Chang Shannon, Agarwal Sachin, Williams Michael A, Rigamonti Daniele, Hillis Argye E
School of Medicine, Johns Hopkins University, Baltimore, Maryland 21287, USA.
Neurologist. 2006 Jan;12(1):39-42. doi: 10.1097/01.nrl.0000186864.75025.48.
Several studies have reported that ventriculoperitoneal shunt insertion for treatment of normal-pressure hydrocephalus results in improvement of gait and, less frequently, improvement of cognition. We sought to identify the demographic factors associated with cognitive improvement after shunt insertion to improve assessment of prognosis for cognitive gains with treatment.
We report cognitive testing before and after ventriculoperitoneal shunt insertion in 36 patients with normal pressure hydrocephalus, who previously had improvement of any clinical symptom--gait, urinary incontinence, cognition--after a diagnostic trial of continuous cerebrospinal fluid drainage.
One third of patients met our definition of good cognitive improvement: improvement by at least 25% on at least half of the cognitive tests administered. There was a significant negative linear relationship between age and probability of good cognitive improvement. Additionally, the degree of cognitive improvement was found to be greater in women than men (P = 0.002). Age was found to be a better predictor of improvement on memory tests, while sex was a better predictor of improvement on non-memory tests after shunt insertion.
多项研究报告称，采用脑室腹腔分流术治疗正常压力脑积水可改善步态，较少情况下可改善认知功能。我们试图确定与分流术后认知功能改善相关的人口统计学因素，以改进对治疗后认知功能改善预后的评估。
我们报告了36例正常压力脑积水患者在脑室腹腔分流术前后的认知测试情况，这些患者在进行连续脑脊液引流诊断性试验后，之前的任何临床症状（步态、尿失禁、认知）均有改善。
三分之一的患者符合我们对良好认知功能改善的定义：在至少一半的认知测试中改善至少25%。年龄与良好认知功能改善的概率之间存在显著的负线性关系。此外，发现女性的认知改善程度大于男性（P = 0.002）。发现年龄是分流术后记忆测试改善情况的更好预测指标，而性别是分流术后非记忆测试改善情况的更好预测指标。
