ABSTRACT

Objective: Diagnosis of idiopathic Normal Pressure Hydrocephalus (iNPH) relies solely on clinical and radiological criteria while, unlike other neurological diseases, the analysis of cerebrospinal fluid markers is not used in clinical practice. Nevertheless, the overlapping of neurodegenerative diseases affects the long-term shunt efficacy and this occurrence should be detected before surgery. Therefore, we performed this study in order to assess the correlation between pre-surgical levels of CSF Beta Amyloid protein, Total Tau protein and Phospho-Tau protein with long-term clinical outcome.

Methods: Between March 2012 and May 2016 we prospective evaluated all patients with iNPH according to guidelines criteria and we analysed CSF concentration of these proteins before and during surgery. Two years after surgery we evaluated iNPH score for all patients, grouping them in shunt responders and non-responders.

Results: A total of 117 patients were included: Tap Test non-responders were 58 and at two years we had 35 shunt responders and 15 shunt non-responders. We found a significative difference between shunt-responders and shunt non-responders for pre surgical T-Tau (p: 0.02) and for P-Tau (p: 0.01). All the proteins were significantly associated with clinical outcome after surgery with different cut-off values; in particular, having a ‘low’ value of T-Tau, P-Tau and Aβ1-42 resulted in favourable outcome after surgery.

Conclusions: Low level of P-Tau is a useful CSF biochemical prognostic factor for good clinical outcome at least two years after shunt; meanwhile a lower Aβ1-42 might suggest that the pathophysiology of iNPH could have something in common with other neurodegenerative diseases of the elderly.

摘要

目的：特发性正常压力脑积水 (iNPH) 的诊断仅依赖于临床和放射学标准，而与其他神经系统疾病不同，临床实践中不使用脑脊液标志物的分析。然而，神经退行性疾病的重叠影响了长期分流疗效，应在手术前检测到这种情况。因此，我们进行这项研究是为了评估 CSF β 淀粉样蛋白、总 Tau 蛋白和磷酸-Tau 蛋白的术前水平与长期临床结果之间的相关性。

方法：在 2012 年 3 月至 2016 年 5 月期间，我们根据指南标准对所有 iNPH 患者进行了前瞻性评估，并在手术前和手术期间分析了这些蛋白质的脑脊液浓度。手术后两年，我们评估了所有患者的 iNPH 评分，将他们分为分流反应者和无反应者。

结果：共纳入 117 名患者：Tap Test 无反应者为 58 人，两年时我们有 35 名分流反应者和 15 名分流无反应者。我们发现手术前 T-Tau (p: 0.02) 和 P-Tau (p: 0.01) 的分流反应者和分流无反应者之间存在显着差异。所有蛋白质与手术后的临床结果显着相关，具有不同的截止值；尤其是，T-Tau、P-Tau 和 Aβ1-42 的“低”值会导致手术后的良好结果。

结论：低水平的 P-Tau 是一种有用的脑脊液生化预后因素，可在分流后至少两年获得良好的临床结果；同时较低的 Aβ1-42 可能表明 iNPH 的病理生理学可能与老年人的其他神经退行性疾病有一些共同之处。