常压性脑积水和认知障碍：步态表型也很重要。
Normal pressure hydrocephalus and cognitive impairment: The gait phenotype matters too.
机构信息
Department of Neurology, University Clinic of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
出版信息
Eur J Neurol. 2024 Aug;31(8):e16328. doi: 10.1111/ene.16328. Epub 2024 May 8.
BACKGROUND AND PURPOSE
Idiopathic normal pressure hydrocephalus (iNPH) is a chronic neurological disease resulting in progressive gait and cognitive disorders. We investigated whether the gait phenotype is associated with the severity of cognitive deficits in iNPH.
METHODS
This retrospective study recruited 88 patients (mean age = 76.18 ± 7.21 years, 42% female). Patients were initially referred for suspicion of iNPH and underwent a comprehensive analysis, including gait analysis and cognitive evaluation.
RESULTS
In this cohort (27% normal gait, 25% frontal gait, 16% parkinsonian gait, 27% other gait abnormalities), patients with parkinsonian and frontal gait had the lowest Mini-Mental State Examination (MMSE) scores and the slowest gait speed. Patients with normal gait had the highest MMSE scores and gait speed. Frontal gait was associated with lower MMSE score, even after adjusting for age, gender, comorbidities, white matter lesions, and education level (β = -0.221 [95% confidence interval (CI) = -3.718 to -0.150], p = 0.034). Normal gait was associated with the best MMSE scores, even after adjusting for the abovementioned variables (β = 0.231 [95% CI = 0.124-3.639], p = 0.036).
CONCLUSIONS
Gait phenotypes among iNPH patients are linked to global cognition as assessed with MMSE.
背景与目的
特发性正常压力脑积水（iNPH）是一种慢性神经系统疾病，可导致进行性步态和认知障碍。我们研究了步态表型是否与 iNPH 患者认知缺陷的严重程度有关。
方法
本回顾性研究招募了 88 名患者（平均年龄 76.18 ± 7.21 岁，42%为女性）。这些患者最初因疑似 iNPH 而被转介，并接受了全面分析，包括步态分析和认知评估。
结果
在本队列中（27%正常步态，25%额状步态，16%帕金森步态，27%其他步态异常），帕金森步态和额状步态患者的 Mini-Mental State Examination（MMSE）评分最低，步态速度最慢。正常步态患者的 MMSE 评分和步态速度最高。即使在调整了年龄、性别、合并症、脑白质病变和教育水平后，额状步态仍与较低的 MMSE 评分相关（β=-0.221[95%置信区间（CI）=-3.718 至-0.150]，p=0.034）。即使在调整了上述变量后，正常步态仍与最佳 MMSE 评分相关（β=0.231[95%CI=0.124-3.639]，p=0.036）。
结论
iNPH 患者的步态表型与 MMSE 评估的总体认知能力相关。
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