Cerebrospinal fluid biomarkers in idiopathic normal pressure hydrocephalus

Xinjie Zhang, Jianfeng Guo, Jun Yang
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引用次数: 2

Abstract

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by abnormal cerebrospinal fluid (CSF) flow and consequent cerebral ventricular enlargement due to imbalance of CSF production and absorption. The typical triad symptoms, namely cognitive decline, gait disturbance, and urinary incontinence, are thought to be caused by disruption of CSF circulation. However, some patients may still experience symptomatic progression after functional shunting, suggesting that iNPH is far more complicated than a simple disorder of CSF circulation. Moreover, the diagnostic workup of iNPH can be challenging due to symptomatic and neuroimaging overlaps with other neurological disorders, such as Alzheimer’s disease. Furthermore, accumulating studies indicate that the pathogenesis of iNPH might relate to multiple mechanisms, including abnormalities of brain development, brain extracellular matrix, synaptic function, blood flow, and cerebral metabolism. Therefore, iNPH is not an isolated entity in occurrence and development. Nevertheless, different pathogeneses may result in protein content changes in CSF, and the biomarkers in CSF may reflect the possible mechanisms involving the etiology of iNPH and are potentially useful in assisting the diagnosis and treatment selection. In this review, we summarize the main findings of CSF biomarkers and aim to outline a possible synthetic profile in assisting iNPH diagnosis and therapeutic options.
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特发性常压脑积水的脑脊液生物标志物
特发性常压脑积水(iNPH)的特征是脑脊液(CSF)流量异常,并由于CSF的产生和吸收失衡而导致脑室增大。典型的三联症状,即认知能力下降、步态障碍和尿失禁,被认为是由脑脊液循环中断引起的。然而,一些患者在功能分流后仍可能出现症状进展,这表明iNPH远比简单的CSF循环障碍复杂。此外,由于症状和神经影像学与其他神经疾病(如阿尔茨海默病)重叠,iNPH的诊断工作可能具有挑战性。此外,越来越多的研究表明,iNPH的发病机制可能与多种机制有关,包括大脑发育异常、大脑细胞外基质异常、突触功能异常、血流异常和大脑代谢异常。因此,iNPH在发生和发展过程中并不是一个孤立的实体。然而,不同的病因可能导致CSF中蛋白质含量的变化,CSF中的生物标志物可能反映了iNPH病因的可能机制,并可能有助于诊断和治疗选择。在这篇综述中,我们总结了CSF生物标志物的主要发现,并旨在概述一种可能的合成图谱,以帮助iNPH的诊断和治疗选择。
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