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Sarcopenia in older patients with idiopathic normal pressure hydrocephalus: an observational study from a single geriatric clinic in Turkey

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Abstract

Objective

Idiopathic normal pressure hydrocephalus (iNPH), a classical triad of gait abnormality, cognitive disturbance, and urinary incontinence, increases in prevalence with aging. Sarcopenia is also characterized by low muscle strength and mass, contributing to gait difficulty. Gait abnormality and lower physical activity also lead to the development of sarcopenia. Therefore, this study aims to investigate the relationship between sarcopenia and iNPH.

Methods

A total of 327 participants were included in this retrospective cross-sectional study. Demographic and clinical characteristics, including age, sex, comorbidity index, number of medications, recurrent falls in the last year, laboratory findings and comprehensive geriatric assessment (CGA) parameters were recorded. Sarcopenia was defined according to the EGWSOP2 criteria. The relationship between sarcopenia and iNPH was assessed with regression analysis.

Results

There were 51 participants with iNPH, 49% female, mean age 78 years (SD 5.7) and 276 control participants, 74% female, mean age 72 years (SD 6.1). The sarcopenia rates in patients with iNPH and controls were 19.6% and 2.5%, respectively (p < 0.01). The odds of probable sarcopenia were 3.89 times, and the slow gait speed was 8.47 times higher in iNPH patients than in controls after adjusting for age, sex, and the other confounders. The Mini-Mental State Examination score (p = 0.042, OR = 0.869 with 95% CI:0.759–0.995) was associated with probable sarcopenia among patients with iNPH.

Conclusion

This study demonstrated that sarcopenia was common in older patients with iNPH, which seems to be closely associated with decreased muscle strength and slowed gait speed. Thus, considering the potential untoward effects of both diseases, it is important for physicians to evaluate sarcopenia routinely in the follow-up and treatment of older patients with iNPH.

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Data availability

The datasets used and analyzed during the present study are available from the corresponding author upon reasonable request.

References

  1. Hakim S, Venegas JG, Burton JD (1976) The physics of the cranial cavity, hydrocephalus and normal pressure hydrocephalus: mechanical interpretation and mathematical model. Surg Neurol 5(3):187–210

    CAS  PubMed  Google Scholar 

  2. Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM (2005) Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 57(3):S4-16

    PubMed  Google Scholar 

  3. Martín-Láez R, Caballero-Arzapalo H, López-Menéndez LÁ, Arango-Lasprilla JC, Vázquez-Barquero A (2015) Epidemiology of idiopathic normal pressure hydrocephalus: a systematic review of the literature. World neurosurgery 84(6):2002–2009. https://doi.org/10.1016/j.wneu.2015.07.005

    Article  PubMed  Google Scholar 

  4. Andersson J, Rosell M, Kockum K, Lilja-Lund O, Söderström L, Laurell K (2019) Prevalence of idiopathic normal pressure hydrocephalus: a prospective, population-based study. PLoS ONE 14(5):e0217705. https://doi.org/10.1371/journal.pone.0217705

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Nakajima M, Yamada S, Miyajima M, Ishii K, Kuriyama N, Kazui H, Kanemoto H, Suehiro T, Yoshiyama K, Kameda M, Kajimoto Y, Mase M, Murai H, Kita D, Kimura T, Samejima N, Tokuda T, Kaijima M, Akiba C, Kawamura K, Atsuchi M, Hirata Y, Matsumae M, Sasaki M, Yamashita F, Aoki S, Irie R, Miyake H, Kato T, Mori E, Ishikawa M, Date I, Arai H (2021) Guidelines for management of idiopathic normal pressure hydrocephalus (third edition): endorsed by the japanese society of normal pressure hydrocephalus. Neurol Med Chir (Tokyo) 61(2):63–97. https://doi.org/10.2176/nmc.st.2020-0292

    Article  PubMed  Google Scholar 

  6. Bonney PA, Briggs RG, Wu K, Choi W, Khahera A, Ojogho B, Shao X, Zhao Z, Borzage M, Wang DJJ, Liu C, Lee DJ (2022) Pathophysiological mechanisms underlying idiopathic normal pressure hydrocephalus: a review of recent insights. Frontiers aging neurosci 14:866313. https://doi.org/10.3389/fnagi.2022.866313

    Article  CAS  Google Scholar 

  7. Halperin JJ, Kurlan R, Schwalb JM, Cusimano MD, Gronseth G, Gloss D (2015) Practice guideline: idiopathic normal pressure hydrocephalus: response to shunting and predictors of response: report of the guideline development, dissemination, and implementation subcommittee of the american academy of neurology. Neurology 85(23):2063–2071. https://doi.org/10.1212/wnl.0000000000002193

    Article  PubMed  PubMed Central  Google Scholar 

  8. Williams MA, Malm J (2016) Diagnosis and treatment of idiopathic normal pressure hydrocephalus. Continuum (Minneap Minn). https://doi.org/10.1212/con.0000000000000305

    Article  PubMed  Google Scholar 

  9. Isik AT, Kaya D, Ates Bulut E, Dokuzlar O, Soysal P (2019) The outcomes of serial cerebrospinal fluid removal in elderly patients with idiopathic normal pressure hydrocephalus. Clin Interv Aging 14:2063–2069. https://doi.org/10.2147/cia.S228257

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kaya D, AT I, (2018) The significance of cerebral comorbidities in idiopathic normal pressure hydrocephalus. Biomed J Sci Tech Res. https://doi.org/10.26717/BJSTR.2018.06.001340

    Article  Google Scholar 

  11. Nikaido Y, Urakami H, Akisue T, Okada Y, Katsuta N, Kawami Y, Ikeji T, Kuroda K, Hinoshita T, Ohno H, Kajimoto Y, Saura R (2019) Associations among falls, gait variability, and balance function in idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 183:105385. https://doi.org/10.1016/j.clineuro.2019.105385

    Article  PubMed  Google Scholar 

  12. Kaya D, Erken N, Ontan MS, Altun ZS, Isik AT (2020) The applause sign in elderly patients with idiopathic normal pressure hydrocephalus. Appl Neuropsychol Adult. https://doi.org/10.1080/23279095.2020.1818563

    Article  PubMed  Google Scholar 

  13. Ates Bulut E, Soysal P, Isik AT (2018) Frequency and coincidence of geriatric syndromes according to age groups: single-center experience in Turkey between 2013 and 2017. Clin Interv Aging 13:1899–1905. https://doi.org/10.2147/cia.s180281

    Article  PubMed  Google Scholar 

  14. Cruz-Jentoft AJ, Bahat G, Bauer J (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age ageing. https://doi.org/10.1093/ageing/afy169

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dost FS, Ates Bulut E, Dokuzlar O, Kaya D, Mutlay F, Yesil Gurel BH, Isik AT (2022) Sarcopenia is as common in older patients with dementia with lewy bodies as it is in those with Alzheimer’s disease. Geriatr Gerontol Int 22(5):418–424. https://doi.org/10.1111/ggi.14383

    Article  PubMed  Google Scholar 

  16. Dost FS, Erken N, Ontan MS, Ates Bulut E, Kaya D, Kocyigit SE, Dokuzlar O, Aydin AE, Isik AT (2022) Muscle strength seems to be related to the functional status and severity of dementia in older adults with Alzheimer’s disease. Curr Aging Sci. https://doi.org/10.2174/1573411018666220616114641

    Article  Google Scholar 

  17. Tsekoura M, Kastrinis A, Katsoulaki M, Billis E, Gliatis J (2017) Sarcopenia and its impact on quality of life. Adv Exp Med Biol 987:213–218. https://doi.org/10.1007/978-3-319-57379-3_19

    Article  PubMed  Google Scholar 

  18. Xu J, Reijnierse EM, Pacifico J, Wan CS, Maier AB (2021) Sarcopenia is associated with 3-month and 1-year mortality in geriatric rehabilitation inpatients: RESORT. Age Ageing 50(6):2147–2156. https://doi.org/10.1093/ageing/afab134

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hsu YH, Liang CK, Chou MY, Liao MC, Lin YT, Chen LK, Lo YK (2014) Association of cognitive impairment, depressive symptoms and sarcopenia among healthy older men in the veterans retirement community in southern Taiwan: a cross-sectional study. Geriatr Gerontol Int 14(Suppl 1):102–108. https://doi.org/10.1111/ggi.12221

    Article  PubMed  Google Scholar 

  20. Schaap LA, van Schoor NM, Lips P, Visser M (2018) Associations of sarcopenia definitions, and their components, with the incidence of recurrent falling and fractures: the longitudinal aging study Amsterdam. J Gerontol A Biol Sci Med Sci 73(9):1199–1204. https://doi.org/10.1093/gerona/glx245

    Article  PubMed  Google Scholar 

  21. Ontan MS, Dokuzlar O, Ates Bulut E, Soysal P, Isik AT (2021) The relationship between osteoporosis and sarcopenia, according to EWGSOP-2 criteria, in outpatient elderly. J Bone Miner Metab 39(4):684–692. https://doi.org/10.1007/s00774-021-01213-6

    Article  CAS  PubMed  Google Scholar 

  22. Knutsson E, Lying-Tunell U (1985) Gait apraxia in normal-pressure hydrocephalus: patterns of movement and muscle activation. Neurology 35(2):155–160. https://doi.org/10.1212/wnl.35.2.155

    Article  CAS  PubMed  Google Scholar 

  23. Stolze H, Kuhtz-Buschbeck JP, Drücke H, Jöhnk K, Diercks C, Palmié S, Mehdorn HM, Illert M, Deuschl G (2000) Gait analysis in idiopathic normal pressure hydrocephalus–which parameters respond to the CSF tap test? Clin Neurophysiol 111(9):1678–1686. https://doi.org/10.1016/s1388-2457(00)00362-x

    Article  CAS  PubMed  Google Scholar 

  24. Matsuoka T, Iida JI, Kawahara M, Uchiyama Y (2016) Investigation and clinical applications of muscle strength change in cerebrospinal fluid tap test in cases of idiopathic normal pressure hydrocephalus: A retrospective study. J Neurol Sci 371:18–23. https://doi.org/10.1016/j.jns.2016.10.009

    Article  PubMed  Google Scholar 

  25. Canaslan K, Ates Bulut E, Kocyigit SE, Aydin AE, Isik AT (2022) Predictivity of the comorbidity indices for geriatric syndromes. BMC Geriatr 22(1):440. https://doi.org/10.1186/s12877-022-03066-8

    Article  PubMed  PubMed Central  Google Scholar 

  26. Unutmaz GD, Soysal P, Tuven B, Isik AT (2018) Costs of medication in older patients: before and after comprehensive geriatric assessment. Clin Interv Aging 13:607–613. https://doi.org/10.2147/cia.s159966

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Guigoz Y, Lauque S, Vellas BJ (2002) Identifying the elderly at risk for malnutrition. the mini nutritional assessment. Clin Geriatr Med 18(4):737–757. https://doi.org/10.1016/s0749-0690(02)00059-9

    Article  PubMed  Google Scholar 

  28. Ates Bulut E, Soysal P, Dokuzlar O, Kocyigit SE, Aydin AE, Yavuz I, Isik AT (2020) Validation of population-based cutoffs for low muscle mass and strength in a population of Turkish elderly adults. Aging Clin Exp Res. https://doi.org/10.1007/s40520-019-01448-4

    Article  PubMed  Google Scholar 

  29. Janssen I, Heymsfield SB, Baumgartner RN (1985) Ross R (2000) estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol (Bethesda, Md : 1985) 89(2):465–471

    Article  Google Scholar 

  30. Owler BK, Momjian S, Czosnyka Z, Czosnyka M, Péna A, Harris NG, Smielewski P, Fryer T, Donovan T, Coles J, Carpenter A, Pickard JD (2004) Normal pressure hydrocephalus and cerebral blood flow: a PET study of baseline values. J Cereb Blood Flow Metab 24(1):17–23. https://doi.org/10.1097/01.Wcb.0000093326.88757.49

    Article  PubMed  Google Scholar 

  31. Wang Z, Zhang Y, Hu F, Ding J, Wang X (2020) Pathogenesis and pathophysiology of idiopathic normal pressure hydrocephalus. CNS Neurosci Ther 26(12):1230–1240. https://doi.org/10.1111/cns.13526

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Manini TM, Hong SL, Clark BC (2013) Aging and muscle: a neuron’s perspective. Curr Opin Clin Nutr Metab Care 16(1):21–26. https://doi.org/10.1097/MCO.0b013e32835b5880

    Article  CAS  PubMed  Google Scholar 

  33. Tarkowski E, Tullberg M, Fredman P, Wikkelsö C (2003) Normal pressure hydrocephalus triggers intrathecal production of TNF-alpha. Neurobiol Aging 24(5):707–714. https://doi.org/10.1016/s0197-4580(02)00187-2

    Article  CAS  PubMed  Google Scholar 

  34. Khoo HM, Kishima H, Tani N, Oshino S, Maruo T, Hosomi K, Yanagisawa T, Kazui H, Watanabe Y, Shimokawa T, Aso T, Kawaguchi A, Yamashita F, Saitoh Y, Yoshimine T (2016) Default mode network connectivity in patients with idiopathic normal pressure hydrocephalus. J Neurosurg 124(2):350–358. https://doi.org/10.3171/2015.1.Jns141633

    Article  PubMed  Google Scholar 

  35. Chistyakov AV, Hafner H, Sinai A, Kaplan B, Zaaroor M (2012) Motor cortex disinhibition in normal-pressure hydrocephalus. J Neurosurg 116(2):453–459. https://doi.org/10.3171/2011.9.Jns11678

    Article  PubMed  Google Scholar 

  36. Morley JE (2021) Sarcopenia and the Brain. Arq Neuropsiquiatr 79(5):373–375. https://doi.org/10.1590/0004-282X-ANP-2021-e005

    Article  PubMed  Google Scholar 

  37. Wolfsegger T, Topakian R (2017) Cognitive impairment predicts worse short-term response to spinal tap test in normal pressure hydrocephalus. J Neurol Sci 379:222–225. https://doi.org/10.1016/j.jns.2017.06.028

    Article  PubMed  Google Scholar 

  38. Hamilton R, Patel S, Lee EB, Jackson EM, Lopinto J, Arnold SE, Clark CM, Basil A, Shaw LM, Xie SX, Grady MS, Trojanowski JQ (2010) Lack of shunt response in suspected idiopathic normal pressure hydrocephalus with Alzheimer disease pathology. Ann Neurol 68(4):535–540. https://doi.org/10.1002/ana.22015

    Article  PubMed  PubMed Central  Google Scholar 

  39. Carson RG (2018) Get a grip: individual variations in grip strength are a marker of brain health. Neurobiol Aging 71:189–222. https://doi.org/10.1016/j.neurobiolaging.2018.07.023

    Article  PubMed  Google Scholar 

  40. Black PM (1980) Idiopathic normal-pressure hydrocephalus. results of shunting in 62 patients. J Neurosurg 52(3):371–377. https://doi.org/10.3171/jns.1980.52.3.037

    Article  CAS  PubMed  Google Scholar 

  41. Stolze H, Kuhtz-Buschbeck JP, Drücke H, Jöhnk K, Illert M, Deuschl G (2001) Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson’s disease. J Neurol Neurosurg Psychiatry 70(3):289–297. https://doi.org/10.1136/jnnp.70.3.289

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Said HM, Kaya D, Yavuz I, Dost FS, Altun ZS, Isik AT (2022) A Comparison of cerebrospinal fluid beta-amyloid and tau in idiopathic normal pressure hydrocephalus and neurodegenerative dementias. Clin Interv Aging 17:467–477. https://doi.org/10.2147/cia.S360736

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors thank Idil Yavuz for the valuable statistical support.

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Authors and Affiliations

Authors

Contributions

AEA: Conceptualization, Methodology, Data Curation, Writing—Original Draft; FSD: Data Curation, Formal analysis, Writing; DK: Conceptualization, Writing—Original Draft; EAB: Conceptualization, Methodology, Writing—Review & Editing; FM: Data Curation, Writing—Original Draft; ATI: Conceptualization, Writing—Review & Editing, Supervision.

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Correspondence to Ahmet Turan Isik.

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The authors declare no conflicts of interest.

Ethical approval

The study was approved by the ethics committee for Non-Interventional Studies. Informed consent was taken from all participants or parents/legal guardians. The study conformed to the ethical norms and standards in the Declaration of Helsinki.

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Aydin, A.E., Dost, F.S., Kaya, D. et al. Sarcopenia in older patients with idiopathic normal pressure hydrocephalus: an observational study from a single geriatric clinic in Turkey. Acta Neurol Belg (2024). https://doi.org/10.1007/s13760-024-02583-0

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