| Autor: |
Leinonen, Ville, Rauramaa, Tuomas, Malm, Tarja, Luikku, Antti J., Junkkari, Antti, Koivisto, Anne M., Hiltunen, Mikko |
| Zdroj: |
Alzheimer's & Dementia: The Journal of the Alzheimer's Association; Dec2020 Supplement S6, Vol. 16 Issue 6, p1-2, 2p |
| Abstrakt: |
Background: Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait apraxia, cognitive deterioration and urinary incontinence. Differential diagnosis with other neurodegenerative disorders like Alzheimer's disease (AD) can be challenging. Furthermore, AD‐related brain pathology is frequent comorbidity and can predict subsequent clinical AD. Here we aim to describe a diagnostic and treatment protocol of iNPH optimized for prediction of clinical outcome, especially future AD, and research value on neurodegenerative diseases. Method: Since 1993 until the end of 2019, 990 patients with possible NPH underwent diagnostic right frontal cortical brain biopsy during intraventricular pressure measurement or CSF shunt surgery. Brain biopsies are routinely evaluated by immunohistochemistry against amyloid‐β (Aβ) and hyperphosphorylated tau (HPτ). Patients are follow‐up until death to gain all available outcome data. Result: We have found an increased occurrence of clinical AD (up to 25%) in previously shunted iNPH patients as compared with rate of dementia in general population (15%). Cortical biopsy with Aβ pathology (seen in around 40% of all biopsies) during shunt insertion was the best predictor of future comorbid AD. These patients would be ideal for clinical trials of potential preventive therapies. Conclusion: Diagnostic work‐up of NPH offer large amount of CSF, repeated brain imaging and cognitive testing. Most importantly, CSF shunt surgery open an ethically sustainable window to living brain including various comorbid neuropathological findings by chance. Along with optimized patient care, Kuopio iNPH work‐up (Figure) offer unique platform for biomarker discovery and validation. [ABSTRACT FROM AUTHOR] |
| Databáze: |
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