title: Bulbar dysfunction in normal pressure hydrocephalus: a prospective study.
abstract: OBJECTIVE Normal pressure hydrocephalus (NPH) is clinically characterized by gait disturbance, cognitive impairment, and urinary incontinence, as well as enlargement of the ventricles. To the best of the authors' knowledge, there have been no previous publications regarding the correlation between bulbar dysfunction and NPH. The primary objective of this study was to compare preoperative and postoperative prevalence of bulbar dysfunction in patients with NPH. Secondary objectives included assessing the results of surgery for swallowing, speech, gait, cognition, and urination, and evaluating the correlation between bulbar dysfunction and triad symptoms. METHODS Fifty-three patients with NPH who underwent shunt placement surgery at Siriraj Hospital were included in the study. Patients were evaluated for gait, cognition, urination, swallowing, and speech before and 6 months after shunt placement. Triad symptoms were assessed using standard methods. Bulbar dysfunctions were assessed using the Swallowing Problem Questionnaire, Thai Articulation Test, Resonation Screening Test (RST), and Thai Nasality Test. The Thai Speech Assessment Program and nasometer were used for objective speech measurement. RESULTS Preoperatively, 86% (43/50) of patients had swallowing problems and 75% (37/49) had speech problems, as measured by the RST. Postoperatively, there was significant improvement in swallowing (p < 0.001), speech problems by RST (p = 0.008), and voice volume (p = 0.009), but no significant change in the nasometer test. All triad symptoms were improved. There were significant correlations between swallowing impairment and gait disturbance (r = 0.358, p = 0.009), and RST and cognitive impairment (r = -0.502, p < 0.001). CONCLUSIONS This is the first study of bulbar dysfunction in patients with NPH. The results showed that the prevalence of bulbar dysfunction is very high. The correlation between bulbar dysfunction and the classic NPH triad has been documented and published. These bulbar symptoms also significantly improved after surgery. As such, bulbar dysfunction should be regarded as a core symptom that should be considered along with the classic triad in the clinical diagnosis and management of NPH.
authors: Division of Neurosurgery, Department of Surgery, and.
authors: Ekawut
authors: E
authors: Chankaew
authors: Division of Neurosurgery, Department of Surgery, and.
authors: Prajak
authors: P
authors: Srirabheebhat
authors: Division of Speech-Language Therapy, Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Sriwimon
authors: S
authors: Manochiopinig
authors: Division of Neurosurgery, Department of Surgery, and.
authors: Theerapol
authors: T
authors: Witthiwej
authors: Division of Neurosurgery, Department of Surgery, and.
authors: Itsara
authors: I
authors: Benjamin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D011446:Prospective Studies; D017287:Ventriculoperitoneal Shunt / Q000639:trends
keywords: CBF = cerebral blood flow; CBT = corticobulbar tract; CST = corticospinal tract; ICH = intracranial hematoma; IQR = interquartile range; LPS = lumboperitoneal shunt; NPH = normal pressure hydrocephalus; PVWM = periventricular white matter; RST = Resonation Screening Test; SPQ = Swallowing Problem Questionnaire; TAT = Thai Articulation Test; TMSE = Thai Mental State Examination; VPI = velopharyngeal inadequacy; VPS = ventriculoperitoneal shunt; bulbar dysfunction; normal pressure hydrocephalus; resonance; rp = point-biserial correlation coefficient; rs = Spearman's rank correlation coefficient; speech; swallowing; voice