title: Steroid hormones and homocysteine in the outcome of patients with normal pressure hydrocephalus.
abstract: Normal pressure hydrocephalus (NPH) is one of a few treatable conditions of cognitive decline affecting predominately elderly people. Treatment, commonly based on the ventriculoperitoneal shunt insertion, leads to a partial or complete correction of patient's state, although its effect does not unfortunately always last. The aim of our study was to observe the changes of homocysteine and selected steroids and neurosteroids and follow-up the patients with respect to the duration of the NPH-related dementia improvement. The cerebrospinal fluid and plasma levels of cortisol, cortisone, dehydroepiandrosterone (DHEA), 7alpha-hydroxy-DHEA, 7beta-hydroxy-DHEA, 7-oxo-DHEA, 16alpha-hydroxy-DHEA (all LC-MS/MS), DHEA-sulphate (DHEAS) (radioimmunoassay) and homocysteine (gas chromatography) were determined in NPH-diagnosed subjects before, during and 6, 12 and 24 months after shunt insertion. The cognitive functions ameliorated after shunt insertion and remain improved within 2 years. Changes in cerebrospinal fluid DHEAS, DHEA and its ratio, cortisone/cortisol and 16alpha-hydroxy-DHEA and plasma DHEAS, 7beta-hydroxy-DHEA, cortisone/cortisol and homocysteine were found. Mentioned changes may contribute to the clarification of NPH pathogenesis. Altered neurosteroids levels are possible indicators to be utilized in the follow-up of NPH subjects. Moreover, plasma homocysteine may serve as an early indicator of NPH-related dementia.
authors.affiliation: Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czech Republic. lsosvorova@endo.cz.
authors.forename: L
authors.initials: L
authors.lastname: Sosvorova
authors.forename: M
authors.initials: M
authors.lastname: Mohapl
authors.forename: M
authors.initials: M
authors.lastname: Hill
authors.forename: L
authors.initials: L
authors.lastname: Starka
authors.forename: M
authors.initials: M
authors.lastname: Bicikova
authors.forename: J
authors.initials: J
authors.lastname: Vitku
authors.forename: R
authors.initials: R
authors.lastname: Kanceva
authors.forename: J
authors.initials: J
authors.lastname: Bestak
authors.forename: R
authors.initials: R
authors.lastname: Hampl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid; D003348:Cortisone / Q000097:blood / Q000134:cerebrospinal fluid; D003687:Dehydroepiandrosterone / Q000097:blood / Q000134:cerebrospinal fluid; D005260:Female; D006710:Homocysteine / Q000097:blood* / Q000134:cerebrospinal fluid*; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000601:surgery; D006854:Hydrocortisone / Q000097:blood / Q000134:cerebrospinal fluid; D008297:Male; D018377:Neurotransmitter Agents / Q000097:blood* / Q000134:cerebrospinal fluid*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D018377:Neurotransmitter Agents; D006710:Homocysteine; D003687:Dehydroepiandrosterone; D003348:Cortisone; D006854:Hydrocortisone