Resting-state functional-MRI in iNPH: can default mode and motor networks changes improve patient selection and outcome? Preliminary report

Fluids and Barriers of the CNS

Research

Enrico Belgrado¹  Yan Tereshko¹  Daniele Bagatto²  Maria Cristina De Colle²  Sara Fabbro³  Maria Caterina Vescovi³  Miran Skrap³  Francesco Tuniz³  Daniele Piccolo⁴  Marta Maieron⁵ 

[1]Department of Neurology, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy

[2]Department of Neuroradiology, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy

[3]Department of Neurosurgery, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy

[4]Department of Neurosurgery, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy

[5]Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla 74, 27100, Pavia, Italy

[6]Department of Physics, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy

关键词: CSF dynamics;    Default-mode network;    Motor network;    Idiopathic normal pressure hydrocephalus;    Tap test;    Resting-state functional-MRI;    Ventriculoperitoneal shunt;   

DOI  :  10.1186/s12987-023-00407-6

 received in 2022-09-16, accepted in 2023-01-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIdiopathic normal pressure hydrocephalus (iNPH) is a progressive and partially reversible form of dementia, characterized by impaired interactions between multiple brain regions. Because of the presence of comorbidities and a lack of accurate diagnostic and prognostic biomarkers, only a minority of patients receives disease-specific treatment. Recently, resting-state functional-magnetic resonance imaging (rs-fMRI) has demonstrated functional connectivity alterations in inter-hemispheric, frontal, occipital, default-mode (DMN) and motor network (MN) circuits. Herein, we report our experience in a cohort of iNPH patients that underwent cerebrospinal fluid (CSF) dynamics evaluation and rs-fMRI. The study aimed to identify functional circuits related to iNPH and explore the relationship between DMN and MN recordings and clinical modifications before and after infusion and tap test, trying to understand iNPH pathophysiology and to predict the best responders to ventriculoperitoneal shunt (VPS) implant.MethodsWe prospectively collected data regarding clinical assessment, neuroradiological findings, lumbar infusion and tap test of thirty-two iNPH patients who underwent VPS implant. Rs-fMRI was performed using MELODIC-ICA both before and after the tap test. Rs-fMRI data of thirty healthy subjects were also recorded.ResultsAt the baseline, reduced z-DMN and z-MN scores were recorded in the iNPH cohort compared with controls. Higher z-scores were recorded in more impaired patients. Both z-scores significantly improved after the tap test except in subjects with a low resistance to outflow value and without a significant clinical improvement after the test. A statistically significant difference in mean MN connectivity scores for tap test responders and non-responders was demonstrated both before (p = 0.0236) and after the test (p = 0.00137). A statistically significant main effect of the tap test on DMN connectivity after CSF subtraction was recorded (p = 0.038).ConclusionsOur results suggest the presence of a partially reversible plasticity functional mechanism in DMN and MN. Low values compensate for the initial stages of the disease, while higher values of z-DMN were recorded in older patients with a longer duration of symptoms, suggesting an exhausted plasticity compensation. The standardization of this technique could play a role as a non-invasive biomarker in iNPH disease, suggesting the right time for surgery.Trial Registration Prot. IRB 090/2021.

【 授权许可】

CC BY   
© The Author(s) 2023

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