title: Difference in white matter microstructure in differential diagnosis of normal pressure hydrocephalus and Alzheimer's disease.
abstract: OBJECTIVE
  Alzheimer's disease (AD) and normal pressure hydrocephalus (NPH) are both associated with cognitive decline and ventriculomegaly. While promising approach in differentiating between the two diseases, only a few diffusion tensor imaging (DTI) studies compared directly NPH and AD patients. The current study compares global whitematter (WM) alterations in AD and NPH addressing some of the methodological issues of previous studies.
  
  
  METHODS
  Diffusion tensor images were obtained from 17 patients with NPH, 14 with AD, and 17 healthy controls. White matter integrity was quantified by fractional anisotropy (FA), mean (MD), axial (λ1) and radial diffusivity (RD). The diffusion parameters were compared between the groups in 'skeletonised' tracts representing the core of the fibre bundles.
  
  
  RESULTS
  Reduced FA was found in NPH patients throughout the corpus callosum, particularly in the splenium, along with increased RD. On the other hand, FA, MD and RD were higher in NPH in the cortico-fugal fibres arising from the frontal and parietal cortex. While no FA changes were detected in AD patients compared to controls, widespread increased RD was observed. When comparing NPH and AD patients, higher FA, MD and RD was observed in the corona radiata in the periventricular fibres arising from the frontal and parietal cortex in NPH patients. The ventricular volumes were correlated with diffusivity parameters in the tracts next to the ventricles in AD and NPH patients.
  
  
  CONCLUSIONS
  Our analysis identified a pattern of WM diffusion alterations that can differentiate NPH patients from controls and AD patients.
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurosurgery, 1st Faculty of Medicine, Charles University and University Central Military Hospital, Prague, Czech Republic. Electronic address: daniel.horinek@gmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hořínek
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Radiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
authors.forename: Irena
authors.initials: I
authors.lastname: Štěpán-Buksakowska
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology, Faculty of General Medicine, University of Szeged, Szeged, Hungary.
authors.forename: Nikoletta
authors.initials: N
authors.lastname: Szabó
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Erickson
authors.affiliation: Department of Neurology, Faculty of General Medicine, University of Szeged, Szeged, Hungary.
authors.forename: Eszter
authors.initials: E
authors.lastname: Tóth
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
authors.forename: Vlastimil
authors.initials: V
authors.lastname: Šulc
authors.affiliation: Department of Neurosurgery, 1st Faculty of Medicine, Charles University and University Central Military Hospital, Prague, Czech Republic.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Beneš
authors.affiliation: Department of Radiodiagnostics, University Central Military Hospital, Prague, Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Vrána
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic; Memory Disorders Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic.
authors.forename: Jakub
authors.initials: J
authors.lastname: Hort
authors.affiliation: Department of Neurosurgery, University Hospital of Marburg, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Nimsky
authors.affiliation: Department of Neurosurgery, 1st Faculty of Medicine, Charles University and University Central Military Hospital, Prague, Czech Republic.
authors.forename: Milan
authors.initials: M
authors.lastname: Mohapl
authors.affiliation: Department of Radiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
authors.forename: Miloslav
authors.initials: M
authors.lastname: Roček
authors.affiliation: Department of Neurology, Faculty of General Medicine, University of Szeged, Szeged, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Vécsei
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic; Department of Neurology, Faculty of General Medicine, University of Szeged, Szeged, Hungary.
authors.forename: Zsigmond Tamás
authors.initials: ZT
authors.lastname: Kincses
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000473:pathology; D016880:Anisotropy; D003937:Diagnosis, Differential; D056324:Diffusion Tensor Imaging / Q000379:methods; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D066127:White Matter / Q000473:pathology*
keywords: Alzheimer's disease; DTI; MRI; Normal pressure hydrocephalus; TBSS; White matter