Document Type : Original Article

Authors

1 Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Normal pressure hydrocephalus (NPH) is a reversible type of dementia, which affects 0.2 to 5.9 percent of elders. It manifests with triad of gait disturbances, urinary incontinence, and cognitive decline. In this study, association between cognitive and neuroradiographic parameters of idiopathic NPH (iNPH) was appraised to find out possible biomarkers for preventive intervention.
Methods: In a cross-sectional study, 16 patients with iNPH were evaluated for third and fourth ventricle diameter, diameter of temporal horn of lateral ventricle, Evans index (EI), callosal angle (CA), callosal bowing, and ballooning of frontal horn. The Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG) was used to take cognitive profile. Relation between brain magnetic resonance imaging (MRI) indices and cognitive domains was extracted, using generalized linear model (GLM).
Results: Patients with mild callosal bowing had better function in memory (P = 0.050) and language (P = 0.001) than those with moderate to severe callosal bowing. Negative or mild ballooning of frontal horn was also associated with higher scores in memory (P = 0.010), executive function (EF) (P = 0.029), and language (P = 0.036) than moderate to severe ballooning of frontal horn. Increased 3rd ventricle diameter was associated with decline in total cognition (P = 0.008), memory (P = 0.019), EF (P = 0.012), and language (P = 0.001). Relation between other radiographic indices and cognitive function was not significant.
Conclusion: Third ventricular diameter, rounding of frontal horn of lateral ventricle, and callosal bowing are more accurate neuroradiographic parameters to predict cognitive decline in iNPH.

Keywords

  1. Picascia M, Zangaglia R, Bernini S, Minafra B, Sinforiani E, Pacchetti C. A review of cognitive impairment and differential diagnosis in idiopathic normal pressure hydrocephalus. Funct Neurol 2015; 30(4): 217-28.
  2. Williams MA, Malm J. Diagnosis and treatment of idiopathic normal pressure hydrocephalus. Continuum (Minneap Minn) 2016; 22(2 Dementia): 579-99.
  3. Kazui H. Cognitive impairment in patients with idiopathic normal pressure hydrocephalus. Brain Nerve 2008; 60(3): 225-31. [In Japanese].
  4. Damasceno BP. Neuroimaging in normal pressure hydrocephalus. Dement Neuropsychol 2015; 9(4): 350-5.
  5. Barekatain M, Walterfang M, Behdad M, Tavakkoli M, Mahvari J, Maracy MR, et al. Validity and reliability of the Persian language version of the neuropsychiatry unit cognitive assessment tool. Dement Geriatr Cogn Disord 2010; 29(6): 516-22.
  6. Huang X, Du X, Song H, Zhang Q, Jia J, Xiao T, et al. Cognitive impairments associated with corpus callosum infarction: A ten cases study. Int J Clin Exp Med 2015; 8(11): 21991-8.
  7. Hattori T, Ito K, Aoki S, Yuasa T, Sato R, Ishikawa M, et al. White matter alteration in idiopathic normal pressure hydrocephalus: Tract-based spatial statistics study. AJNR Am J Neuroradiol 2012; 33(1): 97-103.
  8. Mataro M, Matarin M, Poca MA, Pueyo R, Sahuquillo J, Barrios M, et al. Functional and magnetic resonance imaging correlates of corpus callosum in normal pressure hydrocephalus before and after shunting. J Neurol Neurosurg Psychiatry 2007; 78(4): 395-8.
  9. Li X, Ba M, Ng KP, Mathotaarachchi S, Pascoal TA, Rosa-Neto P, et al. Characterizing biomarker features of cognitively normal individuals with ventriculomegaly. Alzheimers Dement (Amst) 2018; 10: 12-21.
  10. Provost JS, Hanganu A, Monchi O. Neuroimaging studies of the striatum in cognition Part I: healthy individuals. Front Syst Neurosci 2015; 9: 140.
  11. Peterson KA, Mole TB, Keong NCH, DeVito EE, Savulich G, Pickard JD, et al. Structural correlates of cognitive impairment in normal pressure hydrocephalus. Acta Neurol Scand 2019; 139(3): 305-12.
  12. Osuka S, Matsushita A, Yamamoto T, Saotome K, Isobe T, Nagatomo Y, et al. Evaluation of ventriculomegaly using diffusion tensor imaging: Correlations with chronic hydrocephalus and atrophy. J Neurosurg 2010; 112(4): 832-9.
  13. Fama R, Sullivan EV. Thalamic structures and associated cognitive functions: Relations with age and aging. Neurosci Biobehav Rev 2015; 54: 29-37.
  14. Klostermann F, Krugel LK, Ehlen F. Functional roles of the thalamus for language capacities. Front Syst Neurosci 2013; 7: 32.
  15. Jang SH, Yeo SS. Thalamocortical connections between the mediodorsal nucleus of the thalamus and prefrontal cortex in the human brain: a diffusion tensor tractographic study. Yonsei Med J 2014; 55(3): 709-14.
  16. Lilja-Lund O, Kockum K, Hellstrom P, Soderstrom L, Nyberg L, Laurell K. Wide temporal horns are associated with cognitive dysfunction, as well as impaired gait and incontinence. Sci Rep 2020; 10(1): 18203.