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Frontal Behavior Syndromes in Idiopathic Normal Pressure Hydrocephalus as a Function of Alzheimer’s Disease Biomarker Status

Published online by Cambridge University Press:  20 May 2020

Madison Niermeyer
Affiliation:
Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT
Chad Gaudet
Affiliation:
Department of Psychology, University of Rhode Island, Kingston, RI
Paul Malloy
Affiliation:
Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI Memory and Aging Program, Butler Hospital, Providence, RI
Irene Piryatinsky
Affiliation:
Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA
Stephen Salloway
Affiliation:
Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI Memory and Aging Program, Butler Hospital, Providence, RI Department of Neurology, Warren Alpert Medical School, Brown University, Providence, RI
Petra Klinge
Affiliation:
Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, RI Lifespan Physician Group, Rhode Island Hospital, Providence, RI
Athene Lee*
Affiliation:
Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI Memory and Aging Program, Butler Hospital, Providence, RI
*
*Correspondence and reprint requests to: Athene Lee, PhD, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, 345 Blackstone Boulevard, Providence, RI02906. E-mail: athene_lee@brown.edu

Abstract

Objectives:

Cognitive impairment and apathy are well-documented features of idiopathic normal pressure hydrocephalus (iNPH). However, research examining other neuropsychiatric manifestations of iNPH is scant, and it is unknown whether the neuropsychiatric presentation differs for iNPH patients with comorbid Alzheimer’s disease (AD) versus iNPH without AD. This study aims to advance our understanding of neuropsychiatric syndromes associated with iNPH.

Methods:

Fifty patients from Butler Hospital’s Normal Pressure Hydrocephalus Clinic met inclusion criteria. Caregiver ratings on the Frontal Systems Behavior Scale (FrSBe) were examined to appraise changes in apathy, executive dysfunction, and disinhibition. Patients also completed cognitive tests of global cognition, psychomotor speed, and executive functioning. AD biomarker status was determined by either amyloid-beta (Aβ) positron emission tomography (PET) imaging or cerebrospinal fluid (CSF) total tau to Aβ-42 ratio.

Results:

Results revealed clinically significant elevations on the FrSBe’s apathy and executive dysfunction scales and modest correlations among these scales and cognitive measures. Of the 44 patients with available neuroimaging or CSF draw data, 14 presented with comorbid AD. Relative to the iNPH-only group, the iNPH + AD group showed a larger increase from pre-illness to current informant ratings on the executive dysfunction scale, but not the apathy or disinhibition scales.

Conclusions:

These results replicate and extend prior research by identifying apathy and executive dysfunction as prominent neuropsychiatric symptoms of iNPH and suggest comorbid AD exacerbates dysexecutive behaviors. Future research is warranted to examine the effects of comorbid AD pathology in response to shunt surgery for iNPH, neuropsychiatric symptom changes, and resultant caregiver burden.

Type
Regular Research
Copyright
Copyright © INS. Published by Cambridge University Press, 2020

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