Abstract Details

Title Prevalence of Cerebral Microbleeds in Patients with Idiopathic Normal Pressure Hydrocephalus and their Impact on Post-Shunt Outcome

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 10-008

Objective To investigate the prevalence of small vessel disease (SVD) and cerebral amyloid angiopathy (CAA) biomarkers in patients with idiopathic normal pressure hydrocephalus (iNPH) and the 1-year post-shunt outcome.

Background iNPH is the leading cause of reversible dementia in older adults and frequently associated with Alzheimer’s disease and vascular dementia. Cerebral microbleeds (CMBs) are considered to be a robust biomarker of brain small-vessel disease (SVD) - frequently associated with cerebral amyloid angiopathy and hypertensive vasculopathy. However, the prevalence of CMBs and their impact on post-shunt outcome have never been studied in iNPH patients.

Design/Methods In this retrospective study, we included 73 consecutive patients (mean age 76±6.9 years, 38% female, median MMSE score 26, range 17-30) diagnosed with iNPH between 07/2004 and 02/2019. The presence and the repartition of CMBs were assessed using the Microbleed Anatomic Rating Scale (MARS). The 1-year post-ventriculoperitoneal shunt outcome has been defined by a clinical gait assessment.

Results CMBs were identified in 30/73 patients (41%, range 1-110) with 15 patients (21%) having at least 2 or more CMBs. The CMB localization was distributed as follows: deep in 9 (30%), superficial in 11 (37%), infratentorial in 3 (10%), and mixed in 7 patients (23%). The CMBs distribution met the diagnosis of probable-CAA according to Boston modified criteria in 10/73 iNPH patients (14%). Among the 24/73 iNPH patients, who underwent a shunt surgery and 1-year follow-up: 14/15 patients without CMBs and 8/9 patients with CMBs presented a gait improvement (p-value = 0.62).

Conclusions The prevalence of CMBs and the presence of CAA are higher in iNPH patients than those reported in the general population. However, the 1-year post shunt outcome did not differ between patients with and without CMBs. Future studies should investigate, if CAA affects the post-shunt outcome in iNPH patients.

Authors/Disclosures
Lukas Sveikata (University of Geneva) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Anand Viswanathan, MD (Massachusetts General Hospital)	Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alnylam Pharmaceuticals. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Pharmaceuticals.
Gilles Allali, MD, PhD	Dr. Allali has nothing to disclose.