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. 2023 Jan 16;23(1):29.
doi: 10.1186/s12877-023-03747-y.

Longitudinal neuropsychological trajectories in idiopathic normal pressure hydrocephalus: a population-based study

Otto Lilja-Lund  1 , Martin Maripuu  2 , Karin Kockum  3 , Johanna Andersson  3 , Anna Lindam  4 , Lars Nyberg  5   6   7   8 , Katarina Laurell  9
Affiliations

Longitudinal neuropsychological trajectories in idiopathic normal pressure hydrocephalus: a population-based study

Otto Lilja-Lund et al. BMC Geriatr. .

Abstract

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a progressive syndrome affecting gait, incontinence, and cognition in a significant number of older adults. Still, prospective studies on early development of symptoms are scarce.

Aim: To investigate how neuropsychological functions develop before and in already diagnosed iNPH over a two-year period in a population-based material.

Method: A sample of 104 participants (median [IQR] 75 [72-80] years old) from the general population underwent CT-imaging and clinical assessment at baseline and follow-up. We used the iNPH symptom scale covering four domains (Neuropsychology, Gait, Balance, Incontinence) and additional tests of executive functions. Morphological signs were rated with the iNPH Radscale. Non-parametric statistics with Bonferroni corrections and a significance-level of p < 0.05 were used.

Results: Median (IQR) time to follow-up was 25 (23-26) months. Effect size (ES) for individuals who developed iNPH (n = 8) showed a large (ES r = -0.55) decline in the Gait domain and on the Radscale (ES r = -0.60), with a medium deterioration in declarative memory (ES r = -0.37). Those having iNPH at baseline (n = 12) performed worse on one executive sub-function i.e., shifting (p = 0.045).

Conclusion: Besides deterioration in gait and radiology, our results suggest that a neuropsychological trajectory for those developing iNPH includes a reduction in declarative memory. Executive dysfunction was limited to those already having iNPH at baseline. These findings could suggest that memory impairments are included in the early development of iNPH.

Keywords: Ageing; Cognition; Cognitive development; Idiopathic normal pressure hydrocephalus; Life-span; Neuropsychology; Older adults; Population-based.

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Conflict of interest statement

None to declare.

Figures

Fig. 1
Fig. 1
Selection flow-chart over participants. In 2014/15 168 older adults participated in the baseline study. Thirteen of the 23 participants lost at follow-up were excluded based on conditions severely affecting gait and/or cognition (Alzheimer’s disease, hip-surgery, cancer, visual impairment, spinal stenosis, and secondary hydrocephalus). Three declined neurological examination, three had incomplete neuropsychological tests, and two declined imaging. Two participants underwent shunt surgery after 2014/15
See this image and copyright information in PMC

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