is independent of practice effects. Furthermore, these findings indicate functional and quality-of-life improvements for both the shunt responder and their caregiver.
Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA. hkatzen@med.miami.edu
Heather
H
Katzen
Lisa D
LD
Ravdin
Stephanie
S
Assuras
Roberto
R
Heros
Michael
M
Kaplitt
Theodore H
TH
Schwartz
Matthew
M
Fink
Bonnie E
BE
Levin
Norman R
NR
Relkin
D000203:Activities of Daily Living; D002557:Cerebrospinal Fluid Shunts; D003072:Cognition Disorders / Q000209:etiology / Q000601:surgery*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000150:complications / Q000601:surgery*; D009483:Neuropsychological Tests; D011788:Quality of Life