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. 2016;56(2):51-61.
doi: 10.2176/nmc.oa.2015-0027. Epub 2015 Sep 11.

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as a Cognitive Evaluation Tool for Patients with Normal Pressure Hydrocephalus

Daisuke Nakatsu  1 , Toru Fukuhara, Naomi S Chaytor, Vaishali S Phatak, Anthony M Avellino
Affiliations

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as a Cognitive Evaluation Tool for Patients with Normal Pressure Hydrocephalus

Daisuke Nakatsu et al. Neurol Med Chir (Tokyo). 2016.

Abstract

External lumbar drainage (ELD) is recognized as a screening method for ventriculo-peritoneal shunting (VPS) candidacy for possible normal pressure hydrocephalus (NPH). This study focused on the ELD predictability of the cognitive outcome after VPS for NPH. In addition, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was examined in ELD cognition screening. ELD results were considered positive with any improvement in gait and/or cognition. Among 36 patients examined for possible NPH, 26 underwent VPS because of positive ELD. Cognitive outcome after VPS was assessed at 6-month follow-up. The RBANS scores, examined pre- and post-ELD, were evaluated statistically to identify consistency with the neuropsychologist judgment and the predictability of cognitive outcome after VPS. Among 26 shunted patients, gait was improved in 24. Cognitive improvement was rated in 19, and there were 9 false negative and 5 false positive in ELD cognition screening. The neuropsychologist judgment in ELD cognition screening is most consistent with the RBANS score in delayed memory. The patients rated as improved in cognition after VPS had significantly lower RBANS scores pre-ELD in immediate memory and delayed memory. If both scores at pre-ELD were ≤ 80 (13 patients), all were rated as improved in cognition after VPS. ELD screening was highly predictive of clinical gait improvement but not of cognitive improvement after VPS for possible NPH. Particularly among patients with a positive ELD gait response, pre-ELD low RBANS scores in memory predicted cognitive improvement after VPS. RBANS seems effective in evaluating cognition for NPH.

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Conflict of interest statement

Conflicts of Interest Disclosure

The authors have no personal, financial, or institutional interests in any of the drugs, materials, or devices cited in this article. All authors who are members of The Japan Neurological Society (DN and TF) have registered online their self-reported COI disclosure statements.

Figures

Fig. 1
Fig. 1
Flowchart showing results of the ELD screening in gait and cognition and assignments of shunting. ELD: external lumbar drainage, pts: patients, VPS: ventriculo-peritoneal shunting.
Fig. 2
Fig. 2
Flowchart showing VPS outcome in gait and cognition and the accuracy of the ELD screening in each symptom. ELD: external lumbar drainage, FN: false negative, FP: false positive, pts: patients, TN: true negative, TP: true positive, VPS: ventriculo-peritoneal shunting.
Fig. 3
Fig. 3
Scatter chart showing 26 shunted patients’ cognitive domains of Repeatable Battery for the Assessment of Neuropsychological Status at the baseline, the score of immediate memory on the X-axis and that of delayed memory on the Y-axis. All the patients with both scores ≤ 80 (13 patients) at the baseline improved cognitively after ventriculo-peritoneal shunting.
See this image and copyright information in PMC

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