Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Idiopathic Normal Pressure Hydrocephalus Diagnosis: Quantitative and Qualitative Score Predicting Outcome of Extended Lumbar Drainage

Version 1 : Received: 21 December 2022 / Approved: 23 December 2022 / Online: 23 December 2022 (08:09:41 CET)

How to cite: Caffo, M.; Laera, R.; Gorgoglione, M.L.; Curcio, A.; Marzano, G.; Caruso, G.; Germanò, A. Idiopathic Normal Pressure Hydrocephalus Diagnosis: Quantitative and Qualitative Score Predicting Outcome of Extended Lumbar Drainage. Preprints 2022, 2022120452. https://doi.org/10.20944/preprints202212.0452.v1 Caffo, M.; Laera, R.; Gorgoglione, M.L.; Curcio, A.; Marzano, G.; Caruso, G.; Germanò, A. Idiopathic Normal Pressure Hydrocephalus Diagnosis: Quantitative and Qualitative Score Predicting Outcome of Extended Lumbar Drainage. Preprints 2022, 2022120452. https://doi.org/10.20944/preprints202212.0452.v1

Abstract

Background: Idiopathic normal pressure hydrocephalus is a syndrome with neuroradiological findings and clinical pattern characteristic but not specific for the pathology. Since the prevalence is growing due to the rapidly aging society, standardized and validated protocol for diagnosis is needed, also because this condition may mimic other disorders among elderly such as Parkinson's and Alzheimer's disease. Material and methods: We analysed data from 44 patients with suspect diagnosis of idiopathic normal pressure hydrocephalus with age > 60 years, clinical triad and neuroradiological pattern examined in our ward from November 2018 to November 2022. Neu-ropsychological assessment includes Mini Mental State Examination and Mental Deterioration Battery. Motor scores were collected from gait and balance tests. The evaluation was performed before and after an extended lumbar drainage last 48h. Patients who has scores improvement after the extended lumbar drainage, undergo ventriculoperitoneal shunt with a programmable valve. Results: All patients undergo neuropsychological assessment and motor tests, only 2 patients were unable to perform motor tests because bedridden. 16 patients showed no benefit from the tests, in 2 cases even a worsening of cognitive performance. 28 patients showed an improvement in their performances, but in most cases the improvement involved only the neuropsychological as-sessment. All patients underwent ventriculoperitoneal shunt have had a typical answers pattern in Mental Deterioration Battery test. We performed 9 ventriculoperitoneal shunt and 1 ventricu-lo-atrial shunt. Conclusions: Qualitative neurocognitive tests come out to be more sensitive compared to quantitative neurocognitive tests in identifying patients with suspected idiopathic normal pressure hydrocephalus benefiting from extended lumbar drainage test and then un-derwent surgical treatment. This could be considered a valid screening in elderly patients with suspected idiopathic normal pressure hydrocephalus in order to minimize the number of invasive procedures. More studies are necessary to validate this tool.

Keywords

Extended lumbar drainage; Hydrocephalus; Idiopathic normal pressure hydrocephalus; neurodegenerative diseases; Qualitative neurocognitive tests; Quantitative neurocognitive tests

Subject

Medicine and Pharmacology, Neuroscience and Neurology

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