Objectives:Cognitive impairment and apathy are well-documented features of idiopathic normal pressure hydrocephalus (iNPH). However, research examining other neuropsychiatric manifestations of iNPH is scant, and it is unknown whether the neuropsychiatric presentation differs for iNPH patients with comorbid Alzheimer’s disease (AD) versus iNPH without AD. This study aims to advance our understanding of neuropsychiatric syndromes associated with iNPH.Methods:Fifty patients from Butler Hospital’s Normal Pressure Hydrocephalus Clinic met inclusion criteria. Caregiver ratings on the Frontal Systems Behavior Scale (FrSBe) were examined to appraise changes in apathy, executive dysfunction, and disinhibition. Patients also completed cognitive tests of global cognition, psychomotor speed, and executive functioning. AD biomarker status was determined by either amyloid-beta (Aβ) positron emission tomography (PET) imaging or cerebrospinal fluid (CSF) total tau to Aβ-42 ratio.Results:Results revealed clinically significant elevations on the FrSBe’s apathy and executive dysfunction scales and modest correlations among these scales and cognitive measures. Of the 44 patients with available neuroimaging or CSF draw data, 14 presented with comorbid AD. Relative to the iNPH-only group, the iNPH + AD group showed a larger increase from pre-illness to current informant ratings on the executive dysfunction scale, but not the apathy or disinhibition scales.Conclusions:These results replicate and extend prior research by identifying apathy and executive dysfunction as prominent neuropsychiatric symptoms of iNPH and suggest comorbid AD exacerbates dysexecutive behaviors. Future research is warranted to examine the effects of comorbid AD pathology in response to shunt surgery for iNPH, neuropsychiatric symptom changes, and resultant caregiver burden.

中文翻译：

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特发性正常压力脑积水的额叶行为综合征作为阿尔茨海默氏病生物标志物状态的函数

目的：认知障碍和冷漠是特发性正常压力脑积水（iNPH）的有据可查的特征。然而，检查 iNPH 其他神经精神表现的研究很少，并且尚不清楚合并阿尔茨海默病 (AD) 的 iNPH 患者的神经精神表现是否有所不同。相对无 AD 的 iNPH。本研究旨在增进我们对与 iNPH 相关的神经精神综合征的理解。方法：巴特勒医院常压脑积水诊所的 50 名患者符合纳入标准。检查护理人员对额叶系统行为量表（FrSBe）的评分，以评估冷漠、执行功能障碍和抑制解除的变化。患者还完成了整体认知、精神运动速度和执行功能的认知测试。AD 生物标志物状态通过淀粉样蛋白-β (Aβ) 正电子发射断层扫描 (PET) 成像或脑脊液 (CSF) 总 tau 与 Aβ-42 的比率来确定。 结果：结果显示 FrSBe 的冷漠和执行功能障碍量表有临床显着升高，并且这些量表和认知测量之间存在适度的相关性。在 44 名可获得神经影像或脑脊液提取数据的患者中，14 名患有 AD 共病。相对于仅使用 iNPH 的组，iNPH + AD 组在执行功能障碍量表上显示出从患病前到当前信息提供者评分的较大增加，但在冷漠或去抑制量表上则没有。 结论：这些结果通过确定冷漠和执行功能障碍是 iNPH 的突出神经精神症状，表明共病 AD 会加剧执行障碍行为。未来的研究有必要检查共病 AD 病理学对 iNPH 分流手术、神经精神症状变化以及由此产生的护理人员负担的影响。