Spielmann Hannah, Lepshokov Magomed, Prajsnar-Borak Anna, Wagenpfeil Gudrun, Oertel Joachim
Klinik für Neurochirurgie, Medizinische Fakultät, Universität des Saarlandes, Homburg, Saar, Germany.
Klinik für Neurochirurgie, Landeskrankenhaus Feldkirch, Feldkirch, Österreich.
Neurosurg Rev. 2025 Jun 5;48(1):484. doi: 10.1007/s10143-025-03609-8.
Idiopathic normal pressure hydrocephalus is an increasingly prevalent neurodegenerative condition among the elderly, characterized by the Hakim triad. Accurate diagnosis and prognosis are essential since the symptoms can be reversible with appropriate treatment, such as VP-shunt surgery. This study investigates the relationship between cerebrospinal fluid biomarkers, particularly Tau, Phospho-tau, the beta-amyloid ratio (Aβ42/Aβ40), and neurocognitive outcomes post-surgery. Eighty patients diagnosed with iNPH who underwent shunt placement between November 2021 and July 2023 were included. A comprehensive neuropsychological test battery was administered before, one hour after, and one day after lumbar puncture, and six weeks and three months post-surgery. CSF samples were analyzed for tau, phospho-tau and the beta-amyloid ratio. Neuropsychological tests assessed various cognitive functions, including executive functions, psychomotor speed, language, and memory. Patients with a higher beta-amyloid ratio showed significant cognitive improvement post-surgery. Neuropsychological tests, such as the DemTect and Trail Making Test A & B indicated enhanced performance over time, particularly at the three-month follow-up. Conversely, the MMSE did not show significant improvement. The data suggest that the beta-amyloid ratio is a potential prognostic marker for positive neurocognitive outcomes following VP-shunt surgery. The beta-amyloid ratio (Aß42/Aß40) may represent a valuable prognostic biomarker for predicting cognitive improvement after VP-shunt surgery. Patients with higher ratios exhibited better neurocognitive outcomes, emphasizing the importance of comprehensive neuropsychological assessments. These findings support the potential of personalized treatment strategies based on biomarker analysis to optimize patient selection and improve outcomes for iNPH patients undergoing VP-shunt surgery.
特发性正常压力脑积水是老年人中一种日益普遍的神经退行性疾病，其特征为哈基姆三联征。由于症状在适当治疗（如脑室腹腔分流术）后可逆转，因此准确诊断和预后评估至关重要。本研究调查了脑脊液生物标志物，特别是 Tau、磷酸化 Tau、β-淀粉样蛋白比率（Aβ42/Aβ40）与术后神经认知结果之间的关系。纳入了 2021 年 11 月至 2023 年 7 月期间接受分流置管的 80 例诊断为特发性正常压力脑积水的患者。在腰椎穿刺前、穿刺后 1 小时、穿刺后 1 天、术后 6 周和 3 个月进行了全面的神经心理测试。对脑脊液样本进行 Tau、磷酸化 Tau 和 β-淀粉样蛋白比率分析。神经心理测试评估了各种认知功能，包括执行功能、精神运动速度、语言和记忆。β-淀粉样蛋白比率较高的患者术后显示出显著的认知改善。DemTect 和连线测验 A&B 等神经心理测试表明，随着时间的推移，表现有所改善，尤其是在 3 个月的随访中。相反，简易精神状态检查表（MMSE）没有显示出显著改善。数据表明，β-淀粉样蛋白比率是脑室腹腔分流术后神经认知结果呈阳性的潜在预后标志物。β-淀粉样蛋白比率（Aβ42/Aβ40）可能是预测脑室腹腔分流术后认知改善的有价值的预后生物标志物。比率较高的患者表现出更好的神经认知结果，强调了全面神经心理评估的重要性。这些发现支持了基于生物标志物分析的个性化治疗策略的潜力，以优化患者选择并改善接受脑室腹腔分流术的特发性正常压力脑积水患者的治疗效果。
