Neurocognitive change over the course of a multiday external lumbar drain trial in patients with suspected normal pressure hydrocephalus.

IF 3 3区 心理学 Q2 CLINICAL NEUROLOGY Clinical Neuropsychologist Pub Date : 2024-10-01 Epub Date: 2024-02-15 DOI:10.1080/13854046.2024.2315737
Michael Brook, James Reilly, Alexander Korutz, Matthew C Tate, John-Christopher A Finley, Emma Pollner, Ketan Yerneni, Caterina Mosti, Constantine Karras, Siting Joy Trybula, John Stratton, Zoran Martinovich
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Abstract

Objective: To characterize neurocognitive response to cerebrospinal fluid (CSF) diversion during a multiday external lumbar drainage (ELD) trial in patients with suspected normal pressure hydrocephalus (NPH). Methods: Inpatients (N = 70) undergoing an ELD trial as part of NPH evaluation participated. Cognition and balance were assessed using standardized measures before and after a three-day ELD trial. Cognitive change pre- to post-ELD trial was assessed in relation to change in balance, baseline neuroimaging findings, NPH symptoms, demographics, and other disease-relevant clinical parameters. Results: Multiday ELD resulted in significant cognitive improvement (particularly on measures of memory and language). This improvement was independent of demographics, test-retest interval, number of medical and psychiatric comorbidities, NPH symptom duration, estimated premorbid intelligence, baseline level of cognitive impairment, cerebrovascular disease burden, degree of ventriculomegaly, or other NPH-related morphological brain alterations. Balance scores evidenced a greater magnitude of improvement than cognitive scores and were weakly, but positively correlated with cognitive change scores. Conclusions: Findings suggest that cognitive improvement associated with a multiday ELD trial can be sufficiently captured with bedside neurocognitive testing. These findings support the utility of neuropsychological consultation, along with balance assessment, in informing clinical decision-making regarding responsiveness to temporary CSF diversion for patients undergoing elective NPH evaluation. Implications for the understanding of neuroanatomical and cognitive underpinnings of NPH are discussed.

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对疑似正常压力脑积水患者进行多日腰椎外引流试验过程中的神经认知变化。
目的在对疑似正常压力脑积水(NPH)患者进行为期多天的腰椎外引流(ELD)试验期间,了解神经认知对脑脊液(CSF)引流的反应。研究方法作为 NPH 评估的一部分,接受 ELD 试验的住院患者(N = 70)参加了此次试验。在为期三天的 ELD 试验前后,使用标准化测量方法对认知和平衡能力进行评估。评估ELD试验前后的认知变化与平衡变化、基线神经影像检查结果、NPH症状、人口统计学和其他疾病相关临床参数的关系。结果:多日 ELD 使认知能力显著提高(尤其是在记忆和语言方面)。这种改善与人口统计学、重测间隔、医疗和精神并发症数量、NPH症状持续时间、估计病前智力、认知障碍基线水平、脑血管疾病负担、脑室肥大程度或其他与NPH相关的脑形态学改变无关。平衡评分的改善幅度大于认知评分,与认知变化评分呈弱正相关。结论:研究结果表明,床旁神经认知测试可充分反映与多日 ELD 试验相关的认知改善情况。这些研究结果支持了神经心理学咨询和平衡评估的实用性,可为临床决策提供依据,以确定接受择期 NPH 评估的患者对临时 CSF 分流的反应。本文还讨论了对 NPH 神经解剖学和认知基础的理解所产生的影响。
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来源期刊
Clinical Neuropsychologist
Clinical Neuropsychologist 医学-临床神经学
CiteScore
8.40
自引率
12.80%
发文量
61
审稿时长
6-12 weeks
期刊介绍: The Clinical Neuropsychologist (TCN) serves as the premier forum for (1) state-of-the-art clinically-relevant scientific research, (2) in-depth professional discussions of matters germane to evidence-based practice, and (3) clinical case studies in neuropsychology. Of particular interest are papers that can make definitive statements about a given topic (thereby having implications for the standards of clinical practice) and those with the potential to expand today’s clinical frontiers. Research on all age groups, and on both clinical and normal populations, is considered.
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