Yasar Sevil, Jusue-Torres Ignacio, Lu Jennifer, Robison Jamie, Patel Mira A, Crain Barbara, Carson Kathryn A, Hoffberger Jamie, Batra Sachin, Sankey Eric, Moghekar Abhay, Rigamonti Daniele
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
PLoS One. 2017 Aug 7;12(8):e0182288. doi: 10.1371/journal.pone.0182288. eCollection 2017.
We aimed to determine whether presence of AD neuropathology predicted cognitive, gait and balance measures in patients with idiopathic normal pressure hydrocephalus (iNPH) after shunt surgery. This is a prospective study of gait and balance measured by Timed Up and Go (TUG) and Tinetti tests, and cognitive function measured by Mini Mental Status Exam (MMSE), before and after shunt surgery in participants 65 years and older with iNPH at the Johns Hopkins University. Random effects models were used and adjusted for confounders. 88 participants were included in the analysis with a median (IQR) time of 104 (57-213) days between surgery and follow-up. 23 (25%) participants had neuritic plaques present (NP+) and were significantly older [76.4 (6.0) years], but were otherwise similar in all demographics and outcome measures, when compared to the group without neuritic plaques (NP-). NP- and NP+ participants equally improved on measures of TUG (β = -3.27, 95% CI -6.24, -0.30, p = 0.03; β = -2.37, 95% CI -3.90, -0.86, p = 0.02, respectively), Tinetti-total (β = 1.95, 95% CI 1.11, 2.78, p<0.001; β = 1.72, 95% CI 0.90, 2.53, p<0.001, respectively), -balance (β = 0.81, 95% CI 0.23, 1.38, p = 0.006; β = 0.87, 95% CI 0.40, 1.34, p<0.001, respectively) and -gait (β = 1.03, 95% CI 0.61, 1.45, p<0.001; β = 0.84, 95% CI 0.16, 1.53, p = 0.02, respectively), while neither NP- nor NP+ showed significant improvement on MMSE (β = 0.10, 95% CI -0.27, 0.46, p = 0.61, β = 0.41, 95% CI -0.27, 1.09, p = 0.24, respectively). In summary, 26% of participants with iNPH had coexisting AD pathology, which does not significantly influence the clinical response to shunt surgery.
我们旨在确定在特发性正常压力脑积水（iNPH）患者分流手术后，阿尔茨海默病神经病理学的存在是否能预测其认知、步态和平衡指标。这是一项前瞻性研究，对约翰·霍普金斯大学65岁及以上iNPH患者在分流手术前后通过定时起立行走测试（TUG）和Tinetti测试测量步态和平衡，以及通过简易精神状态检查表（MMSE）测量认知功能。使用随机效应模型并对混杂因素进行了调整。88名参与者纳入分析，手术与随访之间的中位（四分位间距）时间为104（57 - 213）天。23名（25%）参与者存在神经炎性斑块（NP +），且年龄显著更大[76.4（6.0）岁]，但与无神经炎性斑块（NP -）的组相比，在所有人口统计学和结局指标方面其他方面相似。NP - 和NP +参与者在TUG测量指标上均有同等改善（β = -3.27，95%置信区间 -6.24，-0.30，p = 0.03；β = -2.37，95%置信区间 -3.90，-0.86，p = 0.02），Tinetti总分（β = 1.95，95%置信区间1.11，2.78，p<0.001；β = 1.72，95%置信区间0.90，2.53，p<0.001），平衡（β = 0.81，95%置信区间0.23，1.38，p = 0.006；β = 0.87，95%置信区间0.40，1.34，p<0.001）和步态（β = 1.03，95%置信区间0.61，1.45，p<0.001；β = 0.84，95%置信区间0.16，1.53，p = 0.02），而NP - 和NP +在MMSE上均未显示出显著改善（β = 0.10，95%置信区间 -0.27，0.46，p = 0.61，β = 0.41，95%置信区间 -0.27，1.09，p = 0.24）。总之，26%的iNPH参与者同时存在阿尔茨海默病病理学改变，这并未显著影响分流手术的临床反应。
