Objective: The pilot study aimed to identify neuroanatomical predictors of cognitive performance in patients with iNPH.

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a specific form of communicating hydrocephalus in which cerebrospinal fluid accumulates in the cerebral ventricles. Several theories explain the cognitive deficits in patients with iNPH, but studies looking at the neuroanatomical correlates yield mixed results.

Method: Eighteen patients with iNPH aged 65-82 years, with a duration of symptoms ranging between one and five years (Mdn=2.0; IQR=2.0). Patients were administered complex neuropsychological battery. Patients underwent brain 3T MRI. Volumetry was performed using the FreeSurfer 7.2 (from T1 weighted images) with additional functionality for automated detection of enlarged ventricles and subsequent manual correction.

Results: In the regression model, the significant predictors of impaired global cognitive performance (Montreal Cognitive Assessment) were the total volume of the cortex (β=0.66, p<0.001), white matter hyperintensities (β=0.51, p=0.004) and the third ventricle (β=-0.40, p=0.018). These predictors explained 70.6% of the variance in the cognitive screening. Executive functions including attention and cognitive flexibility (Symbol Digit Test) were predicted by the total volume of the cortex (β=0.80, p=0.002) and white matter hyperintensities (β=0.589, p=0.012). These predictors explained 74.9% of the variance. Higher volume of the amygdala was associated with better performance in verbal fluency, both in the phonemic (β=0.78, p=0.03, R²=0.61) and the semantic (β=0.70, p=0.01, R²=0.50).

Conclusion: Results show the presence of cognitive impairment in patients with iNPH and they can be predicted based on the volume of brain structures. Preliminary results need to be verified in a larger set of participants.

The research was supported by grants GAAA/2022/12, VEGA 1/0545/22, VEGA 1/0618/21.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/predictors-of-cognitive-deficits-in-patients-with-idiopathic-normal-pressure-hydrocephalus-a-pilot-mri-volumetric-study/