Risk Factors For Cognitive Impairment Of Patients With Normal Pressure Hydrocephalus And The Role Of Cerebrospinal Fluid Shunt

ObjectiveCognitive impairment is a common symptom in patients with normal pressure hydrocephalus(NPH)and the clinical presentation is often insidious,which makes the assessment of such patients difficult.Cerebrospinal fluid shunts are effective treatments for NPH,early surgery can significantly improve the patient’s condition and prognosis,while the impact on cognitive impairment has not been conclusively established.In this study,the risk factors for cognitive impairment in patients with NPH were analysed,and the effect of cerebrospinal fluid shunts on cognitive impairment was investigated to provide a basis for the standard assessment and treatment of patients with NPH.The study is divided into two parts:(1)analysis of risk factors for cognitive dysfunction in patients with normal pressure hydrocephalus;(2)the effect of cerebrospinal fluid shunt surgery on cognitive impairment in patients with NPH.Methods(1)Using a retrospective study,56 patients with NPH admitted from January 2016 to December 2019 were selected,and clinical indicators such as basic conditions,past history,lumbar puncture findings and imaging were collected.According to the results of Montreal Cognitive Assessment(Mo CA)scale,they were divided into normal cognitive function group and impaired cognitive function group,and the differences between the above clinical indicators in the two groups were analyzed by one-factor and multi-factor stepwise method logistic regression.(2)Using a prospective study,30 patients with NPH admitted from October 2018 to June 2020 were selected to collect relevant clinical data,and the corresponding scales were used to assess the cognitive function and daily living ability of the patients before and 6months after cerebrospinal fluid shunt surgery.The changes in cognitive function indicators before and after surgery were compared,and the ROC curves were used to analyze the predictive value of the Simple Mental State Examination Scale(MMSE)and Mo CA scale on the changes in cognitive level of patients before and after shunt surgery.Results(1)Patients in the cognitively impaired group had higher age,proportion of smokers,proportion of those with a history of hypertension,first lumbar puncture pressure,proportion of cerebral white matter degeneration,maximum frontal horn width,and Evan’s index than the normal group(P < 0.05).Logistic regression analysis showed that history of hypertension(OR=0.144,95%:0.021 ～0.976;P=0.047),cerebral white matter degeneration(OR=13.563,95%: 1.660-110.798;P=0.015),and maximum width of the frontal horn(OR=16.562,95%: 3.043-90.156;P=0.001)were independent risk factors for the development of cognitive impairment in patients with NPH.(2)Patients showed improvement in gait impairment,cognitive impairment,Idiopathic Normal Pressure Hydrocephalus Rating Scale(i NPHGS)total score,Activity of daily living scale(ADL),modified Rankin Scale(m RS),MMSE,and Mo CA scale indicators 6 months after cerebrospinal fluid shunt compared with preoperative period(p<0.05);cognitive function scales,including Digital Span Test cis-backward/backward(DST cis-backward/backward),Frontal Function Assessment Scale(FAB),and Drawing Clock The Mo CA scale had a higher specificity(96.7%)compared to the MMSE.Conclusion(1)Patients with NPH with a history of hypertension,cerebral white matter degeneration and maximum width of forehead are more likely to develop cognitive impairment.Therefore,in the clinical management of these patients,a standardised and comprehensive clinical assessment,especially in terms of cognitive function,should be carried out as early as possible and treated promptly to avoid further worsening of cognitive impairment.(2)Patients with NPH have clear overall cognitive impairment.Cerebrospinal fluid shunts have shown that can improve cognitive impairment in NPH patients,their ability to perform daily activities and improve their quality of life.The Mo CA scale is more suitable for the clinical assessment of NPH patients with risk factors for cognitive impairment and suspected cognitive dysfunction.