Ball M J, Vis C L
J Gerontol. 1978 Nov;33(6):815-24. doi: 10.1093/geronj/33.6.815.
Neuropathological findings could not explain the dramatic improvement after shunting exhibited by one patient demented with a "normal-pressure" hydrocephalus (NPH)-like syndrome. He contrastred markedly with the unchanged condition of four similar dements also shunted successfully. Quantitative morphometry was done on the five brains to determine the degree of granulovacuolar degeneration in hippocampal neurones. The severity of this change, like that of neurofibrillary tangle formation quantified in earlier work, was not attributable merely to aging, being greater in the four unimproved cases that that in age-matched control brains from 18 normal subjects, and falling in the same elevated range as that of eight dements with necropsy-confirmed Alzheimer's disease. The intensity of granulovacuolar degeneration in the one shunted dement who improved was within normal limits. A positive linear correlation existed between the Granulovacuolar Indices and the total duration of dementia. A similar relationship had been shown for Tangle Indices. These data suggest that earlier diagnosis may improve the chances of reversing dementia in NPH-like syndromes before histopathology is too severe; and that a more careful search for laboratory features of NPH may be warranted in some cases of Alzheimer's dementia.
神经病理学检查结果无法解释一名患有“正常压力”脑积水（NPH）样综合征的痴呆患者在分流术后出现的显著改善。他与另外四名同样成功接受分流手术但病情未变的类似痴呆患者形成了鲜明对比。对这五个大脑进行了定量形态学分析，以确定海马神经元中颗粒空泡变性的程度。这种变化的严重程度，如同早期研究中量化的神经原纤维缠结形成的严重程度一样，不仅仅归因于衰老。在四名病情未改善的患者中，其严重程度高于18名正常受试者年龄匹配的对照大脑，且与八名经尸检确诊为阿尔茨海默病的痴呆患者处于相同的升高范围。一名病情改善的分流痴呆患者的颗粒空泡变性强度在正常范围内。颗粒空泡指数与痴呆总病程之间存在正线性相关。缠结指数也显示出类似的关系。这些数据表明，早期诊断可能会增加在组织病理学不太严重之前逆转NPH样综合征中痴呆的机会；并且在某些阿尔茨海默病痴呆病例中，可能需要更仔细地寻找NPH的实验室特征。
