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Cognitive functions after spinal tap in patients with normal pressure hydrocephalus
H Schmidt1, J Elster, I Eckert
1Department of Neurology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
Journal of Neurology
|September 21, 2014
Summary
The Mini-Mental State Examination (MMSE) is sensitive to changes after spinal tap in normal pressure hydrocephalus (NPH) patients. This cognitive test may aid NPH diagnosis and prognosis for shunt surgery.
Area of Science:
- Neurology
- Neuropsychology
Background:
- Normal pressure hydrocephalus (NPH) presents with gait disturbance, urinary incontinence, and dementia.
- Cognitive functioning in NPH is a cardinal symptom, yet data on its evaluation is limited.
Purpose of the Study:
- To assess the utility of neuropsychological (NPSY) tests before and after spinal tap in NPH patients.
- To determine if NPSY tests can aid in NPH diagnosis, treatment, and prognosis for shunt surgery.
Main Methods:
- An observational case-control study involving 15 NPH patients and 18 controls.
- Eleven NPSY tests were administered on two consecutive days, with NPH patients undergoing a spinal tap between tests.
Main Results:
- A significant difference in the change between baseline and post-spinal tap scores was observed only in the Mini-Mental State Examination (MMSE) between NPH patients and controls.
- Controls showed a slight improvement in visuo-constructive function and attention, potentially due to a learning effect, but this was not statistically significant after multiple testing adjustments.
- Other NPSY tests demonstrated less pronounced changes within 24 hours after spinal fluid removal.
Conclusions:
- The MMSE appears to be a sensitive indicator of response to spinal tap in NPH patients.
- Routine inclusion of the MMSE in the workup of NPH patients is suggested for diagnostic and prognostic purposes.
- Most other NPSY tests showed limited value in detecting acute changes post-spinal tap in this cohort.
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