Predicting Cognitive Improvement in Normal Pressure Hydrocephalus Patients Using Preoperative Neuropsychological Testing and Cerebrospinal Fluid Biomarkers.

Abstract

BACKGROUND:

Though it is well known that normal pressure hydrocephalus (NPH) patients can cognitively improve after ventriculoperitoneal shunting (VPS), one of the major dilemmas in NPH is the ability to prospectively predict which patients will improve.

OBJECTIVE:

To prospectively assess preoperative predictors of postshunt cognitive improvement.

METHODS:

This was a prospective observational cohort including 52 consecutive patients with approximately 1-yr follow-up. Patients underwent neuropsychological testing at baseline, postlumbar drainage, and postshunt. Cerebrospinal fluid (CSF) biomarkers and cortical biopsies were also collected to examine their relationship with postshunt cognitive improvement.

RESULTS:

Rey Auditory Verbal Learning Test-L (RAVLT-L) was the only neuropsychological test to demonstrate statistically significant improvement both postlumbar drain and postshunt. Improvement on the RAVLT-L postlumbar drain predicted improvement on the RAVLT-L postshunt. Patients with biopsies demonstrating Aβ+ Tau+ had lower ventricular CSF Aβ42 and higher lumbar CSF pTau compared to Aβ- Tau- patients. A receiver operating curve analysis using lumbar pTau predicted Aβ+ Tau+ biopsy status but was not related to neuropsychological test outcome.

CONCLUSION:

The RAVLT can be a useful preoperative predictor of postoperative cognitive improvement, and thus, we recommend using the RAVLT to evaluate NPH patients. CSF biomarkers could not be related to neuropsychological test outcome. Future research in a larger patient sample will help determine the prospective utility of CSF biomarkers in the evaluation of NPH patients.

• Authors: Robert A McGovern, Taylor B Nelp, Kathleen M Kelly, Andrew K Chan, Pietro Mazzoni, Sameer A Sheth, Lawrence S Honig, Andrew F Teich, Guy M McKhann
• Journal: Neurosurgery (Neurosurgery) Vol. 85 Issue 4 Pg. E662-E669 (10 01 2019) ISSN: 1524-4040 [Electronic] United States
• PMID: 30937451 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2019 by the Congress of Neurological Surgeons.

Chemical References

• Biomarkers

Topics

• Aged
• Aged, 80 and over
• Biomarkers (cerebrospinal fluid)
• Cognition (physiology)
• Cohort Studies
• Drainage (methods, trends)
• Female
• Humans
• Hydrocephalus, Normal Pressure (cerebrospinal fluid, psychology, surgery)
• Male
• Middle Aged
• Neuropsychological Tests
• Predictive Value of Tests
• Preoperative Care (methods, trends)
• Prospective Studies
• Ventriculoperitoneal Shunt (methods, trends)