Idiopathic Normal Pressure Hydrocephalus (iNPH) patients have various response levels to shunt surgery. Some patients' symptoms ameliorate significantly and their gait improves, while others remain unaffected.
Considering that shunt surgery is in invasive procedure that exposes patients to a higher risk of meningitis (infection of meninges), scientific efforts have been made to distinguish responders from non-responders.
In this research article published on April 2022 in the journal of Neurology. Clinical practice., we measured CSF neurofilament light (NfL), β-amyloid 42 (Aβ1–42), β-amyloid 40 (Aβ1–40), total tau (tTau), and phosphorylated tau 181 (pTau181) and leucine-rich alpha-2-glycoprotein-1 (LRG1) by ELISA and then, the ability of these measures to predict immediate improvement following CSF tap test (CSF TT) and long-term improvement following shunt surgery was compared by univariate and adjusted multivariate regression.
Lower NfL, pTau181, tTau, and Aβ1–40 were individually predictive of long-term improvement in gait outcomes after shunt surgery. A multivariate model of these biomarkers and MRI Evans index, adjusted for age, improved prediction (area under the receiver operating curve 0.76, 95% confidence interval 0.66–0.86).
Using CSF biomarkers such as NfL and pTau181 and MRI Evans Index, a model was designed to predict the response of iNPH patients to shunt surgery.
A combination of CSF biomarkers can predict improvement following shunt surgery for iNPH. However, these measures only modestly discriminate responders from non-responders following CSF TT. The findings further suggest that abnormal CSF biomarkers in non-responders may represent comorbid neurodegenerative pathology or a predegenerative phase that presents with an iNPH phenotype.
Comments