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A computerized neuropsychological test battery designed for idiopathic normal pressure hydrocephalus
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. Blekinge Centre of Competence, Blekinge Hospital Karlskrona, Karlskrona, Sweden.
Umeå University, Faculty of Science and Technology, Centre for Biomedical Engineering and Physics (CMTF). Umeå University, Faculty of Medicine, Department of Radiation Sciences.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
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2014 (English)In: Fluids and Barriers of the CNS, ISSN 2045-8118, Vol. 11, 22Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A tool for standardized and repeated neuropsychological assessments in patients with idiopathic normal pressure hydrocephalus (INPH) is needed. The objective of this study was to develop a computerized neuropsychological test battery designed for INPH and to evaluate its reliability, validity and patient's ability to complete the tests.

METHODS: Based on a structured review of the literature on neuropsychological testing in INPH, the eight tests most sensitive to the INPH cognitive profile were implemented in a computerized format. The Geriatric Depression Scale (GDS) was also included. Tests were presented on a touch-screen monitor, with animated instructions and speaker sound. The battery was evaluated with the following cohorts: A. Test-retest reliability, 44 healthy elderly; B. Validity against standard pen and pencil testing, 28 patients with various cognitive impairments; C. Ability to complete test battery, defined as completion of at least seven of the eight tests, 40 investigated for INPH.

RESULTS: A. All except the figure copy test showed good test-retest reliability, r = 0.67-0.90; B. A high correlation was seen between conventional and computerized tests (r = 0.66-0.85) except for delayed recognition and figure copy task; C. Seventy-eight percent completed the computerized battery; Patients diagnosed with INPH (n = 26) performed worse on all tests, including depression score, compared to healthy controls.

CONCLUSIONS: A new computerized neuropsychological test battery designed for patients with communicating hydrocephalus and INPH was introduced. Its reliability, validity for general cognitive impairment and completion rate for INPH was promising. After exclusion of the figure copy task, the battery is ready for clinical evaluation and as a next step we suggest validation for INPH and a comparison before and after shunt surgery.


Place, publisher, year, edition, pages
2014. Vol. 11, 22
Keyword [en]
Dementia, Hydrocephalus, Normal pressure, Neuropsychological tests, Neuropsychology, Reliability and validity, Software
National Category
Psychiatry Neurology
Research subject
URN: urn:nbn:se:umu:diva-96190DOI: 10.1186/2045-8118-11-22PubMedID: 25279138OAI: diva2:762517
Available from: 2014-11-12 Created: 2014-11-12 Last updated: 2015-05-25Bibliographically approved
In thesis
1. Measurements in Idiopathic Normal Pressure Hydrocephalus: Computerized neuropsychological test battery and intracranial pulse waves
Open this publication in new window or tab >>Measurements in Idiopathic Normal Pressure Hydrocephalus: Computerized neuropsychological test battery and intracranial pulse waves
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Idiopathic Normal Pressure Hydrocephalus (INPH) is a condition affecting gait, cognition and continence. Radiological examination reveals enlarged ventricles of the brain. A shunt that drains CSF from the ventricles to the abdomen often improves the symptoms. Much research on INPH has been focused on identifying tests that predict the outcome after shunt surgery. As part of this quest, there are attempts to find measurement methods of intracranial parameters that are valid, reliable, tolerable and safe for patients.

Today's technologies for intracranial pressure (ICP) measurement are invasive, often requiring a burr-hole in the skull. Recently, a method for non-invasive ICP measurements was suggested: the Pulsatile Index (PI) calculated from transcranial Doppler data assessed from the middle cerebral artery. In this thesis the relation between PI and ICP was explored in INPH patients during controlled ICP regulation by lumbar infusion. The confidence interval for predicted ICP, based on measured PI was too large for the method to be of clinical utility.

In the quest for better predictive tests for shunt success in INPH, recent studies have shown promising results with criteria based on cardiac related ICP wave amplitudes. The brain ventricular system, and the fluid surrounding the spinal cord are in contact. In this thesis it was shown that ICP waves could be measured via lumbar subarachnoid space, with a slight underestimation.

One of the cardinal symptoms of hydrocephalus is cognitive impairment. Neuropsychological studies have demonstrated cognitive tests that are impaired and improve after shunt surgery in INPH patients. However, there is currently no standardized test battery and different studies use different tests. In response, in this thesis a fully automated computerized neuropsychological test battery was developed. The validity, reliability, responsiveness to improvement after shunt surgery and feasibility for testing INPH patients was demonstrated. It was also demonstrated that INPH patients were impaired in all subtests, compared to healthy elderly. 

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 67 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1689
Hydrocephalus, Normal Pressure; Neuropsychological tests; Neuropsychology; Reliability and validity; Software; Dementia; intracranial pressure; spinal puncture; cerebrospinal fluid pressure; pulse pressure waves; Blood flow velocity; Middle cerebral artery; Pulsatility index
National Category
Medical and Health Sciences
Research subject
urn:nbn:se:umu:diva-96195 (URN)978-91-7601-155-3 (ISBN)
Public defence
2014-12-05, Sal E04 Unod R1, Umeå, 13:00 (Swedish)
Available from: 2014-11-14 Created: 2014-11-12 Last updated: 2015-10-01Bibliographically approved

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