Real-Time Neuropsychological Testing for Hydrocephalus: Ultra-Fast Neuropsychological Testing During Infusion and Tap Test in Patients with Idiopathic Normal-Pressure Hydrocephalus
Background/Objectives: Ventriculoperitoneal shunting is a validated procedure for the treatment of idiopathic normal-pressure hydrocephalus. To select shunt-responsive patients, infusion and tap tests can be used. Only gait is evaluated after the procedure to establish a potential improvement. In th...
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2025-01-01
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| author | Ilaria Guarracino Sara Fabbro Daniele Piccolo Serena D’Agostini Miran Skrap Enrico Belgrado Marco Vindigni Francesco Tuniz Barbara Tomasino |
| author_facet | Ilaria Guarracino Sara Fabbro Daniele Piccolo Serena D’Agostini Miran Skrap Enrico Belgrado Marco Vindigni Francesco Tuniz Barbara Tomasino |
| author_sort | Ilaria Guarracino |
| collection | DOAJ |
| description | Background/Objectives: Ventriculoperitoneal shunting is a validated procedure for the treatment of idiopathic normal-pressure hydrocephalus. To select shunt-responsive patients, infusion and tap tests can be used. Only gait is evaluated after the procedure to establish a potential improvement. In this study, we present our Hydro-Real-Time Neuropsychological Testing protocol to assess the feasibility of performing an ultra-fast assessment of patients during the infusion and tap test. Methods: We tested 57 patients during the infusion and tap test to obtain real-time feedback on their cognitive status. Data were obtained immediately before the infusion phase (T0), when the pressure plateau was reached (T1), and immediately after cerebrospinal fluid subtraction (T2). Based on cerebrospinal fluid dynamics, 63.15% of the patients presented a resistance to outflow > 12 mmHg/mL/min, while 88% had a positive tap test response. Results: Compared to T0, cerebrospinal fluid removal significantly improved performance on tasks exploring executive functions (counting backward, <i>p</i> < 0.001; verbal fluency, <i>p</i> < 0.001). Patients were significantly faster at counting backward at T2 vs. T1 (<i>p</i> < 0.05) and at T2 vs. T0 (<i>p</i> < 0.001) and were significantly faster at counting forward at T2 vs. T1 (<i>p</i> < 0.005), suggesting an improvement in speed at T2. There was a significantly smaller index at T1 vs. T0 (<i>p</i> = 0.005) and at T2 vs. T0 (<i>p</i> < 0.001), suggesting a more marked improvement in patients’ executive abilities at T2 and a smaller improvement at T1. Regarding verbal fluency, patients were worse at T1 vs. T0 (<i>p</i> < 0.001) and at T2 vs. T0 (<i>p</i> < 0.001). Conclusions: Patients’ performance can be monitored during the infusion and tap test as significant changes in executive functions are observable. In future, this protocol might help improve patients’ selection for surgery. |
| format | Article |
| id | doaj-art-f9c408d127e94299be694d4048079f2c |
| institution | Kabale University |
| issn | 2076-3425 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
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| series | Brain Sciences |
| spelling | doaj-art-f9c408d127e94299be694d4048079f2c2025-01-24T13:25:45ZengMDPI AGBrain Sciences2076-34252025-01-011513610.3390/brainsci15010036Real-Time Neuropsychological Testing for Hydrocephalus: Ultra-Fast Neuropsychological Testing During Infusion and Tap Test in Patients with Idiopathic Normal-Pressure HydrocephalusIlaria Guarracino0Sara Fabbro1Daniele Piccolo2Serena D’Agostini3Miran Skrap4Enrico Belgrado5Marco Vindigni6Francesco Tuniz7Barbara Tomasino8Scientific Institute, IRCCS E. Medea, Dipartimento/Unità Operativa Pasian di Prato, 33037 Pasian di Prato, ItalyNeurosurgery Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, 33100 Udine, ItalyNeurosurgery Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, 33100 Udine, ItalyNeuroradiology Unit, Department of Diagnostic Imaging, Santa Maria della Misericordia University Hospital, 33100 Udine, ItalyNeurosurgery Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, 33100 Udine, ItalyDepartment of Neurology, Santa Maria della Misericordia University Hospital, 33100 Udine, ItalyNeurosurgery Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, 33100 Udine, ItalyNeurosurgery Unit, Head-Neck and Neurosciences Department, Santa Maria della Misericordia University Hospital, 33100 Udine, ItalyScientific Institute, IRCCS E. Medea, Dipartimento/Unità Operativa Pasian di Prato, 33037 Pasian di Prato, ItalyBackground/Objectives: Ventriculoperitoneal shunting is a validated procedure for the treatment of idiopathic normal-pressure hydrocephalus. To select shunt-responsive patients, infusion and tap tests can be used. Only gait is evaluated after the procedure to establish a potential improvement. In this study, we present our Hydro-Real-Time Neuropsychological Testing protocol to assess the feasibility of performing an ultra-fast assessment of patients during the infusion and tap test. Methods: We tested 57 patients during the infusion and tap test to obtain real-time feedback on their cognitive status. Data were obtained immediately before the infusion phase (T0), when the pressure plateau was reached (T1), and immediately after cerebrospinal fluid subtraction (T2). Based on cerebrospinal fluid dynamics, 63.15% of the patients presented a resistance to outflow > 12 mmHg/mL/min, while 88% had a positive tap test response. Results: Compared to T0, cerebrospinal fluid removal significantly improved performance on tasks exploring executive functions (counting backward, <i>p</i> < 0.001; verbal fluency, <i>p</i> < 0.001). Patients were significantly faster at counting backward at T2 vs. T1 (<i>p</i> < 0.05) and at T2 vs. T0 (<i>p</i> < 0.001) and were significantly faster at counting forward at T2 vs. T1 (<i>p</i> < 0.005), suggesting an improvement in speed at T2. There was a significantly smaller index at T1 vs. T0 (<i>p</i> = 0.005) and at T2 vs. T0 (<i>p</i> < 0.001), suggesting a more marked improvement in patients’ executive abilities at T2 and a smaller improvement at T1. Regarding verbal fluency, patients were worse at T1 vs. T0 (<i>p</i> < 0.001) and at T2 vs. T0 (<i>p</i> < 0.001). Conclusions: Patients’ performance can be monitored during the infusion and tap test as significant changes in executive functions are observable. In future, this protocol might help improve patients’ selection for surgery.https://www.mdpi.com/2076-3425/15/1/36neuropsychologyreal timeidiopathic hydrocephaluscerebrospinal fluid |
| spellingShingle | Ilaria Guarracino Sara Fabbro Daniele Piccolo Serena D’Agostini Miran Skrap Enrico Belgrado Marco Vindigni Francesco Tuniz Barbara Tomasino Real-Time Neuropsychological Testing for Hydrocephalus: Ultra-Fast Neuropsychological Testing During Infusion and Tap Test in Patients with Idiopathic Normal-Pressure Hydrocephalus Brain Sciences neuropsychology real time idiopathic hydrocephalus cerebrospinal fluid |
| title | Real-Time Neuropsychological Testing for Hydrocephalus: Ultra-Fast Neuropsychological Testing During Infusion and Tap Test in Patients with Idiopathic Normal-Pressure Hydrocephalus |
| title_full | Real-Time Neuropsychological Testing for Hydrocephalus: Ultra-Fast Neuropsychological Testing During Infusion and Tap Test in Patients with Idiopathic Normal-Pressure Hydrocephalus |
| title_fullStr | Real-Time Neuropsychological Testing for Hydrocephalus: Ultra-Fast Neuropsychological Testing During Infusion and Tap Test in Patients with Idiopathic Normal-Pressure Hydrocephalus |
| title_full_unstemmed | Real-Time Neuropsychological Testing for Hydrocephalus: Ultra-Fast Neuropsychological Testing During Infusion and Tap Test in Patients with Idiopathic Normal-Pressure Hydrocephalus |
| title_short | Real-Time Neuropsychological Testing for Hydrocephalus: Ultra-Fast Neuropsychological Testing During Infusion and Tap Test in Patients with Idiopathic Normal-Pressure Hydrocephalus |
| title_sort | real time neuropsychological testing for hydrocephalus ultra fast neuropsychological testing during infusion and tap test in patients with idiopathic normal pressure hydrocephalus |
| topic | neuropsychology real time idiopathic hydrocephalus cerebrospinal fluid |
| url | https://www.mdpi.com/2076-3425/15/1/36 |
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