Madison Niermeyer1, Chad Gaudet2, Paul Malloy3,4, Irene Piryatinsky5, Stephen Salloway3,4,6, Petra Klinge7,8, Athene Lee3,4. 1. Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT. 2. Department of Psychology, University of Rhode Island, Kingston, RI. 3. Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI. 4. Memory and Aging Program, Butler Hospital, Providence, RI. 5. Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA. 6. Department of Neurology, Warren Alpert Medical School, Brown University, Providence, RI. 7. Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, RI. 8. Lifespan Physician Group, Rhode Island Hospital, Providence, RI.
Abstract
OBJECTIVES: Cognitive impairment and apathy are well-documented features of idiopathic normal pressure hydrocephalus (iNPH). However, research examining other neuropsychiatric manifestations of iNPH is scant, and it is unknown whether the neuropsychiatric presentation differs for iNPH patients with comorbid Alzheimer's disease (AD) versus iNPH without AD. This study aims to advance our understanding of neuropsychiatric syndromes associated with iNPH. METHODS: Fifty patients from Butler Hospital's Normal Pressure Hydrocephalus Clinic met inclusion criteria. Caregiver ratings on the Frontal Systems Behavior Scale (FrSBe) were examined to appraise changes in apathy, executive dysfunction, and disinhibition. Patients also completed cognitive tests of global cognition, psychomotor speed, and executive functioning. AD biomarker status was determined by either amyloid-beta (Aβ) positron emission tomography (PET) imaging or cerebrospinal fluid (CSF) total tau to Aβ-42 ratio. RESULTS: Results revealed clinically significant elevations on the FrSBe's apathy and executive dysfunction scales and modest correlations among these scales and cognitive measures. Of the 44 patients with available neuroimaging or CSF draw data, 14 presented with comorbid AD. Relative to the iNPH-only group, the iNPH + AD group showed a larger increase from pre-illness to current informant ratings on the executive dysfunction scale, but not the apathy or disinhibition scales. CONCLUSIONS: These results replicate and extend prior research by identifying apathy and executive dysfunction as prominent neuropsychiatric symptoms of iNPH and suggest comorbid AD exacerbates dysexecutive behaviors. Future research is warranted to examine the effects of comorbid AD pathology in response to shunt surgery for iNPH, neuropsychiatric symptom changes, and resultant caregiver burden.
OBJECTIVES:Cognitive impairment and apathy are well-documented features of idiopathic normal pressure hydrocephalus (iNPH). However, research examining other neuropsychiatric manifestations of iNPH is scant, and it is unknown whether the neuropsychiatric presentation differs for iNPH patients with comorbid Alzheimer's disease (AD) versus iNPH without AD. This study aims to advance our understanding of neuropsychiatric syndromes associated with iNPH. METHODS: Fifty patients from Butler Hospital's Normal Pressure Hydrocephalus Clinic met inclusion criteria. Caregiver ratings on the Frontal Systems Behavior Scale (FrSBe) were examined to appraise changes in apathy, executive dysfunction, and disinhibition. Patients also completed cognitive tests of global cognition, psychomotor speed, and executive functioning. AD biomarker status was determined by either amyloid-beta (Aβ) positron emission tomography (PET) imaging or cerebrospinal fluid (CSF) total tau to Aβ-42 ratio. RESULTS: Results revealed clinically significant elevations on the FrSBe's apathy and executive dysfunction scales and modest correlations among these scales and cognitive measures. Of the 44 patients with available neuroimaging or CSF draw data, 14 presented with comorbid AD. Relative to the iNPH-only group, the iNPH + AD group showed a larger increase from pre-illness to current informant ratings on the executive dysfunction scale, but not the apathy or disinhibition scales. CONCLUSIONS: These results replicate and extend prior research by identifying apathy and executive dysfunction as prominent neuropsychiatric symptoms of iNPH and suggest comorbid AD exacerbates dysexecutive behaviors. Future research is warranted to examine the effects of comorbid AD pathology in response to shunt surgery for iNPH, neuropsychiatric symptom changes, and resultant caregiver burden.
Authors: José Luis Molinuevo; Kaj Blennow; Bruno Dubois; Sebastiaan Engelborghs; Piotr Lewczuk; Armand Perret-Liaudet; Charlotte E Teunissen; Lucilla Parnetti Journal: Alzheimers Dement Date: 2014-08-20 Impact factor: 21.566
Authors: Nicole C Keong; Alonso Pena; Stephen J Price; Marek Czosnyka; Zofia Czosnyka; Elise E DeVito; Charlotte R Housden; Barbara J Sahakian; John D Pickard Journal: PLoS One Date: 2017-08-17 Impact factor: 3.240