We sought to describe the cognitive profile of patients with Idiopathic Normal Pressure Hydrocephalus (iNPH) using a comprehensive neuropsychological battery. Based on age and education correlated norms, we aimed to compare performance in each measured cognitive domain: executive functions (EFs), verbal memory (VM), non-verbal memory (nVM), visuoconstructional abilities (VA) and attention/psychomotor speed (A/PS). Patients diagnosed with iNPH underwent comprehensive neuropsychological evaluation before shunting. Their performance was compared to the age and education correlated norms. Correlation of different cognitive domains in iNPH profile was performed. A total of 53 iNPH patients (73.21 ± 5.48 years) were included in the study. All of the measured cognitive domains were significantly damaged. The most affected domains were EFs and VM (p<0.001 and p<0.001, respectively). A/PS domain was affected milder than EFs and VM (p<0.001). The least affected domains were nVM (p<0.001) and VA (p<0.001). Patients with iNPH are affected in all cognitive domains and the cognitive decline is uneven across these domains. The impairment of memory was shown to depend on the presented material. VM was shown to be much more severely affected than nVM and along with VM, EFs were shown to be the most affected. A/PS speed was shown to be less affected than VM and EFs and the least affected domains were nVM and VA.

Department of Anaesthesiology and Intensive Care Sligo University Hospital Sligo Ireland

Department of Neuropsychology 1st Medical Faculty Charles University and Military University Hospital Prague Czech Republic

Department of Neuropsychology 2nd Medical Faculty Charles University and Motol University Hospital Prague Czech Republic

Department of Neurosurgery 2nd Medical Faculty Charles University and Motol University Hospital Prague Czech Republic

Department of Neurosurgery and Neurooncology 1st Medical Faculty Charles University and Military University Hospital Prague Czech Republic

Zobrazit více v PubMed

Nakajima M, Yamada S, Miyajima M, Ishii K, Kuriyama N, Kazui H, Kanemoto H, Suehiro T, Yoshiyama K, Kameda M et al (2021) Guidelines for management of idiopathic normal pressure hydrocephalus (third edition): endorsed by the Japanese society of normal pressure hydrocephalus, Neurol Med Chir (Tokyo) 61(63–97). 10.2176/nmc.st.2020-0292 PubMed PMC

Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH (1965) Symptomatic occult hydrocephalus with "normal" cerebrospinal-fluid pressure.a treatable syndrome. N Engl J Med 273:117–126. 10.1016/10.1056/nejm196507152730301 PubMed

Wang Z, Zhang Y, Hu F, Ding J, Wang X (2020) Pathogenesis and pathophysiology of idiopathic normal pressure hydrocephalus. CNS Neurosci Therapeut 26:1230–1240. 10.1111/cns.13526 PubMed PMC

Zaccaria V, Bacigalupo I, Gervasi G et al (2020) A systematic review on the epidemiology of normal pressure hydrocephalus. Acta Neurol Scand 141:101–114. 10.1111/ane.13182 PubMed

Shprecher D, Schwalb J, Kurlan R (2008) Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep 8:371–376. 10.1007/s11910-008-0058-2 PubMed PMC

Andersson J, Rosell M, Kockum K, Lilja-Lund O, Söderström L, Laurell K (2019) Prevalence of idiopathic normal pressure hydrocephalus: A prospective, population-based study. Plos One 14:e0217705. 10.1371/journal.pone.0217705 PubMed PMC

Tanaka N, Yamaguchi S, Ishikawa H, Ishii H, Meguro K (2008) Prevalence of Possible Idiopathic Normal-Pressure Hydrocephalus in Japan: The Osaki-Tajiri Project. Neuroepidemiology 32:171–175. 10.1159/000186501 PubMed

Ogino A, Kazui H, Miyoshi N, Hashimoto M, Ohkawa S, Tokunaga H, Ikejiri Y, Takeda M (2006) Cognitive impairment in patients with idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Disord 21(113–119). 10.1159/000090510 PubMed

Kapur N (2005) Neuropsychological Assessment, Fourth Edition. J Neurol 252:1290–1291. 10.1007/s00415-005-0003-0

Turner MA, Moran NF, Kopelman MD (2002) Subcortical dementia. The British J Psychiatr 180:148–151. 10.1192/bjp.180.2.148 PubMed

Brown RG, Marsden CD (1988) 'Subcortical dementia': the neuropsychological evidence. Neuroscience 25:363–387. 10.1016/0306-4522(88)90246-1 PubMed

Bugalho P, Alves L, Miguel R, Ribeiro O (2014) Profile of cognitive dysfunction and relation with gait disturbance in Normal Pressure Hydrocephalus. Clin Neurol Neurosurg 118:83–88. 10.1016/j.clineuro.2014.01.006 PubMed

Devito EE, Pickard JD, Salmond CH, Iddon JL, Loveday C, Sahakian BJ (2005) The neuropsychology of normal pressure hydrocephalus (NPH). British Journal of Neurosurgery 19(217–224). 10.1080/02688690500201838 PubMed

Solana E, Sahuquillo J, Junqué C, Quintana M, Poca MA (2012) Cognitive Disturbances and Neuropsychological Changes after Surgical Treatment in a Cohort of 185 Patients with Idiopathic Normal Pressure Hydrocephalus. Arch Clin Neuropsychol 27:304–317. 10.1093/arclin/acs002 PubMed

Xiao H, Hu F, Ding J, Ye Z (2022) Cognitive Impairment in Idiopathic Normal Pressure Hydrocephalus. Neurosci Bull 38:1085–1096. 10.1007/s12264-022-00873-2 PubMed PMC

Carone DA, Strauss E, Sherman EMS, Spreen O (2007) A compendium of neuropsychological tests: administration, norms, and commentary. Appl Neuropsychol 14:62–63. 10.1080/09084280701280502

Keys BA, White DA (2000) Exploring the relationship between age, executive abilities, and psychomotor speed. J Int Neuropsychol Soc 6:76–82. 10.1017/S1355617700611098 PubMed

Saito M, Nishio Y, Kanno S, Uchiyama M, Hayashi A, Takagi M, Kikuchi H, Yamasaki H, Shimomura T, Iizuka O et al (2011) Cognitive Profile of Idiopathic Normal Pressure Hydrocephalus. Dement Geriatr Cogn Disord Extra 1:202–211. 10.1159/000328924 PubMed PMC

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383. 10.1016/0021-9681(87)90171-8 PubMed

Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Hermans J (2000) The Dutch normal-pressure hydrocephalus study. How to select patients for shunting? An analysis of four diagnostic criteria. Surg Neurol 53:201–207. 10.1016/s0090-3019(00)00182-8 PubMed

Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (2005) The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment. J Am Geriatr Soc 53:695–699. 10.1111/j.1532-5415.2005.53221.x PubMed

Kopecek M, Stepankova H, Lukavsky J, Ripova D, Nikolai T, Bezdicek O (2017) Montreal cognitive assessment (MoCA): Normative data for old and very old Czech adults. Appl Neuropsychol: Adult 24(1):23–29. 10.1080/23279095.2015.1065261 PubMed

Bowie CR, Harvey PD (2006) Administration and interpretation of the Trail Making Test. Nat Protoc 1:2277–2281. 10.1038/nprot.2006.390 PubMed

Bezdicek O, Motak L, Axelrod BN, Preiss M, Nikolai T, Vyhnalek M et al (2012) Czech version of the Trail Making Test: Normative data and clinical utility. Arch Clin Neuropsychol 27(8):906–914. 10.1093/arclin/acs084 PubMed

Rey A (1964) L' examen clinique en psychologie, 2nd edn. Presses universitaires de France, Paris, France

Bezdicek O, Stepankova H, Motak L, Axelrod BN, Woodard JL, Preiss M, Nikolai T, Růžička E, Poreh A (2014) Czech version of Rey Auditory Verbal Learning test: Normative data. Aging Neuropsychol Cogn 21(6):693–721. 10.1080/13825585.2013.865699 PubMed

Zhang X, Lv L, Min G, Wang Q, Zhao Y, Li Y (2021) Overview of the complex figure test and its clinical application in neuropsychiatric disorders, including copying and recall. Front Neurol 12:680474. 10.3389/fneur.2021.680474 PubMed PMC

Drozdova K, Stepankova Georgi H, Lukavsky J, Bezdicek O, Kopecek M (2015) Normative data for the reyosterrieth complex figure test in older Czech adults. Česká a Slovenská neurologie a neurochirurgie 78(111):542–549

Kaufman AS (1983) Test Review: Wechsler, D. Manual for the Wechsler Adult Intelligence Scale, Revised. New York: Psychological Corporation, 1981. J Psychoeduc Assess 1:309–313. 10.1177/073428298300100310

Černochová D, Goldmann P, Král P, Soukupová T, Šnorek P, Havlůj V (2010) Wechslerova inteligenční škála pro dospělé WAIS III. Praha. Hogrefe-Testcentrum, Czech republic

Nikolai T, Štěpánková H, Michalec J, Bezdíček O, Horáková K, Marková H, Kopeček M (2015) Testy verbální fluence, česká normativní studie pro osoby vyššího věku. Česká a slovenská neurologie a neurochirurgie 78, 111(3):292–299

da Rocha SFB, Kowacs PA, de Souza RKM, Pedro MKF, Ramina R, Teive HAG (2021) Serial Tap Test of patients with idiopathic normal pressure hydrocephalus: impact on cognitive function and its meaning. Fluids Barriers CNS 18:22. 10.1186/s12987-021-00254-3 PubMed PMC

Hülser M, Spielmann H, Oertel J, Sippl C (2022) Motor skills, cognitive impairment, and quality of life in normal pressure hydrocephalus: early effects of shunt placement. Acta Neurochirurg 164:1765–1775. 10.1007/s00701-022-05149-2 PubMed PMC

Gleichgerrcht E, Cervio A, Salvat J, Loffredo AR, Vita L, Roca M, Torralva T, Manes F (2009) Executive function improvement in normal pressure hydrocephalus following shunt surgery. Behav Neurol 21:181–185. 10.3233/BEN-2009-0249 PubMed PMC

Sahakian BJ, Downes JJ, Eagger S, Everden JL, Levy R, Philpot MP, Roberts AC, Robbins TW (1990) Sparing of attentional relative to mnemonic function in a subgroup of patients with dementia of the Alzheimer type. Neuropsychologia 28:1197–1213. 10.1016/0028-3932(90)90055-S PubMed

Vlasák A, Skalický P, Mládek A, Vrána J, Beneš V, Bradáč O (2021) Structural volumetry in NPH diagnostics and treatment—future or dead end? Neurosurg Rev 44:503–514. 10.1007/s10143-020-01245-y PubMed

Nerg O, Junkkari A, Hallikainen I, Rauramaa T, Luikku A, Hiltunen M, Jääskeläinen JE, Leinonen V, Hänninen T, Koivisto A (2021) The CERAD Neuropsychological Battery in Patients with Idiopathic Normal Pressure Hydrocephalus Compared with Normal Population and Patients with Mild Alzheimer's Disease. J Alzheimers Dis 81(3):1117–1130. 10.3233/JAD-201363 PubMed

Diehl J, Kurz A (2002) Frontotemporal dementia: patient characteristics, cognition, and behaviour. Int J Geriatr Psychiatr 17:914–918. 10.1002/gps.709 PubMed

Korhonen VE, Solje E, Suhonen NM, Rauramaa T, Vanninen R, Remes AM, Leinonen V (2017) Frontotemporal dementia as a comorbidity to idiopathic normal pressure hydrocephalus (iNPH): a short review of literature and an unusual case. Fluids Barriers CNS 14(10). 10.1186/s12987-017-0060-7 PubMed PMC

Serggio CL, Bruce LM (2016) The behavioural variant frontotemporal dementia (bvFTD) syndrome in psychiatry. J Neurol Neurosurg Psychiatr 87:501. 10.1136/jnnp-2015-310697 PubMed PMC

Picascia M, Pozzi NG, Todisco M, Minafra B, Sinforiani E, Zangaglia R, Ceravolo R, Pacchetti C (2019) Cognitive disorders in normal pressure hydrocephalus with initial parkinsonism in comparison with de novo Parkinson's disease. Eur J Neurol 26:74–79. 10.1111/ene.13766 PubMed

Golomb J, Wisoff J, Miller DC, Boksay I, Kluger A, Weiner H, Salton J, Graves W (2000) Alzheimer’s disease comorbidity in normal pressure hydrocephalus: prevalence and shunt response. J Neurol Neurosurg Psychiatr 68:778. 10.1136/jnnp.68.6.778 PubMed PMC