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Prognostic value of amyloid PET scan in normal pressure hydrocephalus

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Abstract

Amyloid positron emission tomography ([18F] florbetaben (FBB) PET) can be used to determine concomitant Alzheimer’s disease (AD) in idiopathic normal pressure hydrocephalus (iNPH) patients. FBB PET scans and the tap test were performed in 31 patients with clinically suspected iNPH, and amyloid positive (iNPH/FBB+) and negative (iNPH/FBB−) groups were compared with respect to clinical characteristics. We evaluated prognostic value of FBB PET scans by analyzing the response to the tap test using a linear mixed model. We also performed a multivariable regression analysis to investigate whether amyloid PET positivity can predict the positive tap test response independent of other AD biomarkers. The results showed that the iNPH/FBB+ group (7/31, 22.6%) had a higher percentage of APOE4 carriers, lower Aβ42, higher CSF t-tau, and p-tau/Aβ42 ratio than the iNPH/FBB− group (24/31, 77.4%), while the two groups did not differ in imaging characteristics. The iNPH/FBB− group had a higher percentage of tap responders and showed a greater improvement in gait scores after the tap test than the iNPH/FBB+ group (group-tap test effect interaction, p = 0.035). A multivariable logistic regression analysis showed that amyloid positivity on PET scans (OR 0.03, p = 0.029) and CSF p-tau (OR 0.87, p = 0.044) were independently associated with the positive tap test response. Among 21 tap responders in the iNPH/FBB− group, 14 patients received shunt surgery and 12/14 (85.7%) patients showed symptom improvement. Our findings suggest that amyloid PET scans can help determine which iNPH patients will benefit from shunt surgery by discriminating concomitant AD.

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Author information

Authors and Affiliations

  1. Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-dong, Gangnam-gu, Seoul, 06351, Republic of Korea

    Hyemin Jang, Seong Beom Park, Yeshin Kim, Ko Woon Kim, Yeong Sim Choe, Sang Won Seo, Hee Jin Kim & Duk L. Na

  2. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Jung Il Lee

  3. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Sung Tae Kim

  4. Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Kyung Han Lee

  5. Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Eun-Suk Kang

  6. Neuroscience Center, Samsung Medical Center, Seoul, Korea

    Hyemin Jang, Yeshin Kim, Ko Woon Kim, Sang Won Seo, Hee Jin Kim & Duk L. Na

  7. Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea

    Sang Won Seo & Duk L. Na

  8. Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea

    Yeo Jin Kim

  9. Department of Neurology, Inha University School of Medicine, Incheon, Korea

    Cindy W. Yoon

  10. Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea

    Duk L. Na

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  1. Hyemin Jang
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Contributions

HJ: design of the study, acquisition and analysis of the data, and drafting the manuscript. YK, KWK, YJK, CWY: acquisition and interpretation of the data. STK, KHL: acquisition of the data. SWS, HJK: design of the study and interpretation of the data. DLN: design of the study, acquisition and analysis of the data, interpretation of the data, revising the manuscript, and study supervision. SBP, YSC: imaging data analysis

Corresponding author

Correspondence to Duk L. Na.

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Conflicts of interest

The authors declare that they have no competing interests.

Study funding

This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI14C3484), the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI14C2746), and the B. Braun Korea.

Ethical standards

The study was approved by the Institutional Review Board of Samsung Medical Center. Written informed consent was obtained from all patients.

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Jang, H., Park, S.B., Kim, Y. et al. Prognostic value of amyloid PET scan in normal pressure hydrocephalus. J Neurol 265, 63–73 (2018). https://doi.org/10.1007/s00415-017-8650-5

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  • DOI: https://doi.org/10.1007/s00415-017-8650-5

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