The etiology of idiopathic normal pressure hydrocephalus (iNPH) remains unclear. Little is known about the pre-symptomatic stage. This study aimed to investigate the association of neuropsychological data with iNPH-characteristic imaging changes compared to normal imaging and unspecific atrophy in a healthy population. We extracted data from the community-dwelling Austrian Stroke Prevention Family Study (ASPS-Fam) database (2006–2010). All subjects underwent a baseline and identical follow-up examination after 3–5 years with MR imaging and an extensive neuropsychological test battery (Trail Making Test B, short physical performance balance, walking speed, memory, visuo-practical skills, composite scores of executive function and g-factor). We categorized the subjects into “iNPH”-associated, non-specific “atrophy,” and “normal” based on the rating of different radiological cerebrospinal fluid (CSF) space parameters. We noted how the categories developed over time. We assessed the association of the image categories with the neuropsychological data, different demographic, and lifestyle parameters (age, sex, education, alcohol intake, arterial hypertension, hypercholesterolemia), and the extent of white matter hyperintensities. We investigated whether neuropsychological data associated with the image categories were independent from other parameters as confounders. One hundred and thirteen subjects, aged 50–70 years, were examined. The imaging category “iNPH” was only present at follow-up. A third of subjects with “atrophy” at baseline changed to the category “iNPH” at follow-up. More white matter hyperintensities (WMH) were present in later “iNPH” subjects. Subjects with “iNPH” performed worse than “normal” subjects on executive function (p = 0.0118), memory (p = 0.0109), and Trail Making Test B (TMT-B. p < 0.0001). Education, alcohol intake, diabetes, arterial hypertension, and hypercholesterolemia had no effect. Age, number of females, and the extent of white matter hyperintensities were higher in “iNPH” than in “normal” subjects but did not significantly confound the neuropsychological results. Apparent asymptomatic subjects with “iNPH” imaging characteristics presented with subclinical cognitive decline and showed worse executive function, memory, and TMT-B results than “normal” subjects. WMH seem to play a role in the etiology before ventriculomegaly. Clinical screening of individuals with incidental iNPH-characteristic imaging and conspicuous results sof these neurocognitive tests needs further validation.

中文翻译：

---

亚临床认知能力下降的无症状受试者中典型 iNPH 影像学征象的偶然发现

特发性正常压力脑积水 (iNPH) 的病因仍不清楚。对症状前阶段知之甚少。本研究旨在调查与健康人群的正常影像学和非特异性萎缩相比，神经心理学数据与 iNPH 特征性影像学变化的关联。我们从居住在社区的奥地利中风预防家庭研究 (ASPS-Fam) 数据库 (2006-2010) 中提取数据。所有受试者在 3-5 年后接受了基线和相同的随访检查，包括 MR 成像和广泛的神经心理学测试（Trail Making Test B、短暂的身体机能平衡、步行速度、记忆力、视觉实践技能、执行力综合得分）函数和 g 因子）。我们将受试者分类为“iNPH”相关的、非特异性的“萎缩、”和“正常”基于不同放射脑脊液 (CSF) 空间参数的评级。我们注意到这些类别是如何随着时间的推移而发展起来的。我们评估了图像类别与神经心理学数据、不同人口统计和生活方式参数（年龄、性别、教育、酒精摄入量、动脉高血压、高胆固醇血症）以及白质高信号程度的关联。我们调查了与图像类别相关的神经心理学数据是否独立于其他参数作为混杂因素。检查了 113 名年龄在 50-70 岁之间的受试者。影像学类别“iNPH”仅在随访时出现。三分之一基线时“萎缩”的受试者在随访时变为“iNPH”类别。在后来的“iNPH”受试者中出现了更多的白质高信号 (WMH)。“iNPH”受试者在执行功能 (p = 0.0118)、记忆力 (p = 0.0109) 和追踪测试 B (TMT-B. p < 0.0001) 方面的表现比“正常”受试者差。教育、饮酒、糖尿病、动脉高血压和高胆固醇血症没有影响。“iNPH”的年龄、女性人数和白质高信号的程度高于“正常”受试者，但并未显着混淆神经心理学结果。具有“iNPH”影像学特征的明显无症状受试者呈现亚临床认知衰退，并表现出比“正常”受试者更差的执行功能、记忆力和 TMT-B 结果。WMH 似乎在脑室扩大之前的病因中起作用。