A clinical and biochemical analysis in the differential diagnosis of idiopathic normal pressure hydrocephalus

Tommaso Schirinzi, Giulia Maria Sancesario, Cristiano Ialongo, Paola Imbriani, Graziella Madeo, Sofia Toniolo, Alessandro Martorana, Antonio Pisani

Research output: Contribution to journalArticle

Abstract

Introduction: Idiopathic normal pressure hydrocephalus (iNPH) can be misdiagnosed with other neurodegenerative diseases, especially in the early disease stages. Considering the opportunity of the shunt surgery, iNPH should be diagnosed with accuracy. Here, we evaluate the utility of CSF biomarkers and their relationship with clinical features in the diagnosis of iNPH. Methods: We performed a multivariate analysis of the CSF levels of Aβ42, t-tau, and p-tau collected from four groups of patients: 14 iNPH, 14 progressive supranuclear palsy (PSP), 14 Alzheimer's disease (AD), 14 controls (CTL). Diagnostic accuracy of biomarkers was determined by the receiver operating characteristic curve analysis. Statistical correlation was calculated between each CSF biomarker and single clinical items of iNPH. Results: Aβ42 levels in iNPH were lower than controls, although not as low as in AD. Likewise, CSF t-tau and p-tau were lower in iNPH than in controls. Of interest, t-tau and p-tau were higher in AD than in controls and hence both t-tau and p-tau were significantly lower in iNPH than in AD. No differences were found between iNPH and PSP. CSF biomarkers levels did not correlate to clinical features of iNPH, whereas two significant correlations emerged within clinical parameters: cognitive impairment was related to gait difficulties, while ventricular enlargement correlated with continence disturbances. Conclusion: Measurement of CSF biomarker levels may be helpful in the differential diagnosis between iNPH and AD but not between iNPH and PSP. Both Aβ42 and tau levels appear unrelated to main clinical features of iNPH.

Original languageEnglish
Article number00086
JournalFrontiers in Neurology
Volume6
Issue numberAPR
DOIs
Publication statusPublished - 2015

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Normal Pressure Hydrocephalus
Differential Diagnosis
Progressive Supranuclear Palsy
Biomarkers
Alzheimer Disease
Diagnostic Errors
Gait
ROC Curve
Neurodegenerative Diseases

Keywords

  • CSF biomarkers
  • Idiopathic normal pressure hydrocephalus
  • Progressive supranuclear palsy

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

A clinical and biochemical analysis in the differential diagnosis of idiopathic normal pressure hydrocephalus. / Schirinzi, Tommaso; Sancesario, Giulia Maria; Ialongo, Cristiano; Imbriani, Paola; Madeo, Graziella; Toniolo, Sofia; Martorana, Alessandro; Pisani, Antonio.

In: Frontiers in Neurology, Vol. 6, No. APR, 00086, 2015.

Research output: Contribution to journalArticle

Schirinzi, T, Sancesario, GM, Ialongo, C, Imbriani, P, Madeo, G, Toniolo, S, Martorana, A & Pisani, A 2015, 'A clinical and biochemical analysis in the differential diagnosis of idiopathic normal pressure hydrocephalus', Frontiers in Neurology, vol. 6, no. APR, 00086. https://doi.org/10.3389/fneur.2015.00086
Schirinzi, Tommaso ; Sancesario, Giulia Maria ; Ialongo, Cristiano ; Imbriani, Paola ; Madeo, Graziella ; Toniolo, Sofia ; Martorana, Alessandro ; Pisani, Antonio. / A clinical and biochemical analysis in the differential diagnosis of idiopathic normal pressure hydrocephalus. In: Frontiers in Neurology. 2015 ; Vol. 6, No. APR.
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AU - Madeo, Graziella

AU - Toniolo, Sofia

AU - Martorana, Alessandro

AU - Pisani, Antonio

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AB - Introduction: Idiopathic normal pressure hydrocephalus (iNPH) can be misdiagnosed with other neurodegenerative diseases, especially in the early disease stages. Considering the opportunity of the shunt surgery, iNPH should be diagnosed with accuracy. Here, we evaluate the utility of CSF biomarkers and their relationship with clinical features in the diagnosis of iNPH. Methods: We performed a multivariate analysis of the CSF levels of Aβ42, t-tau, and p-tau collected from four groups of patients: 14 iNPH, 14 progressive supranuclear palsy (PSP), 14 Alzheimer's disease (AD), 14 controls (CTL). Diagnostic accuracy of biomarkers was determined by the receiver operating characteristic curve analysis. Statistical correlation was calculated between each CSF biomarker and single clinical items of iNPH. Results: Aβ42 levels in iNPH were lower than controls, although not as low as in AD. Likewise, CSF t-tau and p-tau were lower in iNPH than in controls. Of interest, t-tau and p-tau were higher in AD than in controls and hence both t-tau and p-tau were significantly lower in iNPH than in AD. No differences were found between iNPH and PSP. CSF biomarkers levels did not correlate to clinical features of iNPH, whereas two significant correlations emerged within clinical parameters: cognitive impairment was related to gait difficulties, while ventricular enlargement correlated with continence disturbances. Conclusion: Measurement of CSF biomarker levels may be helpful in the differential diagnosis between iNPH and AD but not between iNPH and PSP. Both Aβ42 and tau levels appear unrelated to main clinical features of iNPH.

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