Kajimoto Yoshinaga, Kameda Masahiro, Kambara Akihiro, Kuroda Kenji, Tsuji Shohei, Nikaido Yasutaka, Saura Ryuichi, Wanibuchi Masahiko
Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
Front Neurol. 2022 Apr 11;13:866352. doi: 10.3389/fneur.2022.866352. eCollection 2022.
Because the progression of idiopathic normal pressure hydrocephalus (iNPH) is partially irreversible, we hypothesized that early intervention would markedly improve its prognosis. To test this hypothesis, we retrospectively investigated the long-term prognosis of patients with early intervention in the prodromal phase of iNPH.
We defined the prodromal phase of iNPH as a 3m Timed Up and Go (TUG) of 13.5 s or less and a Mini-Mental State Examination (MMSE) of 24 or more. Of the 83 iNPH patients who underwent shunt surgery at Osaka Medical and Pharmaceutical University Hospital over 3 years from January 2015, 12 prodromal phase cases (73.3 ± 6.2 years, 10 males and 2 females) were included in the study. The iNPH grading scale (INPHGS), MMSE, Frontal Assessment Battery (FAB), intermittent gait disturbance (IGD), social participation status, and development of comorbidities were evaluated over 4 years.
Preoperative MMSE was 27.2 ± 1.5, FAB was 14.1 ± 1.8, TUG was 10.7 ± 1.4 s, and total iNPHGS was 2.8 ± 1.4. At 1, 2, 3, and 4 years postoperatively, total INPHGS improved to 0.8, 0.9, 1.5, and 1.7, respectively, and remained significantly better than preoperatively except at 4 years postoperatively. The MMSE improved slightly to 27.5 after 1 year and then declined by 0.35 per year. After 4 years, the mean MMSE was 26.1, and only one patient had an MMSE below 23. FAB improved to 15.2 after 1 year and then declined slowly at 0.85/year. Ten patients (83%) maintained a high capacity for social participation postoperatively. The preoperative tendency to fall and IGD in 9 (75%) and 8 (67%) patients, respectively, completely disappeared postoperatively, resulting in improved mobility. Shunt malfunction associated with four weight fluctuations and one catheter rupture caused temporary worsening of symptoms, which were recovered by valve re-setting and catheter revision, respectively.
Early intervention in the prodromal phase of iNPH patients maintained good cognitive and mobility function and social participation ability in the long term. The maintenance of long-term cognitive function suggests its preventive effect on dementia. To realize early intervention for iNPH, it is desirable to establish an early diagnosis system for iNPH.
由于特发性正常压力脑积水（iNPH）的病情进展部分不可逆，我们推测早期干预将显著改善其预后。为验证这一假设，我们回顾性研究了iNPH前驱期进行早期干预患者的长期预后。
我们将iNPH的前驱期定义为计时起立行走测试（TUG）3分钟用时13.5秒或更短，以及简易精神状态检查表（MMSE）得分24分或更高。在2015年1月起的3年里于大阪医科药科大学医院接受分流手术的83例iNPH患者中，12例前驱期病例（73.3±6.2岁，男10例，女2例）被纳入研究。在4年时间里对iNPH分级量表（INPHGS）、MMSE、额叶评估量表（FAB）、间歇性步态障碍（IGD）、社会参与状况以及合并症的发生情况进行了评估。
术前MMSE为27.2±1.5，FAB为14.1±1.8，TUG为10.7±1.4秒，iNPHGS总分2.8±1.4。术后1年、2年、3年和4年时，INPHGS总分分别改善至0.8、0.9、1.5和1.7，除术后4年外，均显著优于术前。MMSE在术后1年时稍有改善至27.5，随后每年下降0.35。4年后，MMSE的平均得分为26.1，只有1例患者MMSE低于23。FAB在术后1年时改善至15.2，随后以每年0.85的速度缓慢下降。10例患者（83%）术后保持了较高的社会参与能力。术前分别有9例（75%）和8例（67%）患者存在跌倒倾向和IGD，术后完全消失，活动能力得到改善。与4次体重波动相关的分流器故障和1次导管破裂导致症状暂时恶化，分别通过重新设置阀门和更换导管得以恢复。
对iNPH患者前驱期进行早期干预可长期维持良好的认知和运动功能以及社会参与能力。长期认知功能的维持表明其对痴呆具有预防作用。为实现对iNPH的早期干预，建立iNPH的早期诊断系统很有必要。
