Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-dong, Gangnam-gu, Seoul, 06351, Republic of Korea.
Neuroscience Center, Samsung Medical Center, Seoul, Korea.
J Neurol. 2018 Jan;265(1):63-73. doi: 10.1007/s00415-017-8650-5. Epub 2017 Nov 11.
Amyloid positron emission tomography ([18F] florbetaben (FBB) PET) can be used to determine concomitant Alzheimer's disease (AD) in idiopathic normal pressure hydrocephalus (iNPH) patients. FBB PET scans and the tap test were performed in 31 patients with clinically suspected iNPH, and amyloid positive (iNPH/FBB+) and negative (iNPH/FBB-) groups were compared with respect to clinical characteristics. We evaluated prognostic value of FBB PET scans by analyzing the response to the tap test using a linear mixed model. We also performed a multivariable regression analysis to investigate whether amyloid PET positivity can predict the positive tap test response independent of other AD biomarkers. The results showed that the iNPH/FBB+ group (7/31, 22.6%) had a higher percentage of APOE4 carriers, lower Aβ42, higher CSF t-tau, and p-tau/Aβ42 ratio than the iNPH/FBB- group (24/31, 77.4%), while the two groups did not differ in imaging characteristics. The iNPH/FBB- group had a higher percentage of tap responders and showed a greater improvement in gait scores after the tap test than the iNPH/FBB+ group (group-tap test effect interaction, p = 0.035). A multivariable logistic regression analysis showed that amyloid positivity on PET scans (OR 0.03, p = 0.029) and CSF p-tau (OR 0.87, p = 0.044) were independently associated with the positive tap test response. Among 21 tap responders in the iNPH/FBB- group, 14 patients received shunt surgery and 12/14 (85.7%) patients showed symptom improvement. Our findings suggest that amyloid PET scans can help determine which iNPH patients will benefit from shunt surgery by discriminating concomitant AD.
淀粉样蛋白正电子发射断层扫描 ([18F]氟比他滨（FBB）PET）可用于确定特发性正常压力脑积水（iNPH）患者中同时存在的阿尔茨海默病（AD）。对 31 例临床疑似 iNPH 患者进行了 FBB PET 扫描和 taps 试验，比较了淀粉样蛋白阳性（iNPH/FBB+）和阴性（iNPH/FBB-）组的临床特征。我们通过使用线性混合模型分析 taps 试验的反应，评估了 FBB PET 扫描的预后价值。我们还进行了多变量回归分析，以研究淀粉样蛋白 PET 阳性是否可以预测 taps 试验阳性反应，而与其他 AD 生物标志物无关。结果显示，iNPH/FBB+组（7/31，22.6%）载脂蛋白 E4 携带者比例较高，Aβ42 较低，CSF t-tau 和 p-tau/Aβ42 比值较高，而 iNPH/FBB-组（24/31，77.4%）则相反，两组在影像学特征上无差异。iNPH/FBB-组 taps 试验应答者比例较高，且 taps 试验后步态评分改善更明显（组间 taps 试验效应交互作用，p=0.035）。多变量逻辑回归分析显示，PET 扫描上的淀粉样蛋白阳性（OR 0.03，p=0.029）和 CSF p-tau（OR 0.87，p=0.044）与 taps 试验阳性反应独立相关。在 iNPH/FBB-组的 21 例 taps 试验应答者中，14 例患者接受了分流手术，其中 12/14（85.7%）患者症状改善。我们的研究结果表明，淀粉样蛋白 PET 扫描可以帮助确定哪些 iNPH 患者将从分流手术中获益，从而区分同时存在的 AD。
