title: Apathy, ventriculomegaly and neurocognitive improvement following shunt surgery in normal pressure hydrocephalus.
abstract: BACKGROUND
  Apathy - impaired motivation and goal-directed behaviour - is a common yet often overlooked symptom in normal pressure hydrocephalus (NPH). Caudate atrophy often yields apathetic symptoms; however, this structural and functional relationship has not yet been explored in NPH. Additionally, little is known about the relationship between apathy and post-shunt cognitive recovery.
  
  
  METHODS
  This audit investigated whether apathetic symptoms improve following shunt surgery in NPH, and whether this relates to cognitive response. In addition, we assessed the relationship between ventriculomegaly and apathy using the bicaudate ratio. Twenty-two patients with NPH completed the Mini-Mental State Examination (MMSE), the Apathy Evaluation Scale (AES) and the Geriatric Depression Scale (GDS) before and 3-9 months after shunt surgery. Pre-operative ventriculomegaly was correlated with pre-operative AES and GDS scores. Difference scores (post-shunt minus baseline values) for AES and GDS were correlated with cognitive outcome.
  
  
  RESULTS
  Greater pre-operative ventriculomegaly was associated with increased level of apathy and depression. A reduction in apathetic symptoms following shunt surgery was associated with improved performance on the MMSE.
  
  
  CONCLUSIONS
  Apathy may be indicative of a greater degree of subcortical atrophy in NPH and may relate to functional outcome.
authors.affiliation: a Department of Psychiatry , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.
authors.forename: Katie A
authors.initials: KA
authors.lastname: Peterson
authors.affiliation: a Department of Psychiatry , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.|c Cambridge Cognition Ltd , Cambridge , UK.
authors.forename: Charlotte R
authors.initials: CR
authors.lastname: Housden
authors.affiliation: a Department of Psychiatry , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Killikelly
authors.affiliation: a Department of Psychiatry , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.|b Department of Neurosurgery , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.|d Department of Psychiatry , Yale University School of Medicine , New Haven , CT , USA.
authors.forename: Elise E
authors.initials: EE
authors.lastname: DeVito
authors.affiliation: b Department of Neurosurgery , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Keong
authors.affiliation: a Department of Psychiatry , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.
authors.forename: George
authors.initials: G
authors.lastname: Savulich
authors.affiliation: b Department of Neurosurgery , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.
authors.forename: Zofia
authors.initials: Z
authors.lastname: Czosnyka
authors.affiliation: b Department of Neurosurgery , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.
authors.forename: John D
authors.initials: JD
authors.lastname: Pickard
authors.affiliation: a Department of Psychiatry , University of Cambridge, Addenbrooke's Hospital , Cambridge , UK.|e MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge , Cambridge , UK.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Sahakian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057565:Apathy / Q000502:physiology*; D003071:Cognition / Q000502:physiology; D003863:Depression / Q000503:physiopathology; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000379:methods
keywords: apathy; audit; caudate nucleus; cognitive function; normal pressure hydrocephalus