title: Amyloid deposits and response to shunt surgery in idiopathic normal-pressure hydrocephalus.
abstract: OBJECTIVE
  In previous studies, patients with idiopathic normal-pressure hydrocephalus (iNPH) occasionally showed Alzheimer's pathology in frontal lobe cortical biopsy during cerebrospinal fluid shunt surgery or intracranial pressure monitoring. In clinical practice, the differential diagnosis of iNPH from Alzheimer's disease (AD) can be problematic, particularly because some iNPH cases exhibit AD comorbidity. In this study, we evaluated amyloid deposition in the brains of patients with iNPH before shunt surgery, and investigated the association between brain amyloid deposits and clinical improvement following the surgery.
  
  
  METHODS
  Amyloid imaging was performed in patients with iNPH or AD and also in healthy control subjects by using positron emission tomography (PET) and a radiolabeled pharmaceutical compound, (11)C-BF227. Using the cerebellar hemispheres as reference regions, the standard uptake value ratio (SUVR) of the neocortex was estimated and used as an index for amyloid deposition. In patients with iNPH, clinical symptoms were assessed before shunt surgery and 3 months after surgery.
  
  
  RESULTS
  Five of the 10 patients with iNPH had neocortical SUVRs that were as high as those of AD subjects, whereas the SUVRs of the 5 patients were as low as those of healthy controls. A significant inverse correlation between neocortical SUVRs and cognitive improvements after shunt surgery was observed in iNPH.
  
  
  CONCLUSIONS
  The amount of amyloid deposits ranges widely in the brains of patients with iNPH and is associated with the degree of cognitive improvement after shunt surgery.
authors.affiliation: Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, 6-3, Aoba, Aramaki, Aoba-ku, Sendai 980-8578, Japan. Electronic address: khiraoka@cyric.tohoku.ac.jp.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Hiraoka
authors.affiliation: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Narita
authors.affiliation: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kikuchi
authors.affiliation: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Baba
authors.affiliation: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
authors.forename: Shigenori
authors.initials: S
authors.lastname: Kanno
authors.affiliation: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Iizuka
authors.affiliation: Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, 6-3, Aoba, Aramaki, Aoba-ku, Sendai 980-8578, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Tashiro
authors.affiliation: Department of Pharmacology, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; Division of Radiopharmaceutical Chemistry, Cyclotron and Radioisotope Center, Tohoku University, 6-3, Aoba, Aramaki, Aoba-ku, Sendai 980-8578, Japan.
authors.forename: Shozo
authors.initials: S
authors.lastname: Furumoto
authors.affiliation: Department of Pharmacology, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Okamura
authors.affiliation: Department of Geriatrics and Gerontology, Institute of Development, Aging and Cancer, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Furukawa
authors.affiliation: Department of Geriatrics and Gerontology, Institute of Development, Aging and Cancer, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Arai
authors.affiliation: Division of Radiopharmaceutical Chemistry, Cyclotron and Radioisotope Center, Tohoku University, 6-3, Aoba, Aramaki, Aoba-ku, Sendai 980-8578, Japan.
authors.forename: Ren
authors.initials: R
authors.lastname: Iwata
authors.affiliation: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
authors.forename: Etsuro
authors.initials: E
authors.lastname: Mori
authors.affiliation: Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, 6-3, Aoba, Aramaki, Aoba-ku, Sendai 980-8578, Japan; Department of Pharmacology, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yanai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000378:metabolism; D000682:Amyloid / Q000378:metabolism*; D000704:Analysis of Variance; D001583:Benzoxazoles / Q000493:pharmacokinetics; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000378:metabolism* / Q000601:surgery*; D007091:Image Processing, Computer-Assisted; D007564:Japan; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019579:Neocortex / Q000000981:diagnostic imaging / Q000473:pathology; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D013223:Statistics as Topic; D013844:Thiazoles / Q000493:pharmacokinetics
chemical_list: C516779:2-(2-(2-dimethylaminothiazol-5-yl)ethenyl)-6-(2-(fluoro)ethoxy)benzoxazole; D000682:Amyloid; D001583:Benzoxazoles; D013844:Thiazoles
keywords: Alzheimer's disease; Amyloid; Dementia; Idiopathic normal-pressure hydrocephalus; Positron emission tomography (PET); Shunt surgery