Review article
https://doi.org/10.3325/cmj.2021.62.387
Differentiating comorbidities and predicting prognosis in idiopathic normal pressure hydrocephalus using cerebrospinal fluid biomarkers: a review
Madoka Nakajima
; Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Kaito Kawamura
; Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Chihiro Akiba
; Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
Koichiro Sakamoto
; Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Hambing Xu
; Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Chihiro Kamohara
; Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Ikuko Ogino
; Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Kostadin Karagiozov
; Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Yuichi Tange
; Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Kazuaki Shimoji
; Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Shinya Yamada
; Department of Neurosurgery, Kugayama Hospital, Tokyo, Japan
Akihide Kondo
; Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Hajime Arai
; Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Masakazu Miyajima
; Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a condition resulting from impaired cerebrospinal fluid (CSF) absorption and excretion characterized by a triad of symptoms comprising dementia, gait disturbance (impaired
trunk balance), and urinary incontinence. CSF biomarkers
not only assist in diagnosis but are also important for analyzing the pathology and understanding appropriate treatment indications. As the neuropathological findings characteristic of iNPH have yet to be defined, there remains no
method to diagnose iNPH with 100% sensitivity and specificity. Neurotoxic proteins are assumed to be involved in
the neurological symptoms of iNPH, particularly the appearance of cognitive impairment. The symptoms of iNPH
can be reversed by improving CSF turnover through shunting. However, early diagnosis is essential as once neurodegeneration has progressed, pathological changes become
irreversible and symptom improvement is minimal, even
after shunting. Combining a variety of diagnostic methods
may lead to a more definitive diagnosis and accurate prediction of the prognosis following shunt treatment. Identifying comorbidities in iNPH using CSF biomarkers does not
contraindicate shunting-based intervention, but does limit
the improvement in symptoms it yields, and provides vital
information for predicting post-treatment prognosis
Keywords
Hrčak ID:
278451
URI
Publication date:
26.8.2021.
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