Objective: The Normal Pressure Hydrocephalus (NPH) is a pathology of the elderly characterized by the presence of cognitive deficits, motor impairment and urinary incontinence. Recently the role of MRI in the selection of patients responders to the surgical intervention has been highlighted. Particularly an alteration of Apparent Diffusion Coefficient (ADC), a measure of the water content in brain regions of interest, has been correlated to the shunt outcome , supporting the hypothesis that one of the most important cause of clinical features of the pathology is related to the brain water accumulation. Methods: In our study we perform ADC in a group of patients with NPH correlating values with clinical (Tinetti scale, UPDRS, gait analysis, visual and auditory Reaction Time), neuropsychological features (MMSE, Frontal Assessment Battery, Weigl's test, CPM, Verbal Fluencies, Judgement of Line Orientation, Short Story, Paired Words Association, Digit Span, Rey's Figure, Visual Memory, ), psychological aspects (depression, anxiety, quality of life, apathy) and the outcome after the tap-test. Results: We found an almost similar profile of ADC in patients that respond to the tap-test and controls. Patients that not respond have a value that is higher indicating a irreversible zone of degeneration. The values of ADC correlates with some neuropsychological performance and psychological characteristics. Conclusion: ADC could be used to select patients for surgery, excluding cases this irreversible damage or with severe cerebrovascular disease and as a marker of progression of cognitive and motor deficits in the follow-up. This study could support the fact that water accumulation is the most important factor related to the clinical features of patients. We presume that the use of specific therapy can reduce the water accumulation in special cases.
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