Real-Time Neuropsychological Testing for Hydrocephalus: Ultra-Fast Neuropsychological Testing During Infusion and Tap Test in Patients with Idiopathic Normal-Pressure Hydrocephalus.

IF 2.8 3区医学 Q3 NEUROSCIENCES Brain Sciences Pub Date : 2025-01-01 DOI:10.3390/brainsci15010036

Ilaria Guarracino, Sara Fabbro, Daniele Piccolo, Serena D'Agostini, Miran Skrap, Enrico Belgrado, Marco Vindigni, Francesco Tuniz, Barbara Tomasino

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Abstract

Background/objectives: Ventriculoperitoneal shunting is a validated procedure for the treatment of idiopathic normal-pressure hydrocephalus. To select shunt-responsive patients, infusion and tap tests can be used. Only gait is evaluated after the procedure to establish a potential improvement. In this study, we present our Hydro-Real-Time Neuropsychological Testing protocol to assess the feasibility of performing an ultra-fast assessment of patients during the infusion and tap test.

Methods: We tested 57 patients during the infusion and tap test to obtain real-time feedback on their cognitive status. Data were obtained immediately before the infusion phase (T0), when the pressure plateau was reached (T1), and immediately after cerebrospinal fluid subtraction (T2). Based on cerebrospinal fluid dynamics, 63.15% of the patients presented a resistance to outflow > 12 mmHg/mL/min, while 88% had a positive tap test response.

Results: Compared to T0, cerebrospinal fluid removal significantly improved performance on tasks exploring executive functions (counting backward, p < 0.001; verbal fluency, p < 0.001). Patients were significantly faster at counting backward at T2 vs. T1 (p < 0.05) and at T2 vs. T0 (p < 0.001) and were significantly faster at counting forward at T2 vs. T1 (p < 0.005), suggesting an improvement in speed at T2. There was a significantly smaller index at T1 vs. T0 (p = 0.005) and at T2 vs. T0 (p < 0.001), suggesting a more marked improvement in patients' executive abilities at T2 and a smaller improvement at T1. Regarding verbal fluency, patients were worse at T1 vs. T0 (p < 0.001) and at T2 vs. T0 (p < 0.001).

Conclusions: Patients' performance can be monitored during the infusion and tap test as significant changes in executive functions are observable. In future, this protocol might help improve patients' selection for surgery.

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脑积水的实时神经心理测试：特发性常压脑积水患者输液和抽头试验期间的超快速神经心理测试。

背景/目的：脑室-腹膜分流术是治疗特发性常压脑积水的有效方法。为了选择分流反应患者，可以使用输注和抽头试验。手术后仅评估步态以确定潜在的改善。在这项研究中，我们提出了我们的Hydro-Real-Time神经心理学测试方案，以评估在输注和抽头测试期间对患者进行超快速评估的可行性。方法：对57例患者进行滴注和轻拍试验，实时反馈患者的认知状态。数据分别在输注期前（T0）、压力平台期后（T1）和脑脊液减液期后（T2）获取。脑脊液动力学结果显示，63.15%的患者出现血流阻力> 12 mmHg/mL/min， 88%的患者出现抽头试验阳性反应。结果：与T0相比，脑脊液去除显著提高了执行功能探索任务的表现(向后计数，p < 0.001；语言流畅性，p < 0.001)。患者在T2时倒数速度明显快于T1时（p < 0.05），在T2时倒数速度明显快于T0时（p < 0.001），在T2时倒数速度明显快于T1时（p < 0.005），提示T2时速度有所提高。T1与T0相比（p = 0.005）， T2与T0相比（p < 0.001），该指数明显较小，表明患者在T2时执行能力改善更为显著，而在T1时改善较小。在语言流畅性方面，患者在T1比T0 （p < 0.001）和T2比T0 （p < 0.001）时更差。结论：通过观察执行功能的显著变化，可以监测患者在输液和轻叩试验中的表现。未来，该方案可能有助于提高患者对手术的选择。

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来源期刊

Brain Sciences Neuroscience-General Neuroscience

CiteScore

4.80

自引率

9.10%

发文量

1472

审稿时长

18.71 days

期刊介绍： Brain Sciences (ISSN 2076-3425) is a peer-reviewed scientific journal that publishes original articles, critical reviews, research notes and short communications in the areas of cognitive neuroscience, developmental neuroscience, molecular and cellular neuroscience, neural engineering, neuroimaging, neurolinguistics, neuropathy, systems neuroscience, and theoretical and computational neuroscience. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced. Electronic files or software regarding the full details of the calculation and experimental procedure, if unable to be published in a normal way, can be deposited as supplementary material.