Leucine-rich α-2-glycoprotein is a marker for idiopathic normal pressure hydrocephalus View Full Text


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Article Info

DATE

2011-02-19

AUTHORS

Madoka Nakajima, Masakazu Miyajima, Ikuko Ogino, Maki Watanabe, Haruko Miyata, Kostadin L. Karagiozov, Hajime Arai, Yoshiaki Hagiwara, Tatsuya Segawa, Kyoko Kobayashi, Yasuhiro Hashimoto

ABSTRACT

ObjectiveCerebrospinal fluid (CSF) shunting can improve symptoms of elderly patients' idiopathic normal pressure hydrocephalus (iNPH). However, adjunctive means for confirming the diagnosis remain unavailable. We have previously reported the specific increase of leucine-rich alpha-2-glycoprotein (LRG) in iNPH CSF, and the present study investigates its potential clinical applications.MethodsWe performed CSF tap test (TT) on 90 patients (mean age 73.4 years) and shunting in 52 patients (mean age 73.5 years), evaluating symptom improvement and higher cerebral functions—mini-mental state examination (MMSE) and Frontal Assessment Battery (FAB) before and 12 months after shunting. LRG and tau protein concentrations in TT CSF were simultaneously measured using enzyme-linked immunosorbent assay. We then compared the predictive value of these concentrations with TT results regarding successful shunting outcomes.ResultsPositive combinations of TT and LRG concentrations of 67 ng/ml or higher, gave 81.6% sensitivity and 78.6% specificity. Therefore we used LRG (67 ng/ml) and tau (200 pg/ml) cut-off values, dividing patients into four groups. In group A (LRG ≥ 67 ng/ml and tau < 200 pg/ml) 31 of 34 patients (91.2%) had a positive TT and all operated 22 patients were shunt responders. Dementia MMSE and FAB scores in them increased from a baseline of 22.05(SE ± 0.96) to 25.65 (±0.85) and 11.38 (±0.68) to 13.08 (±0.57) respectively. In group B, (LRG ≥ 67 ng/ml and tau ≥ 200 pg/ml), the mean MMSE score increased from 17.62 (±2.03) to 21.62 (±1.96), and the FAB decreased slightly from 9.25 (±1.15) to 10.5 (±1.59), without improvement beyond the range of dementia. In group C, (LRG < 67 ng/ml, tau < 200 pg/ml), the mean MMSE score improved from 22.06 (±1.25) to 24.29 (±1.23) and the FAB score improved slightly from 12.0 (±0.72) to 12.87 (±0.72). Finally, in group D, (LRG < 67 ng/ml, tau ≥ 200 pg/ml), there was almost no improvement in MMSE scoreConclusionsA combination of positive TT and biomarkers quantification such as LRG and tau protein, can reliably predict shunting outcome in iNPH patients. More... »

PAGES

1339-1346

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00701-011-0963-z

DOI

http://dx.doi.org/10.1007/s00701-011-0963-z

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1047371336

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/21336807


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27 schema:description ObjectiveCerebrospinal fluid (CSF) shunting can improve symptoms of elderly patients' idiopathic normal pressure hydrocephalus (iNPH). However, adjunctive means for confirming the diagnosis remain unavailable. We have previously reported the specific increase of leucine-rich alpha-2-glycoprotein (LRG) in iNPH CSF, and the present study investigates its potential clinical applications.MethodsWe performed CSF tap test (TT) on 90 patients (mean age 73.4 years) and shunting in 52 patients (mean age 73.5 years), evaluating symptom improvement and higher cerebral functions—mini-mental state examination (MMSE) and Frontal Assessment Battery (FAB) before and 12 months after shunting. LRG and tau protein concentrations in TT CSF were simultaneously measured using enzyme-linked immunosorbent assay. We then compared the predictive value of these concentrations with TT results regarding successful shunting outcomes.ResultsPositive combinations of TT and LRG concentrations of 67 ng/ml or higher, gave 81.6% sensitivity and 78.6% specificity. Therefore we used LRG (67 ng/ml) and tau (200 pg/ml) cut-off values, dividing patients into four groups. In group A (LRG ≥ 67 ng/ml and tau < 200 pg/ml) 31 of 34 patients (91.2%) had a positive TT and all operated 22 patients were shunt responders. Dementia MMSE and FAB scores in them increased from a baseline of 22.05(SE ± 0.96) to 25.65 (±0.85) and 11.38 (±0.68) to 13.08 (±0.57) respectively. In group B, (LRG ≥ 67 ng/ml and tau ≥ 200 pg/ml), the mean MMSE score increased from 17.62 (±2.03) to 21.62 (±1.96), and the FAB decreased slightly from 9.25 (±1.15) to 10.5 (±1.59), without improvement beyond the range of dementia. In group C, (LRG < 67 ng/ml, tau < 200 pg/ml), the mean MMSE score improved from 22.06 (±1.25) to 24.29 (±1.23) and the FAB score improved slightly from 12.0 (±0.72) to 12.87 (±0.72). Finally, in group D, (LRG < 67 ng/ml, tau ≥ 200 pg/ml), there was almost no improvement in MMSE scoreConclusionsA combination of positive TT and biomarkers quantification such as LRG and tau protein, can reliably predict shunting outcome in iNPH patients.
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34 schema:keywords Assessment Battery
35 CSF
36 CSF tap test
37 FAB scores
38 Frontal Assessment Battery
39 LRG
40 MMSE
41 MMSE scores
42 Mental State Examination
43 MethodsWe
44 State Examination
45 TT results
46 applications
47 baseline
48 batteries
49 biomarkers
50 clinical application
51 combination
52 concentration
53 dementia
54 diagnosis
55 enzyme-linked immunosorbent
56 examination
57 group
58 group B
59 group C
60 group D
61 hydrocephalus
62 iNPH patients
63 idiopathic normal pressure hydrocephalus
64 immunosorbent
65 improvement
66 increase
67 markers
68 mean MMSE
69 mean MMSE score
70 months
71 normal pressure hydrocephalus
72 outcomes
73 patients
74 positive tap test
75 potential clinical applications
76 predictive value
77 present study
78 pressure hydrocephalus
79 protein
80 protein concentration
81 range
82 range of dementia
83 responders
84 results
85 scores
86 sensitivity
87 shunt responders
88 shunting
89 specific increase
90 specificity
91 study
92 symptom improvement
93 symptoms
94 tap test
95 tau
96 tau protein
97 tau protein concentration
98 test
99 values
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