December 21, 2007

Shunt study seeks to refine dementia diagnosis

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Lynn Matrisian, Ph.D.

Shunt study seeks to refine dementia diagnosis

Normal pressure hydrocephalus (NPH) is a condition that can mimic other neurological disorders that affect the elderly.

It occurs when cerebrospinal fluid accumulates in the ventricles of the brain, causing them to enlarge. People with NPH develop symptoms such as imbalance, dementia and urinary incontinence, which are also associated with Alzheimer's and Parkinson's diseases.

For people with dementia, getting the proper diagnosis is critical. Unlike Alzheimer's, NPH-induced dementia is often reversible.

Symptoms of NPH can be alleviated by surgically implanting a shunt in the brain that redirects the fluid to the abdominal cavity, where it is reabsorbed into the bloodstream. The procedure works in 60 percent to 70 percent of patients.

Noel Tulipan, M.D., professor of Neurosurgery, is hoping to identify a marker that will indicate which patients stand to benefit the most from the shunt.

“It's critical to differentiate patients who have NPH from patients who have Alzheimer's because we can actually help the patients who have NPH,” Tulipan said.

With a grant from Medtronic, Tulipan will study 50 patients who receive the shunts. Upon placement of the shunt, he'll remove a small amount of fluid and study the level of transforming growth factor-beta (TGF-beta), a specific chemical in the spinal fluid.

“The study will attempt to see if there is a correlation between patients' responses to shunting and the level of this substance in the CSF,” Tulipan said. “We know for a fact that patients with NPH tend to have elevated levels of this compound.”

Patients will be evaluated to correlate response to shunting with levels of TGF-beta.

“I hope to find that there will be some clear-cut difference between the responders and the non-responders,” Tulipan said. “The eventual goal would be to bring a patient in, do a spinal tap on him, measure his TGF beta level and be able to tell him in advance what his chances are of responding to a shunt.”

Tulipan is currently recruiting 50 patients over the age of 18, with a target age range of 60-80. The procedure is relatively low risk, even for the elderly, Tulipan said. For more information about the NPH study, call 322-6875. Study participants will need a referral from their primary care physician or neurologist.