Though the Japanese version of the Montreal Cognitive Assessment (MoCA-J) scores change after a cerebrospinal fluid tap test (CSFTT), their characteristics remain unclear. To compare patient response rate to changes in cognitive function observed in the cerebrospinal fluid tap test, and to determine which group of patients were good responders.

This study included 32 patients who were suspected of having idiopathic normal pressure hydrocephalus (iNPH) between May 2017 and October 2018. Cases were divided into, following a CSFTT, a gait responder group and a non-responder group. Scores of the MoCA-J were compared and examined before, one day after, and one week after the CSFTT.

Significant changes in MoCA-J scores were observed 1 day and 1 week after the CSFTT in the gait responder group. The change in scores was larger, and had a larger effect size, one week after the CSFTT. On assessment, MoCA-J sub-items began to show changes in attention and abstract items one day after the CSFTT, and significant changes were noted in attention and abstract items in addition to executive functions and orientation one week after the CSFTT. The degree of cognitive function before the CSFTT was less closely related to the amount of change. Changes in cognitive function can be assessed at each time point after the CSFTT, and changes in cognitive function are measured regardless of the level of cognitive function.

These results suggest that evaluating patients with the MoCA-J may potentially support a more accurate iNPH diagnosis ¹⁾.

2: Williams MA, Nagel SJ, Luciano MG, Relkin N, Zwimpfer TJ, Katzen H, Holubkov R, Moghekar A, Wisoff JH, McKhann GM, Golomb J, Edwards RJ, Hamilton MG. The clinical spectrum of hydrocephalus in adults: report of the first 517 patients of the Adult Hydrocephalus Clinical Research Network registry. J Neurosurg. 2019 May 24:1-12. doi: 10.3171/2019.2.JNS183538. [Epub ahead of print] PubMed PMID: 31125971.

3: Leal NS, Dentoni G, Schreiner B, Kämäräinen OP, Partanen N, Herukka SK, Koivisto AM, Hiltunen M, Rauramaa T, Leinonen V, Ankarcrona M. Alterations in mitochondria-endoplasmic reticulum connectivity in human brain biopsies from idiopathic normal pressure hydrocephalus patients. Acta Neuropathol Commun. 2018 Oct 1;6(1):102. doi: 10.1186/s40478-018-0605-2. PubMed PMID: 30270816; PubMed Central PMCID: PMC6166280.

4: Akiba C, Nakajima M, Miyajima M, Ogino I, Motoi Y, Kawamura K, Adachi S, Kondo A, Sugano H, Tokuda T, Irie K, Arai H. Change of Amyloid-β 1-42 Toxic Conformer Ratio After Cerebrospinal Fluid Diversion Predicts Long-Term Cognitive Outcome in Patients with Idiopathic Normal Pressure Hydrocephalus. J Alzheimers Dis. 2018;63(3):989-1002. doi: 10.3233/JAD-180059. PubMed PMID: 29710721; PubMed Central PMCID: PMC6004932.

5: Mendes GAS, de Oliveira MF, Pinto FCG. The Timed Up and Go Test as a Diagnostic Criterion in Normal Pressure Hydrocephalus. World Neurosurg. 2017 Sep;105:456-461. doi: 10.1016/j.wneu.2017.05.137. Epub 2017 May 31. PubMed PMID: 28578116.

6: Schniepp R, Trabold R, Romagna A, Akrami F, Hesselbarth K, Wuehr M, Peraud A, Brandt T, Dieterich M, Jahn K. Walking assessment after lumbar puncture in normal-pressure hydrocephalus: a delayed improvement over 3 days. J Neurosurg. 2017 Jan;126(1):148-157. doi: 10.3171/2015.12.JNS151663. Epub 2016 Mar 18. PubMed PMID: 26991388.

7: Elobeid A, Laurell K, Cesarini KG, Alafuzoff I. Correlations between mini-mental state examination score, cerebrospinal fluid biomarkers, and pathology observed in brain biopsies of patients with normal-pressure hydrocephalus. J Neuropathol Exp Neurol. 2015 May;74(5):470-9. doi: 10.1097/NEN.0000000000000191. PubMed PMID: 25868149.

8: Serulle Y, Rusinek H, Kirov II, Milch H, Fieremans E, Baxter AB, McMenamy J, Jain R, Wisoff J, Golomb J, Gonen O, George AE. Differentiating shunt-responsive normal pressure hydrocephalus from Alzheimer disease and normal aging: pilot study using automated MRI brain tissue segmentation. J Neurol. 2014 Oct;261(10):1994-2002. doi: 10.1007/s00415-014-7454-0. Epub 2014 Aug 1. PubMed PMID: 25082631.

9: Konglund A, Helseth R, Lund-Johansen M, Helseth E, Meling TR. Surgery for high-grade gliomas in the aging. Acta Neurol Scand. 2013 Sep;128(3):185-93. doi: 10.1111/ane.12105. Epub 2013 Feb 21. PubMed PMID: 23432636.

10: Klinge P, Hellström P, Tans J, Wikkelsø C; European iNPH Multicentre Study Group. One-year outcome in the European multicentre study on iNPH. Acta Neurol Scand. 2012 Sep;126(3):145-53. doi: 10.1111/j.1600-0404.2012.01676.x. Epub 2012 May 10. PubMed PMID: 22571428.

11: Solana E, Sahuquillo J, Junqué C, Quintana M, Poca MA. Cognitive disturbances and neuropsychological changes after surgical treatment in a cohort of 185 patients with idiopathic normal pressure hydrocephalus. Arch Clin Neuropsychol. 2012 May;27(3):304-17. doi: 10.1093/arclin/acs002. Epub 2012 Mar 1. PubMed PMID: 22382387.

12: Fountas KN, Kapsalaki EZ, Paterakis KN, Lee GP, Hadjigeorgiou GM. Role of endoscopic third ventriculostomy in treatment of selected patients with normal pressure hydrocephalus. Acta Neurochir Suppl. 2012;113:129-33. doi: 10.1007/978-3-7091-0923-6_26. PubMed PMID: 22116438.

13: Nakajima M, Miyajima M, Ogino I, Watanabe M, Miyata H, Karagiozov KL, Arai H, Hagiwara Y, Segawa T, Kobayashi K, Hashimoto Y. Leucine-rich α-2-glycoprotein is a marker for idiopathic normal pressure hydrocephalus. Acta Neurochir (Wien). 2011 Jun;153(6):1339-46; discussion 1346. doi: 10.1007/s00701-011-0963-z. Epub 2011 Feb 19. PubMed PMID: 21336807; PubMed Central PMCID: PMC3098968.

14: Cusimano MD, Rewilak D, Stuss DT, Barrera-Martinez JC, Salehi F, Freedman M. Normal-pressure hydrocephalus: is there a genetic predisposition? Can J Neurol Sci. 2011 Mar;38(2):274-81. PubMed PMID: 21320833.

15: Chen Z, Song W, Du J, Li G, Yang Y, Ling F. Rehabilitation of patients with chronic normal-pressure hydrocephalus after aneurysmal subarachnoid hemorrhage benefits from ventriculoperitoneal shunt. Top Stroke Rehabil. 2009 Sep-Oct;16(5):330-8. doi: 10.1310/tsr1605-330. PubMed PMID: 19903651.

16: Chen Z, Chen G, Song W, Liu L, Yang Y, Ling F. Rehabilitation combined with ventriculoperitoneal shunt for patients with chronic normal pressure hydrocephalus due to aneurysm subarachnoid haemorrhage: a preliminary study. J Rehabil Med. 2009 Nov;41(13):1096-9. doi: 10.2340/16501977-0461. PubMed PMID: 19894008.

17: Feick D, Sickmond J, Liu L, Metellus P, Williams M, Rigamonti D, Hill-Briggs F. Sensitivity and predictive value of occupational and physical therapy assessments in the functional evaluation of patients with suspected normal pressure hydrocephalus. J Rehabil Med. 2008 Oct;40(9):715-20. doi: 10.2340/16501977-0241. PubMed PMID: 18843422.

18: Factora R, Luciano M. When to consider normal pressure hydrocephalus in the patient with gait disturbance. Geriatrics. 2008 Feb;63(2):32-7. Review. PubMed PMID: 18312021.

19: Thomas-Antérion C, Moreaud O. [Idiopathic normal pressure hydrocephalus]. Rev Prat. 2006 May 31;56(10):1051-6. French. PubMed PMID: 16836199.

20: Tarkowski E, Tullberg M, Fredman P, Wikkelsö C. Normal pressure hydrocephalus triggers intrathecal production of TNF-alpha. Neurobiol Aging. 2003 Sep;24(5):707-14. PubMed PMID: 12885578.

21: Savolainen S, Hurskainen H, Paljärvi L, Alafuzoff I, Vapalahti M. Five-year outcome of normal pressure hydrocephalus with or without a shunt: predictive value of the clinical signs, neuropsychological evaluation and infusion test. Acta Neurochir (Wien). 2002 Jun;144(6):515-23; discussion 523. PubMed PMID: 12111484.

22: Svendsen F, Hugdahl K, Wester K. [Surgical treatment of normal pressure hydrocephalus]. Tidsskr Nor Laegeforen. 2001 May 30;121(14):1683-6. Norwegian. PubMed PMID: 11446009.

23: Golomb J, Wisoff J, Miller DC, Boksay I, Kluger A, Weiner H, Salton J, Graves W. Alzheimer's disease comorbidity in normal pressure hydrocephalus: prevalence and shunt response. J Neurol Neurosurg Psychiatry. 2000 Jun;68(6):778-81. PubMed PMID: 10811706; PubMed Central PMCID: PMC1736969.

24: Bárcena A, Mestre C, Cañizal JM, Rivero B, Lobato RD. Idiopathic normal pressure hydrocephalus: analysis of factors related to cerebrospinal fluid dynamics determining functional prognosis. Acta Neurochir (Wien). 1997;139(10):933-41. PubMed PMID: 9401653.

25: Lindqvist G, Andersson H, Bilting M, Blomstrand C, Malmgren H, Wikkelsø C. Normal pressure hydrocephalus: psychiatric findings before and after shunt operation classified in a new diagnostic system for organic psychiatry. Acta Psychiatr Scand Suppl. 1993;373:18-32. PubMed PMID: 8372699.

26: Spanu G, Santagostino G, Marzatico F, Gaetani P, Silvani V, Rodriguez y Baena R. Idiopathic hydrocephalic dementia in aging brain the neurosurgical approach. Funct Neurol. 1989 Jul-Sep;4(3):293-8. PubMed PMID: 2792865.

27: Cammermeyer M, Evans JE. A brief neurobehavioral exam useful for early detection of postoperative complications in neurosurgical patients. J Neurosci Nurs. 1988 Oct;20(5):314-23. PubMed PMID: 2976791.