Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center of Neuroprosthetics, Ecole Polytechnique Fédérale De Lausanne (EPFL), Lausanne, Switzerland.
Institute of Bioengineering, Center of Neuroprosthetics, Ecole Polytechnique Fédérale De Lausanne (EPFL), Lausanne, Switzerland; Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.
Neurosci Biobehav Rev. 2020 May;112:452-471. doi: 10.1016/j.neubiorev.2020.02.023. Epub 2020 Feb 20.
Idiopathic normal pressure hydrocephalus (iNPH) is a prevalent reversible neurological disorder characterized by impaired locomotion, cognition and urinary control with ventriculomegaly. Symptoms can be relieved with cerebrospinal fluid drainage, which makes iNPH the leading cause of reversible dementia. Because of a limited understanding of pathophysiological mechanisms, unspecific symptoms and the high prevalence of comorbidity (i.e. Alzheimer's disease), iNPH is largely underdiagnosed. For these reasons, there is an urgent need for developing noninvasive quantitative biomarkers for iNPH diagnosis and prognosis. Structural and functional changes of brain circuits in relation to symptoms and treatment response are expected to deliver major advances in this direction. We review structural and functional brain connectivity findings in iNPH and complement those findings with iNPH symptom meta-analyses in healthy populations. Our goal is to reinforce our conceptualization of iNPH as to brain network mechanisms and foster the development of new hypotheses for future research and treatment options.
特发性正常压力脑积水（iNPH）是一种常见的可逆转的神经退行性疾病，其特征是步态障碍、认知和尿控功能受损，并伴有脑室扩大。通过脑脊液引流可以缓解症状，这使得 iNPH 成为可逆性痴呆的主要原因。由于对病理生理机制、非特异性症状和高共病率（即阿尔茨海默病）的认识有限，iNPH 很大程度上被漏诊了。基于这些原因，迫切需要开发用于 iNPH 诊断和预后的非侵入性定量生物标志物。与症状和治疗反应相关的脑回路的结构和功能变化有望在这方面取得重大进展。我们综述了 iNPH 的结构和功能脑连接研究，并结合健康人群中 iNPH 症状的荟萃分析进行了补充。我们的目标是加强对 iNPH 作为脑网络机制的概念化，并为未来的研究和治疗选择提出新的假设。
