title: [Diagnostic value of CSF biomarker profile in idiopathic normal pressure hydrocephalus; leucine-rich α-2-glycoprotein is a potential biological marker].
abstract: OBJECTIVE
  Cerebrospinal fluid (CSF) shunting can improve symptoms of elderly patients idiopathic normal pressure hydrocephalus (iNPH). However, adjunctive means for confirming the diagnosis remain unavailable. We have previously reported specific increase of leucine-rich alpha-2-glycoprotein (LRG) in iNPH CSF, and present study investigates its potential clinical applications.
  
  
  METHODS
  We performed CSF tap test (TT) on 90 patients and shunting in 52 patients (mean age 73.5 years), evaluating symptom improvement and higher cerebral functions-MMSE and Frontal Assessment Battery (FAB) before and twelve months after shunting. LRG and tau protein concentrations in TT CSF were simultaneously measured using ELIZA. Then we compared the predictive value of these concentrations with TT results regarding successful shunting outcomes.
  
  
  RESULTS
  Positive combinations of TT and LRG concentrations of 67 ng/mL or higher, gave 81.6% sensitivity and 78.6% specificity. Therefore we used LRG (67 ng/mL) and tau (200 pg/mL) cutoff values, LRG ≥ 67 ng/ml and tau < 200 pg/ml, 31 of 34 patients (91.2%) had a positive TT and all operated 22 patients were shunt responders. Dementia MMSE and FAB scores in them increased from a baseline of 22.05 to 25.65 and 11.38 to 13.08 respectively.
  
  
  CONCLUSIONS
  A combination of positive TT and biomarkers quantification such as LRG and tau protein, can reliably predict shunting outcome in iNPH patients.
authors.affiliation: Department of Neurosurgery, Juntendo University School of Medicine.
authors.forename: Madoka
authors.initials: M
authors.lastname: Nakajima
authors.forename: Hajime
authors.initials: H
authors.lastname: Arai
authors.forename: Masakazu
authors.initials: M
authors.lastname: Miyajima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000134:cerebrospinal fluid; D002557:Cerebrospinal Fluid Shunts; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006023:Glycoproteins / Q000134:cerebrospinal fluid*; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011933:Reagent Kits, Diagnostic; D016875:tau Proteins / Q000134:cerebrospinal fluid
chemical_list: D015415:Biomarkers; D006023:Glycoproteins; C015246:LRG1 protein, human; D011933:Reagent Kits, Diagnostic; D016875:tau Proteins