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AANS: Findings Shed Light on Surgical Treatment of Dementia

Markers may ID normal pressure hydrocephalus, Alzheimer's patients who are surgical candidates

WEDNESDAY, May 5 (HealthDay News) -- Many patients with normal pressure hydrocephalus (NPH) experience clinical declines similar to those of Alzheimer's disease (AD) patients, and newly discovered cerebrospinal fluid (CSF) biomarkers may help better diagnose forms of early dementia, as well as better identify patients who may benefit from surgical implantation of a shunt, according to research presented at the annual meeting of the American Association of Neurological Surgeons, held from May 1 to 5 in Philadelphia.

In an effort to assess the clinical association of NPH and AD, Sebastian F. Koga, M.D., of the University of Virginia Health Science Center in Charlottesville, and colleagues performed CSF profiling for biomarkers beta-amyloid, T-tau, P-tau and APOε4 genotyping, and completed cortical biopsy evaluations for neuritic plaques and tau tangles in patients treated for NPH at their institution. They then assessed the results as they related to clinical progress and neuropsychological testing.

The researchers found that the presence of a large number of neuritic plaques on biopsy and increased beta-amyloid levels were associated with a failure to improve after surgical shunt implantation. An analysis of the CSF biomarkers T-tau, P-tau and beta-amyloid showed that NPH progression was similar to the changes occurring in patients with AD. In addition, the researchers found that in a significant number of patients, a high number of plaques and tangles in frontal lobe biopsies were an indication of an advanced AD.

"Although there are certain differences in the clinical presentation of NPH and AD, our research suggests that these two forms of dementia are part of a wider spectrum of tau-protein abnormalities in the brain. This new perspective could change diagnostic criteria and redefine the surgical treatment options available to patients suffering from dementia," Koga said in a statement.

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