White Matter Distortion and Dementia Biomarkers in Normal Pressure Hydrocephalus (NPH)
Observational Study to Investigate the Effect of White Matter Tract Distortion and Neurodegenerative Biomarkers on Shunt-responsiveness in Idiopathic Normal Pressure Hydrocephalus (iNPH)
Imperial College London
100 participants
Mar 25, 2025
OBSERVATIONAL
Conditions
Summary
Idiopathic Normal Pressure Hydrocephalus (iNPH) is a progressive condition of the elderly that results in severe disability. iNPH can dramatically respond to Cerebral spinal fluid(CSF)-shunting where excess ventricular fluid is diverted from the brain. Not all patients with iNPH respond to CSF-shunting however. The reasons for this are uncertain. Aim 1: To understand if specific nerve pathways (white matter tracts) that are near ventricles are damaged in patients that respond to shunting as opposed to those that do not. Aim 2: Can we explain shunt non-responsiveness by screening for dementia like illnesses (neurodegeneration) using a large array of methods. Aim 3: To understand whether wearable activity and bed sleep monitors are palatable in a NPH population and to understand if these metrics relate to quality of life. Aim 4: To see whether self-administered digital cognitive assessments can measure improvements pre and post surgery.
Eligibility
Inclusion Criteria11
- Group 1 (communicating hydrocephalus):
- Adult patients \>60
- With gait apraxia
- With or without cognitive impairment
- Urinary dysfunction
- Communicating Hydrocephalus
- Healthy Carers
- Members of the Public
- Staff of Imperial College/ICHT
- Non-NPH Dementias (including Alzheimer's disease or vascular dementia)
- Asymptomatic Hydrocephalus
Exclusion Criteria13
- Asymptomatic hydrocephalus
- High pressure-hydrocephalus
- Serious head injury within 5 years of presentation or a clear secondary cause (e.g. brain infection)
- History of childhood gait disturbance
- Clear alternative explanation for symptoms (e.g. Parkinson's disease with limb rigidity, peripheral neuropathy with sensory ataxia, cervical myelopathy).
- Too frail for shunt surgery
- Medically unstable (e.g. active angina, respiratory disease, recurrent delirium, active epilepsy).
- Unable to tolerate MRI brain imaging
- Unable to have a lumbar puncture
- Immobile
- Unable to attend the hospital for study visits
- Group 2 (asymptomatic and non-hydrocepahlus dementia and healthy controls):
- \- Unable to attend the hospital for study visits
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Interventions
VP Shunt surgery involves surgical insertion of a catheter (tube) to divert brain fluid from the cerebral ventricles to the abdominal peritoneum. This will be performed in Group 1 patients as clinically indicated.
Brain and skin biopsy's may be taken during the VP shunt to assist in histological analysis for neurodegenerative changes.
MRI brain with diffusion imagining will be performed before and after shunt surgery.
Locations(1)
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NCT07103681