title: A clinical and biochemical analysis in the differential diagnosis of idiopathic normal pressure hydrocephalus.
abstract: BACKGROUND
  Idiopathic normal pressure hydrocephalus (iNPH) can be misdiagnosed with other neurodegenerative diseases, especially in the early disease stages. Considering the opportunity of the shunt surgery, iNPH should be diagnosed with accuracy. Here, we evaluate the utility of CSF biomarkers and their relationship with clinical features in the diagnosis of iNPH.
  
  
  METHODS
  We performed a multivariate analysis of the CSF levels of Aβ42, t-tau, and p-tau collected from four groups of patients: 14 iNPH, 14 progressive supranuclear palsy (PSP), 14 Alzheimer's disease (AD), 14 controls (CTL). Diagnostic accuracy of biomarkers was determined by the receiver operating characteristic curve analysis. Statistical correlation was calculated between each CSF biomarker and single clinical items of iNPH.
  
  
  RESULTS
  Aβ42 levels in iNPH were lower than controls, although not as low as in AD. Likewise, CSF t-tau and p-tau were lower in iNPH than in controls. Of interest, t-tau and p-tau were higher in AD than in controls and hence both t-tau and p-tau were significantly lower in iNPH than in AD. No differences were found between iNPH and PSP. CSF biomarkers levels did not correlate to clinical features of iNPH, whereas two significant correlations emerged within clinical parameters: cognitive impairment was related to gait difficulties, while ventricular enlargement correlated with continence disturbances.
  
  
  CONCLUSIONS
  Measurement of CSF biomarker levels may be helpful in the differential diagnosis between iNPH and AD but not between iNPH and PSP. Both Aβ42 and tau levels appear unrelated to main clinical features of iNPH.
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata" , Rome , Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Schirinzi
authors.affiliation: IRCCS Santa Lucia Foundation , Rome , Italy.
authors.forename: Giulia Maria
authors.initials: GM
authors.lastname: Sancesario
authors.affiliation: Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata" , Rome , Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Ialongo
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata" , Rome , Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Imbriani
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata" , Rome , Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: Madeo
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata" , Rome , Italy.
authors.forename: Sofia
authors.initials: S
authors.lastname: Toniolo
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata" , Rome , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Martorana
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata" , Rome , Italy ; IRCCS Santa Lucia Foundation , Rome , Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pisani
keywords: CSF biomarkers; idiopathic normal pressure hydrocephalus; progressive supranuclear palsy