scholarly journals Data-Driven Investigation of Gait Patterns in Individuals Affected by Normal Pressure Hydrocephalus

Sensors ◽  
2021 ◽  
Vol 21 (19) ◽  
pp. 6451
Author(s):  
Kiran Kuruvithadam ◽  
Marcel Menner ◽  
William R. Taylor ◽  
Melanie N. Zeilinger ◽  
Lennart Stieglitz ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Real World ◽  
Normal Pressure ◽  
Visual Observation ◽  
Gait Disorders ◽  
Elderly Subjects ◽  
Control Group ◽  
P Value ◽  
Testing Environments ◽  
World Environment

Normal pressure hydrocephalus (NPH) is a chronic and progressive disease that affects predominantly elderly subjects. The most prevalent symptoms are gait disorders, generally determined by visual observation or measurements taken in complex laboratory environments. However, controlled testing environments can have a significant influence on the way subjects walk and hinder the identification of natural walking characteristics. The study aimed to investigate the differences in walking patterns between a controlled environment (10 m walking test) and real-world environment (72 h recording) based on measurements taken via a wearable gait assessment device. We tested whether real-world environment measurements can be beneficial for the identification of gait disorders by performing a comparison of patients’ gait parameters with an aged-matched control group in both environments. Subsequently, we implemented four machine learning classifiers to inspect the individual strides’ profiles. Our results on twenty young subjects, twenty elderly subjects and twelve NPH patients indicate that patients exhibited a considerable difference between the two environments, in particular gait speed (p-value p=0.0073), stride length (p-value p=0.0073), foot clearance (p-value p=0.0117) and swing/stance ratio (p-value p=0.0098). Importantly, measurements taken in real-world environments yield a better discrimination of NPH patients compared to the controlled setting. Finally, the use of stride classifiers provides promise in the identification of strides affected by motion disorders.

scholarly journals Serial Tap Test of Patients With Idiopathic Normal Pressure Hydrocephalus - Impact on Cognitive Function and Its Meaning

2021 ◽  
Author(s):  
Samanta Fabricio Blattes da Rocha ◽  
Pedro Andre Kowacs ◽  
Ricardo Krause Martinez de Souza ◽  
Matheus Kahakura Franco Pedro ◽  
Ricardo Ramina ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Digit Span ◽  
Normal Pressure ◽  
Stroop Test ◽  
Control Group ◽  
Test Protocol ◽  
Tap Test ◽  
Cognitive Improvement ◽  
Cerebrospinal Fluid Shunting

Abstract BackgroundIdiopathic normal pressure hydrocephalus (INPH) is characterized by gait disturbance, urinary incontinence and cognitive decline. Symptoms are potentially reversible and treatment is based on cerebrospinal fluid shunting. The tap test (TT) is used to identify patients that will benefit from surgery. This procedure consists on the withdrawal of 20 to 50 mL of cerebrospinal fluid (CSF) through a lumbar puncture (LP) after which the symptoms of the triad are tested. Improvement in the quality and speed of gait are already recognized but cognitive improvement depends on several factors such as tests used, time elapsed after LP for re-testing, and number of punctures. Serial punctures may trigger similar conditions as external lumbar drainage (ELD) to the organism. ObjectiveThis study aimed to identify how serial punctures affect cognition in order to increase the sensitivity of the test and consequently the accuracy of surgical indication. MethodsSixty-one patients with INPH underwent baseline memory and executive tests repeatedly following the 2-Step Tap Test protocol (2-STT – two procedures of 30 mL lumbar CSF drainage separated by a 24-hour interval). The baseline scores of INPH patients were compared with those of 55 healthy controls, and with intragroup post-puncture scores of the 2-STT. ResultsThe group with INPH had lower performance than the control group in all cognitive tests (RAVLT, Stroop, CFT, FAR-COWA, FAB, MMSE, orientation, mental control), except for the forward digit span test (p = 0.707). After conducting LP procedures, the Stroop test (words, colors and errors), RAVLT (stage A1, A6 and B1), and CFT (immediate and delayed R) scores were equal to those of the control group (p > 0.05). The INPH group presented significant improvement after the first puncture in MMSE (p = 0.031) and in the Stroop Test (points) (p < 0.001). After the second puncture, subjects improved in orientation, MMSE, RAVLT (B1), Stroop (points, words, errors) and CFT (IR). ConclusionProgressive cognitive improvement occurred over the 2-STT and changes were more significant after the second LP in all cognitive domains except for RAVLT (A7). Encephalic alert system ‘arousal’ seems to participate in early improvements observed during 2-STT. The second LP increased the sensitivity of the drainage test to detect changes in cognitive variables, and consequently improved the quality of the method.

Blink reflex recovery cycle distinguishes patients with idiopathic normal pressure hydrocephalus from elderly subjects

2021 ◽  
Vol 429 ◽  
pp. 118511
Author(s):  
Alessandro Mechelli ◽  
Andrea Quattrone ◽  
Rita Nisticò ◽  
Marianna Crasà ◽  
Domenico La Torre ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Blink Reflex ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Elderly Subjects ◽  
Recovery Cycle

scholarly journals Postshunt Cognitive and Functional Improvement in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. 416-419 ◽  
Author(s):  
Heather Katzen ◽  
Lisa D. Ravdin ◽  
Stephanie Assuras ◽  
Roberto Heros ◽  
Michael Kaplitt ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Repeated Measures ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Practice Effects ◽  
Control Group ◽  
Significant Group ◽  
Shunt Placement ◽  
Cognitive Improvement ◽  
Control Subjects

Abstract BACKGROUND: Improvement in gait after shunt placement has been well documented in idiopathic normal pressure hydrocephalus (iNPH); however, controversy remains regarding the extent and pattern of postsurgical cognitive changes. Conflicting findings may be explained by variability in both test selection and follow-up intervals across studies. Furthermore, most investigations lack a control group, making it difficult to disentangle practice effects from a true treatment effect. OBJECTIVE: To examine postshunt changes in a sample of well-characterized iNPH participants compared with a group of age- and education-matched healthy control subjects. METHODS: We identified 12 participants with iNPH undergoing shunt placement and 9 control participants. All participants were evaluated with comprehensive neuropsychological testing and standardized gait assessment at baseline and were followed up for 6 months. RESULTS: Repeated-measures analysis of variance revealed a significant group- (iNPH and control) by-time (baseline and 6 months) interaction for Trailmaking Test B: (P &lt; .003) and Symbol Digit Modalities (P &lt; .02), with greater improvement in iNPH participants relative to control subjects. In addition, the iNPH group showed greater improvement in gait (P &lt; .001) and caregivers reported improved activities of daily living (P &lt; .01) and reduced caregiver distress (P &lt; .01). CONCLUSION: This study demonstrates improvements in mental tracking speed and sustained attention 6 months after shunt placement in iNPH. The present investigation is the first study to use a controlled design to show that cognitive improvement in iNPH is independent of practice effects. Furthermore, these findings indicate functional and quality-of-life improvements for both the shunt responder and their caregiver.

Estimating Real-World Performance of Percutaneously Coupled Bone-Conduction Device Users With Severe-to-Profound Unilateral Hearing Loss

2020 ◽  
Vol 29 (2) ◽  
pp. 170-187
Author(s):  
Elizabeth Elkins ◽  
Anne Harvey ◽  
Jake Hillyer ◽  
Chantel Hazlewood ◽  
Stacey Watson ◽  
...  
Keyword(s):  
Real World ◽  
Bone Conduction ◽  
Control Group ◽  
Noise Performance ◽  
Speech Stimuli ◽  
Speech In Noise ◽  
Directional Microphone ◽  
Bone Conduction Device ◽  
Subjective Reports ◽  
World Environment

Purpose The bone-conduction device attached to a percutaneous screw (BCD) is an important treatment option for individuals with severe-to-profound unilateral hearing loss (UHL). Clinicians may use subjective questionnaires and speech-in-noise measures to evaluate BCD use in this patient population; however, the translation of these metrics to real-world aided performance is unclear. The purpose of this study was twofold: first, to measure speech-in-noise performance in BCD users with severe-to-profound UHL in a simulated real-world environment, relative to individuals with normal hearing bilaterally; second, to determine if BCD users' subjective reports of aided performance relate to simulated real-world performance. Method A between-subjects design with two groups was conducted with 14 adults with severe-to-profound UHL (BCD group) and 10 age-matched participants with normal hearing bilaterally (control group). Speech-in-noise tests were administered in an eight-speaker R-Space simulating a real-world environment. To further explore speech-in-noise evaluation methods for this population, testing was also completed in a clinically common two-speaker array. The effects of various microphone settings on performance were explored for BCD users. Subjective performance was measured with the Abbreviated Profile of Hearing Aid Benefit (APHAB; Cox & Alexander, 1995) and the Speech, Spatial and Qualities of Hearing Scale (Gatehouse & Noble, 2004). Statistical analyses to explore relationships between variables included repeated-measures analysis of variance, regression analyses, independent-samples t tests, nonparametric Mann–Whitney tests, and correlations. Results In the simulated real-world environment, BCD group participants struggled with speech-in-noise understanding compared to control group participants. BCD benefit was observed for all microphone settings when speech stimuli were presented to the side with the BCD. When adaptive directional or fixed directional microphone settings were used, a relationship was noted between simulated real-world speech-in-noise performance for speech stimuli presented to the side with the BCD and subjective reports on the Background Noise subscale of the APHAB. Conclusions The Background Noise subscale of the APHAB may help estimate real-world speech-in-noise performance for BCD users with severe-to-profound UHL for signals of interest presented to the implanted side, specifically when adaptive or fixed directional microphone settings are used. This subscale may provide an efficient and accessible alternative to assessing real-world speech-in-noise performance in lieu of less clinically available measurement tools, such as an R-Space.

scholarly journals Abnormal cortical thickening and thinning in idiopathic normal-pressure hydrocephalus

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Kyunghun Kang ◽  
Jaehwan Han ◽  
Sang-Woo Lee ◽  
Shin Young Jeong ◽  
Yong-Hyun Lim ◽  
...  
Keyword(s):  
Cortical Thickness ◽  
Normal Pressure Hydrocephalus ◽  
Neuronal Degeneration ◽  
Superior Temporal Gyrus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Control Group ◽  
Healthy Controls ◽  
Cortical Thickening ◽  
Cortical Thinning

AbstractWe investigated differences in cortical thickness between idiopathic normal-pressure hydrocephalus (INPH) patients and healthy controls. We also explored whether a relationship exists between cortical thinning and gait disturbance in INPH patients. Forty-nine INPH patients and 26 healthy controls were imaged with MRI, including 3-dimensional volumetric images, for automated surface-based cortical thickness analysis across the entire brain. Compared with age- and gender-matched healthy controls, unexpectedly, INPH patients showed statistically significant cortical thickening mainly in areas located in the high convexity of the frontal, parietal, and occipital regions. Additionally, cortical thinning mainly in temporal and orbitofrontal regions was observed in the INPH group relative to the control group. The Gait Status Scale (GSS) scores were negatively correlated with cortical thickness in the medial orbital part of the superior frontal gyrus, gyrus rectus, superior temporal gyrus, temporal pole, and insula. A distinctive pattern of cortical thickness changes was found in INPH patients. We cautiously suggest that cortical thickening in INPH can result from reactive gliosis. Further, our results support the hypothesis that cortical thinning in INPH can result from neuronal degeneration. In addition, cortical thinning can play an important role in gait disturbances in INPH patients.

scholarly journals Incidence, diagnostic criteria and outcome following ventriculoperitoneal shunting of idiopathic normal pressure hydrocephalus in a memory clinic population: a prospective observational cross-sectional and cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e028103 ◽  
Author(s):  
George Razay ◽  
Melissa Wimmer ◽  
Iain Robertson
Keyword(s):  
Cohort Study ◽  
Cognitive Impairment ◽  
Diagnostic Criteria ◽  
Diagnostic Test ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Gait Disorders ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Index Test ◽  
Shunt Surgery

ObjectiveTo evaluate diagnostic criteria for idiopathic normal pressure hydrocephalus (INPH) among patients with memory impairment, and to estimate the incidence of INPH.DesignProspective observational cross-section and cohort study of diagnostic accuracy.SettingMemory Disorders Clinic following referral by the medical practitioners.Participants408 consecutive patients enrolled 2010–2014.Outcome measuresReference diagnostic test was the clinical judgement of an experienced specialist based on the presence of cognitive impairment and/or balance and gait disorders in the presence of dilated ventricles. Mini-Mental State Examination (MMSE), Tinetti balance and gait tests were performed before and 12 months after ventriculoperitoneal shunt surgery. The association between reference diagnosis, clinical and brain CT scan measurements was estimated by multivariate Poisson regression. Triage index diagnostic test scores were calculated from the regression coefficients, with diagnostic thresholds selected using receiver operating characteristic analysis.ResultsThe presence of balance and/or gait disorders, especially fear of falling, difficulty standing on toes/heals, urinary disturbances, ventriculomegaly with Evans ratio greater than Combined Diagnostic Threshold (0.377-{Maximum width of posterior horns*0.0054}), strongly predict the diagnosis of INPH; while hallucinations and/or delusions and forgetfulness reduce the likelihood of the diagnosis. This triage index test had high sensitivity (95.2%) and specificity (91.7%). 62 of 408 (15%) participants with cognitive impairment had INPH, an incidence of 11.9/100 000/year and 120/100 000/year over 75 years. 96% of participants following shunting, compared with 45% of the non-shunted, improved by over 25% of available measurable improvement in either MMSE or balance/gait scores (51% difference; 95% CI 28% to 74%; p<0.001), and 56% vs 5% improved by over 50% of maximum in both (51% difference; 95% CI 30% to 73%; p<0.001).ConclusionThe triage index test score is a simple tool that may be useful for physicians to identify INPH diagnoses and need for referral for shunt surgery, which may improve cognitive, balance and gait functioning.

Vasopressin in the cerebrospinal fluid of patients with normal pressure hydrocephalus and benign intracranial hypertension

1982 ◽  
Vol 100 (2) ◽  
pp. 211-215 ◽  
Author(s):  
Mogens Hammer ◽  
Per Soelberg Sørensen ◽  
Flemming Gjerris ◽  
Kim Larsen
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Normal Pressure Hydrocephalus ◽  
Plasma Osmolality ◽  
Normal Pressure ◽  
Lumbar Pain ◽  
Control Group ◽  
Benign Intracranial Hypertension ◽  
Severe Dementia ◽  
Pain Syndromes

Abstract. We have studied plasma and cerebrospinal fluid vasopressin (CSF-AVP) and osmolality in 28 patients with cervical or lumbar pain syndromes (control patients), 11 patients with normal pressure hydrocephalus (NPH) and in 5 patients with benign intracranial hypertension (BIH). Vasopressin concentration in lumbar CSF to a high extent reflected the actual ventricular CSF-AVP concentration. In all groups CSF-AVP was lower than plasma AVP. Mean CSF-AVP in the control group was 1.3 pg/ml ± 0.1 (sem). In the NPH patients, who all suffered from severe dementia, CSF-AVP level was not different from that found in the control group (1.4 pg/ml ± 0.2). In contrast to the findings in the two other groups CSF osmolality in BIH patients was higher than plasma osmolality (P < 0.02). CSF-AVP in the BIH patients, characterized by an elevated intracranial pressure (ICP), was higher than in the control group (2.7 pg/ml ± 0.4, P < 0.001).

scholarly journals Apathy in idiopathic normal pressure hydrocephalus: A marker of reversible gait disorders

2018 ◽  
Vol 33 (5) ◽  
pp. 735-742 ◽  
Author(s):  
Gilles Allali ◽  
Magali Laidet ◽  
Stéphane Armand ◽  
Arnaud Saj ◽  
Paul Krack ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Gait Disorders ◽  
Idiopathic Normal Pressure Hydrocephalus
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