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Surgically treatable dementia

Article information

J Korean Med Assoc. 2012;55(3):250-258
Publication date (electronic) : 2012 March 09
doi : https://doi.org/10.5124/jkma.2012.55.3.250
Seong Ho Kim, MD
Department of Neurosurgery, Yeungnam University College of Medicine, Daegu, Korea.
Corresponding author: Seong Ho Kim, shkim@med.yu.ac.kr
Received 2011 October 08; Accepted 2011 October 22.

Abstract

Dementia is a clinical syndrome that can be caused by multiple conditions, with variable speed of onset, rate of evolution, and duration. Some of these conditions are relentlessly progressive and ultimately fatal, some are treatable, and a few are reversible. Approximately 10% of patients are categorized as having treatable dementias, with normal pressure hydrocephalus (NPH), chronic subdural hematoma, and slow growing brain tumors being the most common etiologies. Idiopathic NPH is a typical treatable form of dementia. The invasive and non-invasive tests of cerebrospinal fluid (CSF) dynamics and drainage can provide an improved measure of postoperative outcomes. However, there is no evidence that testing is superior to clinical examination. Therefore, we should be cautious when excluding patients from shunting based on testing. Two changes in CSF circulatory physiology have been noted as part of ageing. CSF production and turnover are further diminished in patients with Alzheimer's disease (AD) and idiopathic NPH. Poor CSF clearance of proteins, such as Tau and beta amyloid, may play a role in the progression of AD. Improving CSF drainage by shunt can enhance the extracellular clearance of end products of oxidative reactions and lower brain lipid peroxidation. Recently, some efforts for treating AD have been reported. Altering the brain micro-environment to foster appropriate maturation of graft-derived neurons may be critical for improving the efficacy of neural stem cell transplantation therapy for AD. Neuroanatomic circuits mediating memory are accessible and the function of memory circuits can be modulated with neurostimulation, such as deep brain stimulation (DBS) and vagal nerve stimulation. We may identify therapeutic implications for patients with memory disorders. Such studies provide the proof of principle that DBS may remotely activate neocortical structures to enhance memory performance.

Keywords: Dementia; Normal pressure hydrocephalus; Chronic subdural hematoma; Ventriculoperitoneal shunt; Deep brain stimulation

References

1. Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH. Symptomatic occult hydrocephalus with normal cerebrospinal-fluid pressure. A treatable syndrome. N Engl J Med 1965. 273117–126.
2. Katzman R. In : Katzman R, Rowe JW, eds. Diagnosis and management of dementia. Principles of geriatric neurology 1992. Philadelphia: Davis; 167–210.
3. Silverberg GD, Mayo M, Saul T, Rubenstein E, McGuire D. Alzheimer's disease, normal-pressure hydrocephalus, and senescent changes in CSF circulatory physiology: a hypo-thesis. Lancet Neurol 2003. 2506–511.
4. Symon L, Dorsch NW. Use of long-term intracranial pressure measurement to assess hydrocephalic patients prior to shunt surgery. J Neurosurg 1975. 42258–273.
5. Sklar FH, Diehl JT, Beyer CW Jr, Clark WK. Brain elasticity changes with ventriculomegaly. J Neurosurg 1980. 53173–179.
6. Tamaki N, Kusunoki T, Wakabayashi T, Matsumoto S. Cerebral hemodynamics in normal-pressure hydrocephalus. Evaluation by 133Xe inhalation method and dynamic CT study. J Neurosurg 1984. 61510–514.
7. Kitagaki H, Mori E, Ishii K, Yamaji S, Hirono N, Imamura T. CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry. AJNR Am J Neuroradiol 1998. 191277–1284.
8. Algin O, Hakyemez B, Parlak M. Phase-contrast MRI and 3D-CISS versus contrast-enhanced MR cisternography on the evaluation of the aqueductal stenosis. Neuroradiology 2010. 5299–108.
9. Hong YJ, Yoon B, Shim YS, Cho AH, Lim SC, Ahn KJ, Yang DW. Differences in microstructural alterations of the hippocampus in Alzheimer disease and idiopathic normal pressure hydrocephalus: a diffusion tensor imaging study. AJNR Am J Neuroradiol 2010. 311867–1872.
10. Ishikawa M. Guideline Committe for Idiopathic Normal Pressure Hydrocephalus, Japanese Society of Normal Pressure Hydrocephalus. Clinical guidelines for idiopathic normal pressure hydrocephalus. Neurol Med Chir (Tokyo) 2004. 44222–223.
11. Marmarou A, Black P, Bergsneider M, Klinge P, Relkin N. International NPH Consultant Group. Guidelines for management of idiopathic normal pressure hydrocephalus: progress to date. Acta Neurochir Suppl 2005. 95237–240.
12. Black PM. In : Scott RM, ed. Congress of Neurological Surgeons. The normal pressure hydrocephalus syndrome. Hydrocephalus 1990. Baltimore: Williams & Wilkins; 109–114.
13. McQuarrie IG, Saint-Louis L, Scherer PB. Treatment of normal pressure hydrocephalus with low versus medium pressure cerebrospinal fluid shunts. Neurosurgery 1984. 15484–488.
14. Petersen RC, Mokri B, Laws ER Jr. Surgical treatment of idiopathic hydrocephalus in elderly patients. Neurology 1985. 35307–311.
15. Thomas-Anterion C, Moreaud O. Idiopathic normal pressure hydrocephalus. Rev Prat 2006. 561051–1056.
16. Ishikawa E, Yanaka K, Sugimoto K, Ayuzawa S, Nose T. Reversible dementia in patients with chronic subdural hematomas. J Neurosurg 2002. 96680–683.
17. Ooba S, Shiomi N, Shigemori M. Clinical features and surgical results of chronic subdural hematoma in the extremely aged patients. No Shinkei Geka 2006. 34273–278.
18. Noble JM, Canoll P, Honig LS. Brain tumor-associated dementia. Sci Aging Knowledge Environ 2005. 2005dn2.
19. Silverberg GD, Levinthal E, Sullivan EV, Bloch DA, Chang SD, Leverenz J, Flitman S, Winn R, Marciano F, Saul T, Huhn S, Mayo M, McGuire D. Assessment of low-flow CSF drainage as a treatment for AD: results of a randomized pilot study. Neurology 2002. 591139–1145.
20. Pratico D, Yao Y, Rokach J, Mayo M, Silverberg GG, McGuire D. Reduction of brain lipid peroxidation by CSF drainage in Alzheimer's disease patients. J Alzheimers Dis 2004. 6385–389.
21. Bateman GA. The role of altered impedance in the pathophysiology of normal pressure hydrocephalus, Alzheimer's disease and syringomyelia. Med Hypotheses 2004. 63980–985.
22. Chakravarty A. Unifying concept for Alzheimer's disease, vascular dementia and normal pressure hydrocephalus - a hypothesis. Med Hypotheses 2004. 63827–833.
23. Harbaugh RE, Reeder TM, Senter HJ, Knopman DS, Baskin DS, Pirozzolo F, Chui HC, Shetter AG, Bakay RA, Leblanc R. Intracerebroventricular bethanechol chloride infusion in Alzheimer's disease. Results of a collaborative double-blind study. J Neurosurg 1989. 71481–486.
24. Goldsmith HS. Omental transposition in treatment of Alzheimer disease. J Am Coll Surg 2007. 205800–804.
25. Waldau B, Shetty AK. Behavior of neural stem cells in the Alzheimer brain. Cell Mol Life Sci 2008. 652372–2384.
26. Sjogren MJ, Hellstrom PT, Jonsson MA, Runnerstam M, Silander HC, Ben-Menachem E. Cognition-enhancing effect of vagus nerve stimulation in patients with Alzheimer's disease: a pilot study. J Clin Psychiatry 2002. 63972–980.
27. Merrill CA, Jonsson MA, Minthon L, Ejnell H, C-son Silander H, Blennow K, Karlsson M, Nordlund A, Rolstad S, Warkentin S, Ben-Menachem E, Sjogren MJ. Vagus nerve stimulation in patients with Alzheimer's disease: additional follow-up results of a pilot study through 1 year. J Clin Psychiatry 2006. 671171–1178.
28. Hamani C, McAndrews MP, Cohn M, Oh M, Zumsteg D, Shapiro CM, Wennberg RA, Lozano AM. Memory enhancement induced by hypothalamic/fornix deep brain stimulation. Ann Neurol 2008. 63119–123.
29. Sauvage MM, Fortin NJ, Owens CB, Yonelinas AP, Eichenbaum H. Recognition memory: opposite effects of hippocampal damage on recollection and familiarity. Nat Neurosci 2008. 1116–18.
30. Bischofberger J. Young and excitable: new neurons in memory networks. Nat Neurosci 2007. 10273–275.

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Table 1

Classification of diseases causing dementia

Table 1

From Katzman R, et al. Principles of geriatric neurology. Philadelphia: Davis; 1992. p. 167-210 [2].

Table 2

Comparison between international and Japanese guidelines for management of idiopathic normal pressure hydrocephalus

Table 2

CT, computed tomography; MRI, magnetic resonance tomography; PVL(H), periventricular low (high) signal intensity on T1(T2)-weighted MRI; SPECT, single-photon emission computed tomography; CBF, cerebral blood flow.