{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:27:23Z","timestamp":1786976843788,"version":"build-2736575974"},"reference-count":45,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["HR22C141101"],"award-info":[{"award-number":["HR22C141101"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["RS\u20102024\u201000404555"],"award-info":[{"award-number":["RS\u20102024\u201000404555"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["RS\u20102024\u201000440131"],"award-info":[{"award-number":["RS\u20102024\u201000440131"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008005","name":"Yonsei University College of Medicine","doi-asserted-by":"publisher","award":["6\u20102021\u20100240"],"award-info":[{"award-number":["6\u20102021\u20100240"]}],"id":[{"id":"10.13039\/501100008005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["alz-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alzheimer's &amp;amp; Dementia"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>INTRODUCTION<\/jats:title>\n                    <jats:p>Coexisting degenerative pathologies may influence the efficacy of ventriculoperitoneal (VP) shunting in idiopathic normal pressure hydrocephalus (iNPH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We evaluated 58 iNPH patients who underwent VP shunting with cortical biopsy assessing pathologies including amyloid beta (A\u03b2). Concordance between biopsy\u2010identified Alzheimer's pathology and amyloid positron emission tomography (PET) and the influence of magnetic resonance imaging\u2010based iNPH indices, dopamine transporter (DAT) imaging, and biopsy pathologies on postoperative outcomes were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A\u03b2 pathology was found in 23 patients (39.7%) and showed high concordance with amyloid PET (95.2%). Although A\u03b2 positivity was associated with poorer 1\u2010year cognitive outcome, and cognitive improvement reached significance only in A\u03b2\u2010negative patients, both A\u03b2\u2010positive and A\u03b2\u2010negative groups exhibited functional improvement after surgery. Lower anterior striatal DAT uptake was paradoxically associated with better postoperative outcomes, particularly in A\u03b2\u2010positive individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>Cortical biopsy provides information concordant with amyloid PET, and biopsy\u2010confirmed Alzheimer's pathology and dopaminergic status influence shunt efficacy. VP shunting remains beneficial in iNPH even with degenerative comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Cortical biopsy findings showed high concordance with amyloid PET in iNPH patients.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>AD pathology was linked to poorer cognitive and functional outcomes after surgery.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>VP shunting remained beneficial even in patients with comorbid AD pathology.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Lower anterior striatal DAT uptake was paradoxically associated with better outcomes.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Combined use of biopsy and DAT imaging may aid prognostication in iNPH management.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.70974","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T05:19:41Z","timestamp":1765343981000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Degenerative pathologies on cortical biopsy, dopaminergic depletion, and shunt efficacy in iNPH"],"prefix":"10.1002","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0187-8440","authenticated-orcid":false,"given":"Byoung Seok","family":"Ye","sequence":"first","affiliation":[{"name":"Department of Neurology Yonsei University College of Medicine  Seoul Republic of Korea"},{"name":"Metabolism\u2010Dementia Research Institute Yonsei University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So Hee","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Yeungnam University College of Medicine  Daegu Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seun","family":"Jeon","sequence":"additional","affiliation":[{"name":"Department of Neurology Yonsei University College of Medicine  Seoul Republic of Korea"},{"name":"Metabolism\u2010Dementia Research Institute Yonsei University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungwoo","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Neurology Hanyang University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Se Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pathology Yonsei University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won Seok","family":"Chang","sequence":"additional","affiliation":[{"name":"Metabolism\u2010Dementia Research Institute Yonsei University College of Medicine  Seoul Republic of Korea"},{"name":"Department of Neurosurgery Yonsei University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25053"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0217705"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000342"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.23736\/S0390-5616.18.04350-3"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.3171\/2022.1.JNS212282"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/2054-7072-1-2"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2015.10.044"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-020-01861-7"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000012064"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(65)90016-X"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.4.576"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/3-211-32318-X_49"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/cercor\/bhae001"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2010.12.008"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.3171\/2015.2.JNS142318"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.34.7.939"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004058"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.149.2.351"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.43.2.250"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-48940-6"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-008-1044-4"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.3171\/2016.9.JNS161080"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2019.10.020"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-024-01429-4"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2015.02.004"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2023.10.008"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.68.6.778"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2006.095117"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0317167100021442"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s007010050386"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22015"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1355617722000868"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22100"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70299-6"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00046-0"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-180645"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-006-0127-z"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00308809"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/cercor\/1.1.103"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-013-1211-9"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-020-01861-7"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.28366"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.28336"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13379"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1355617702813248"}],"container-title":["Alzheimer's &amp; Dementia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/alz-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alz.70974","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/alz-journals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/alz.70974","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/alz-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alz.70974","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T03:40:36Z","timestamp":1780285236000},"score":1,"resource":{"primary":{"URL":"https:\/\/alz-journals.onlinelibrary.wiley.com\/doi\/10.1002\/alz.70974"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":45,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/alz.70974"],"URL":"https:\/\/doi.org\/10.1002\/alz.70974","archive":["Portico"],"relation":{},"ISSN":["1552-5260","1552-5279"],"issn-type":[{"value":"1552-5260","type":"print"},{"value":"1552-5279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"2025-04-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70974"}}