| Autor: |
Giovane, Martina Del, Parker, Thomas D, David, Michael CB, Kolanko, Magdalena A, Giunchiglia, Valentina, Trender, William, Carswell, Christopher J, Malhotra, Paresh A, Sharp, David J, Hampshire, Adam |
| Zdroj: |
Alzheimer's & Dementia: The Journal of the Alzheimer's Association; Dec2023 Supplement 18, Vol. 19, p1-4, 4p |
| Abstrakt: |
Background: Idiopathic normal pressure hydrocephalus (iNPH) is characterised by gait disturbance, urinary incontinence and cognitive impairment. Symptoms are potentially reversible via cerebrospinal fluid (CSF) diversion; thus early and accurate diagnosis is crucial. Symptoms and imaging features of iNPH often overlap with Alzheimer's disease (AD) and other neurodegenerative conditions, which represent a major diagnostic challenge. We aimed to demonstrate the utility of computerised neuropsychology testing to aid iNPH diagnosis, as well as exploring the neuroanatomical correlates of cognitive dysfunction in iNPH. Method: iNPH (N = 11) and Alzheimer's disease (N = 14) patients underwent online computerised cognitive testing (Figure 1) and MRI scanning. Raw cognitive scores were converted into 'deviation from expected' (DfE) scores using a novel normative approach, training linear models to N = ∼200,000 norms while accounting for demographics. T‐tests against 0 were conducted on the DfE scores to identify tasks sensitive to iNPH and/or AD. ANOVAs were used to identify differences in regional brain volumes and tract‐specific fractional anisotropy (FA) values in AD and iNPH relative to 10 age‐matched healthy controls (HC). General linear models were used to investigate whether cognitive tasks sensitive to iNPH and AD could predict the identified MRI abnormalities. Result: AD patients demonstrated significant impairments in all tasks, while iNPH patients scored significantly lower than controls in motor control, processing speed, visuospatial, and executive function tasks (Figure 2). One‐way multivariate ANOVA identified cognitive differences between groups (F(22,554) = 14.47, p<0.001), with iNPH performing significantly better on memory and language tests relative to AD. Compared to HC, iNPH patients had lower FA in the corpus callosum and skeleton, reduced cingulate cortex volume and higher total ventricular volume. AD patients, instead, had reduced FA in the inferior longitudinal fasciculus and skeleton, with lower temporal and parietal volumes relative to HC (Figure 3). For iNPH, target detection and words delayed recall predicted corpus callosum FA, while visuospatial tasks predicted ventricular and cingulate volumes. In the AD group, no statistically significant link was detected between task performance and structural changes following multiple comparisons correction. Conclusion: Remote computerised cognitive testing can discriminate between AD and iNPH and has the potential to predict disease‐related MRI abnormalities. [ABSTRACT FROM AUTHOR] |
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