Tap Test Can Predict Cognitive Improvement in Patients With iNPH-Results From the Multicenter Prospective Studies SINPHONI-1 and -2

Madoka Nakajima; Shigeki Yamada; Masakazu Miyajima; Kaito Kawamura; Chihiro Akiba; Hiroaki Kazui; Etsuro Mori; Masatsune Ishikawa; SINPHONI-2 Investigators

doi:10.3389/fneur.2021.769216

Tap Test Can Predict Cognitive Improvement in Patients With iNPH-Results From the Multicenter Prospective Studies SINPHONI-1 and -2

Front Neurol. 2021 Nov 2:12:769216. doi: 10.3389/fneur.2021.769216. eCollection 2021.

Authors

Madoka Nakajima¹, Shigeki Yamada², Masakazu Miyajima³, Kaito Kawamura¹, Chihiro Akiba³, Hiroaki Kazui⁴, Etsuro Mori⁵, Masatsune Ishikawa⁶; SINPHONI-2 Investigators

Affiliations

¹ Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
² Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan.
³ Department of Neurosurgery, Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan.
⁴ Department of Neuropsychiatry, Kochi Medical School, Kochi University, Nankoku, Japan.
⁵ Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Japan.
⁶ Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan.

Abstract

Background: We analyzed the predictive value of the tap test (TT) on the outcome of cerebrospinal fluid (CSF) shunting in patients with idiopathic normal pressure hydrocephalus (iNPH) and cognitive impairment up to 12 months postoperatively. Methods: We analyzed the data of two prospective multicenter studies on ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS) use in iNPH patients. We selected patients with Mini-Mental State Examination (MMSE) scores ≤ 26 points as study subjects. We used a multivariate logistic regression model to obtain the optimal threshold of MMSE scores after TT to predict the score improvement at 12 months following shunting and that helped to control for confounding factors such as age and MMSE scores before TT. We used logistic regression models to identify variables with age-adjusted odds ratio (A-OR) and multivariate-adjusted OR (M-OR). Results: For an improvement of ≥3 points in the MMSE score cutoff 7 days following TT in VPS and LPS cohort studies, the MMSE scores improved by 6 points after 12 months. The VPS cohort had sensitivity, specificity, and area under the curve (AUC) of 69.2, 73.7, and 0.771%, respectively; however, for the LPS cohort, they were 86.2, 90.9, and 0.906%, respectively. For MMSE scores that improved by ≥3 points in patients after the TT, the possibility of an improvement by 6 points at 12 months following CSF shunt had A-OR 7.77 and M-OR 6.3 times for the VPS, and A-OR 62.3 and M-OR 59.6 times for the LPS cohort. Conclusion: CSF shunting contributes to improved cognitive function in iNPH patients. Furthermore, MMSE score evaluation at the TT can sensitively predict improvement in postoperative MMSE scores following LPS intervention. Clinical Trial Registration: SINPHONI-1 (ClinicalTrials.gov, no. NCT00221091), first posted: September 22, 2005. SINPHONI-2 [University Hospital Medical Information Network (UMIN) Clinical Trials no. UMIN000002730], the posted: February 1, 2010.

Keywords: Mini-Mental State Examination; cerebrospinal fluid shunt; cognitive function; healthy life expectancy; normal pressure hydrocephalus.

Associated data

ClinicalTrials.gov/NCT00221091