{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T21:54:31Z","timestamp":1788904471002,"version":"build-2803163510"},"reference-count":104,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,9]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Normal pressure hydrocephalus (NPH) is clinically characterized by gait disturbance, cognitive impairment, and urinary incontinence, as well as enlargement of the ventricles. To the best of the authors' knowledge, there have been no previous publications regarding the correlation between bulbar dysfunction and NPH. The primary objective of this study was to compare preoperative and postoperative prevalence of bulbar dysfunction in patients with NPH. Secondary objectives included assessing the results of surgery for swallowing, speech, gait, cognition, and urination, and evaluating the correlation between bulbar dysfunction and triad symptoms.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Fifty-three patients with NPH who underwent shunt placement surgery at Siriraj Hospital were included in the study. Patients were evaluated for gait, cognition, urination, swallowing, and speech before and 6 months after shunt placement. Triad symptoms were assessed using standard methods. Bulbar dysfunctions were assessed using the Swallowing Problem Questionnaire, Thai Articulation Test, Resonation Screening Test (RST), and Thai Nasality Test. The Thai Speech Assessment Program and nasometer were used for objective speech measurement.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Preoperatively, 86% (43\/50) of patients had swallowing problems and 75% (37\/49) had speech problems, as measured by the RST. Postoperatively, there was significant improvement in swallowing (p < 0.001), speech problems by RST (p = 0.008), and voice volume (p = 0.009), but no significant change in the nasometer test. All triad symptoms were improved. There were significant correlations between swallowing impairment and gait disturbance (r = 0.358, p = 0.009), and RST and cognitive impairment (r = \u22120.502, p < 0.001).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This is the first study of bulbar dysfunction in patients with NPH. The results showed that the prevalence of bulbar dysfunction is very high. The correlation between bulbar dysfunction and the classic NPH triad has been documented and published. These bulbar symptoms also significantly improved after surgery. As such, bulbar dysfunction should be regarded as a core symptom that should be considered along with the classic triad in the clinical diagnosis and management of NPH.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2016.6.focus16183","type":"journal-article","created":{"date-parts":[[2016,9,1]],"date-time":"2016-09-01T03:39:30Z","timestamp":1472701170000},"page":"E15","source":"Crossref","is-referenced-by-count":12,"title":["Bulbar dysfunction in normal pressure hydrocephalus: a prospective study"],"prefix":"10.3171","volume":"41","author":[{"given":"Ekawut","family":"Chankaew","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prajak","family":"Srirabheebhat","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sriwimon","family":"Manochiopinig","sequence":"additional","affiliation":[{"name":"Division of Speech-Language Therapy, Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theerapol","family":"Witthiwej","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itsara","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus16183","series-title":"Schweiz Arch Neurol Neurochir Psychiatr","first-page":"7","article-title":"Recent observations on normal pressure hydrocephalus","volume":"116","author":"Adams","year":"1975"},{"key":"b2-focus16183","series-title":"N Engl J Med","first-page":"117","article-title":"Symptomatic occult hydrocephalus with \u201cnormal\u201d cerebrospinal-fluid pressure. A treatable syndrome","volume":"273","author":"Adams","year":"1965"},{"key":"b3-focus16183","series-title":"J Adv Nurs","first-page":"477","article-title":"Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review","volume":"65","author":"Bours","year":"2009"},{"key":"b4-focus16183","series-title":"J Neurosurg","first-page":"453","article-title":"Motor cortex disinhibition in normal-pressure hydrocephalus","volume":"116","author":"Chistyakov","year":"2012"},{"key":"b5-focus16183","series-title":"Cleft Palate Craniofac J","first-page":"285","article-title":"Nasometric sensitivity and specificity: a cross-dialect and cross-culture study","volume":"30","author":"Dalston","year":"1993"},{"key":"b6-focus16183","series-title":"Acta Neurochir (Wien)","first-page":"1141","article-title":"Changes in intracranial pulse pressure amplitudes after shunt implantation and adjustment of shunt valve opening pressure in normal pressure hydrocephalus","volume":"150","author":"Eide","year":"2008"},{"key":"b7-focus16183","series-title":"Neurosurgery","first-page":"1219","article-title":"The neuropsychology of patients with clinically diagnosed idiopathic normal pressure hydrocephalus","volume":"61","author":"Hellstr\u00f6m","year":"2007"},{"key":"b8-focus16183","series-title":"Acta Neurol Scand","first-page":"229","article-title":"A new scale for assessment of severity and outcome in iNPH","volume":"126","author":"Hellstr\u00f6m","year":"2012"},{"key":"b9-focus16183","series-title":"Neurosurg Rev","first-page":"239","article-title":"DTI-MRI biomarkers in the search for normal pressure hydrocephalus aetiology: a review","volume":"38","author":"Hoza","year":"2015"},{"key":"b10-focus16183","series-title":"J Commun Disord","first-page":"469","article-title":"Patterns of nasalance in a sample of normal gerontologic subjects","volume":"11","author":"Hutchinson","year":"1978"},{"key":"b11-focus16183","series-title":"Neurology","first-page":"309","article-title":"Corticofugal projections to the motor nuclei of the brain-stem and spinal cord in humans","volume":"40","author":"Iwatsubo","year":"1990"},{"key":"b12-focus16183","series-title":"JAMA","first-page":"510","article-title":"\u201cNormal-pressure\u201d hydrocephalus. Relationship of clinical and radiographic findings to improvement following shunt surgery","volume":"235","author":"Jacobs","year":"1976"},{"key":"b13-focus16183","series-title":"Neurosci Lett","first-page":"80","article-title":"The anatomical location of the corticobulbar tract at the corona radiata in the human brain: diffusion tensor tractography study","volume":"590","author":"Jang","year":"2015"},{"key":"b14-focus16183","series-title":"J Neurol","first-page":"1949","article-title":"White matter involvement in idiopathic normal pressure hydrocephalus: a voxel-based diffusion tensor imaging study","volume":"258","author":"Kanno","year":"2011"},{"key":"b15-focus16183","series-title":"AJNR Am J Neuroradiol","first-page":"1496","article-title":"Differential diagnosis of idiopathic normal pressure hydrocephalus from other dementias using diffusion tensor imaging","volume":"32","author":"Kim","year":"2011"},{"key":"b16-focus16183","series-title":"Acta Neurol Scand","first-page":"145","article-title":"One-year outcome in the European multicentre study on iNPH","volume":"126","author":"Klinge","year":"2012"},{"issue":"3 Suppl","key":"b17-focus16183","series-title":"Neurosurgery","first-page":"S40","article-title":"Outcome of shunting in idiopathic normal-pressure hydrocephalus and the value of outcome assessment in shunted patients","volume":"57","author":"Klinge","year":"2005"},{"key":"b18-focus16183","series-title":"Lang Speech Hear Serv Sch","first-page":"271","article-title":"Evaluation and treatment of resonance disorders","volume":"27","author":"Kummer","year":"1996"},{"key":"b19-focus16183","series-title":"Brain","first-page":"364","article-title":"Corticobular connexions to the pons and lower brain-stem in man: an anatomical study","volume":"81","author":"Kuypers","year":"1958"},{"key":"b20-focus16183","series-title":"Dysphagia","first-page":"142","article-title":"Periventricular white matter changes and oropharyngeal swallowing in normal individuals","volume":"7","author":"Levine","year":"1992"},{"key":"b21-focus16183","series-title":"Brain Struct Funct","first-page":"3337","article-title":"Anatomy and lateralization of the human corticobulbar tracts: an fMRI-guided tractography study","volume":"221","author":"Liegeois","year":"2016"},{"key":"b22-focus16183","series-title":"J Commun Disord","first-page":"55","article-title":"The effect of gender upon nasalance scores among normal adult speakers","volume":"25","author":"Litzaw","year":"1992"},{"key":"b23-focus16183","series-title":"Evaluation and Treatment of Swallowing Disorders","author":"Logemann","year":"1998"},{"key":"b24-focus16183","series-title":"Clin Neurol Neurosurg","first-page":"192","article-title":"How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study","volume":"115","author":"Lundin","year":"2013"},{"key":"b25-focus16183","series-title":"Siriraj Hosp Gaz","first-page":"155","article-title":"Applicability of Thai nasality test","volume":"52","author":"Manochiopinig","year":"2000"},{"key":"b26-focus16183","series-title":"Siriraj Hosp Gaz","first-page":"763","article-title":"[The Articulation Characteristics of Normal Thai Children age 3\u201310 years Assessing by Using the Thai Articulation Test (TAT).]","volume":"50","author":"Manochiopinig","year":"1998"},{"key":"b27-focus16183","series-title":"Disabil Rehabil Assist Technol","first-page":"332","article-title":"Dysarthric speech characteristics of Thai stroke patients","volume":"3","author":"Manochiopinig","year":"2008"},{"key":"b28-focus16183","series-title":"Acta Neurochir Suppl","first-page":"237","article-title":"Guidelines for management of idiopathic normal pressure hydrocephalus: progress to date","volume":"95","author":"Marmarou","year":"2005"},{"key":"b29-focus16183","series-title":"J Neurosurg","first-page":"987","article-title":"Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patients","volume":"102","author":"Marmarou","year":"2005"},{"key":"b30-focus16183","series-title":"Neurosurgery","first-page":"699","article-title":"Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus","volume":"57","author":"McGirt","year":"2005"},{"key":"b31-focus16183","series-title":"Acta Neurochir (Wien)","first-page":"1241","article-title":"Restoration of sexual activity in patients with chronic hydrocephalus after shunt placement","volume":"151","author":"Missori","year":"2009"},{"key":"b32-focus16183","series-title":"Brain","first-page":"965","article-title":"Pattern of white matter regional cerebral blood flow and autoregulation in normal pressure hydrocephalus","volume":"127","author":"Momjian","year":"2004"},{"key":"b33-focus16183","series-title":"Neurol Med Chir (Tokyo)","first-page":"775","article-title":"Guidelines for management of idiopathic normal pressure hydrocephalus: second edition","volume":"52","author":"Mori","year":"2012"},{"key":"b34-focus16183","series-title":"Arq Neuropsiquiatr","first-page":"435","article-title":"Psychiatric symptoms are present in most of the patients with idiopathic normal pressure hydrocephalus","volume":"72","author":"Oliveira","year":"2014"},{"key":"b35-focus16183","series-title":"J Neurosurg","first-page":"832","article-title":"Evaluation of ventriculomegaly using diffusion tensor imaging: correlations with chronic hydrocephalus and atrophy","volume":"112","author":"Osuka","year":"2010"},{"key":"b36-focus16183","series-title":"AJNR Am J Neuroradiol","first-page":"1274","article-title":"Somatotopic organization of motor pathways in the internal capsule: a probabilistic diffusion tractography study","volume":"33","author":"Pan","year":"2012"},{"key":"b37-focus16183","series-title":"J Plast Reconstr Aesthet Surg","first-page":"173","article-title":"Nasalance scores for normal Korean-speaking adults and children","volume":"67","author":"Park","year":"2014"},{"key":"b38-focus16183","series-title":"Brain","first-page":"389","article-title":"Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation","volume":"60","author":"Penfield","year":"1937"},{"key":"b39-focus16183","series-title":"Int Psychogeriatr","first-page":"465","article-title":"Psychiatric manifestations of normal-pressure hydrocephalus: a short review and unusual case","volume":"9","author":"Pinner","year":"1997"},{"key":"b40-focus16183","series-title":"Neurochirurgie","first-page":"216","article-title":"Deformation of the corona radiata and internal capsule in normal pressure hydrocephalus","volume":"60","author":"Rogers","year":"2014"},{"key":"b41-focus16183","series-title":"J Am Med Dir Assoc","first-page":"697","article-title":"Dysphagia in dementia: influence of dementia severity and food texture on the prevalence of aspiration and latency to swallow in hospitalized geriatric patients","volume":"16","author":"R\u00f6sler","year":"2015"},{"key":"b42-focus16183","series-title":"Ann Nucl Med","first-page":"39","article-title":"Cerebral perfusion pattern of idiopathic normal pressure hydrocephalus studied by SPECT and statistical brain mapping","volume":"21","author":"Sasaki","year":"2007"},{"key":"b43-focus16183","series-title":"Acta Neurochir (Wien)","first-page":"849","article-title":"Prevalence of Alzheimer's disease in patients investigated for presumed normal pressure hydrocephalus: a clinical and neuropathological study","volume":"141","author":"Savolainen","year":"1999"},{"key":"b44-focus16183","series-title":"Curr Opin Neurobiol","first-page":"15","article-title":"The laryngeal motor cortex: its organization and connectivity","volume":"28","author":"Simonyan","year":"2014"},{"key":"b45-focus16183","series-title":"Clin Neurophysiol","first-page":"1678","article-title":"Gait analysis in idiopathic normal pressure hydrocephalus\u2014which parameters respond to the CSF tap test?","volume":"111","author":"Stolze","year":"2000"},{"key":"b46-focus16183","series-title":"Cleft Palate Craniofac J","first-page":"168","article-title":"Nasalance scores for normal-speaking Irish children","volume":"41","author":"Sweeney","year":"2004"},{"key":"b47-focus16183","series-title":"Neurosurg Rev","first-page":"433","article-title":"Natural history of idiopathic normal-pressure hydrocephalus","volume":"34","author":"Toma","year":"2011"},{"key":"b48-focus16183","series-title":"Siriraj Hosp Gaz","first-page":"359","article-title":"[Thai Mental State Examination (TMSE).]","volume":"45","author":"Train The Brain Forum Committee","year":"1993"},{"key":"b49-focus16183","series-title":"Cleft Palate Craniofac J","first-page":"112","article-title":"Nasometric values for normal nasal resonance in the speech of young Flemish adults","volume":"38","author":"Van Lierde","year":"2001"},{"key":"b50-focus16183","series-title":"AJNR Am J Neuroradiol","first-page":"2311","article-title":"Preoperative prognostic value of MRI findings in 108 patients with idiopathic normal pressure hydrocephalus","volume":"35","author":"Virhammar","year":"2014"},{"key":"b51-focus16183","series-title":"Cleft Palate Craniofac J","first-page":"119","article-title":"Nasalance measures in Cantonese-speaking women","volume":"38","author":"Whitehill","year":"2001"},{"key":"b52-focus16183","series-title":"J Comput Assist Tomogr","first-page":"531","article-title":"In patients with idiopathic normal pressure hydrocephalus postoperative cerebral perfusion changes measured by dynamic susceptibility contrast magnetic resonance imaging correlate with clinical improvement","volume":"39","author":"Ziegelitz","year":"2015"},{"key":"b1-focus16183","series-title":"Schweiz Arch Neurol Neurochir Psychiatr","first-page":"7","article-title":"Recent observations on normal pressure hydrocephalus","volume":"116","author":"Adams","year":"1975"},{"key":"b2-focus16183","series-title":"N Engl J Med","first-page":"117","article-title":"Symptomatic occult hydrocephalus with \u201cnormal\u201d cerebrospinal-fluid pressure. A treatable syndrome","volume":"273","author":"Adams","year":"1965"},{"key":"b3-focus16183","series-title":"J Adv Nurs","first-page":"477","article-title":"Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review","volume":"65","author":"Bours","year":"2009"},{"key":"b4-focus16183","series-title":"J Neurosurg","first-page":"453","article-title":"Motor cortex disinhibition in normal-pressure hydrocephalus","volume":"116","author":"Chistyakov","year":"2012"},{"key":"b5-focus16183","series-title":"Cleft Palate Craniofac J","first-page":"285","article-title":"Nasometric sensitivity and specificity: a cross-dialect and cross-culture study","volume":"30","author":"Dalston","year":"1993"},{"key":"b6-focus16183","series-title":"Acta Neurochir (Wien)","first-page":"1141","article-title":"Changes in intracranial pulse pressure amplitudes after shunt implantation and adjustment of shunt valve opening pressure in normal pressure hydrocephalus","volume":"150","author":"Eide","year":"2008"},{"key":"b7-focus16183","series-title":"Neurosurgery","first-page":"1219","article-title":"The neuropsychology of patients with clinically diagnosed idiopathic normal pressure hydrocephalus","volume":"61","author":"Hellstr\u00f6m","year":"2007"},{"key":"b8-focus16183","series-title":"Acta Neurol Scand","first-page":"229","article-title":"A new scale for assessment of severity and outcome in iNPH","volume":"126","author":"Hellstr\u00f6m","year":"2012"},{"key":"b9-focus16183","series-title":"Neurosurg Rev","first-page":"239","article-title":"DTI-MRI biomarkers in the search for normal pressure hydrocephalus aetiology: a review","volume":"38","author":"Hoza","year":"2015"},{"key":"b10-focus16183","series-title":"J Commun Disord","first-page":"469","article-title":"Patterns of nasalance in a sample of normal gerontologic subjects","volume":"11","author":"Hutchinson","year":"1978"},{"key":"b11-focus16183","series-title":"Neurology","first-page":"309","article-title":"Corticofugal projections to the motor nuclei of the brain-stem and spinal cord in humans","volume":"40","author":"Iwatsubo","year":"1990"},{"key":"b12-focus16183","series-title":"JAMA","first-page":"510","article-title":"\u201cNormal-pressure\u201d hydrocephalus. Relationship of clinical and radiographic findings to improvement following shunt surgery","volume":"235","author":"Jacobs","year":"1976"},{"key":"b13-focus16183","series-title":"Neurosci Lett","first-page":"80","article-title":"The anatomical location of the corticobulbar tract at the corona radiata in the human brain: diffusion tensor tractography study","volume":"590","author":"Jang","year":"2015"},{"key":"b14-focus16183","series-title":"J Neurol","first-page":"1949","article-title":"White matter involvement in idiopathic normal pressure hydrocephalus: a voxel-based diffusion tensor imaging study","volume":"258","author":"Kanno","year":"2011"},{"key":"b15-focus16183","series-title":"AJNR Am J Neuroradiol","first-page":"1496","article-title":"Differential diagnosis of idiopathic normal pressure hydrocephalus from other dementias using diffusion tensor imaging","volume":"32","author":"Kim","year":"2011"},{"key":"b16-focus16183","series-title":"Acta Neurol Scand","first-page":"145","article-title":"One-year outcome in the European multicentre study on iNPH","volume":"126","author":"Klinge","year":"2012"},{"issue":"3 Suppl","key":"b17-focus16183","series-title":"Neurosurgery","first-page":"S40","article-title":"Outcome of shunting in idiopathic normal-pressure hydrocephalus and the value of outcome assessment in shunted patients","volume":"57","author":"Klinge","year":"2005"},{"key":"b18-focus16183","series-title":"Lang Speech Hear Serv Sch","first-page":"271","article-title":"Evaluation and treatment of resonance disorders","volume":"27","author":"Kummer","year":"1996"},{"key":"b19-focus16183","series-title":"Brain","first-page":"364","article-title":"Corticobular connexions to the pons and lower brain-stem in man: an anatomical study","volume":"81","author":"Kuypers","year":"1958"},{"key":"b20-focus16183","series-title":"Dysphagia","first-page":"142","article-title":"Periventricular white matter changes and oropharyngeal swallowing in normal individuals","volume":"7","author":"Levine","year":"1992"},{"key":"b21-focus16183","series-title":"Brain Struct Funct","first-page":"3337","article-title":"Anatomy and lateralization of the human corticobulbar tracts: an fMRI-guided tractography study","volume":"221","author":"Liegeois","year":"2016"},{"key":"b22-focus16183","series-title":"J Commun Disord","first-page":"55","article-title":"The effect of gender upon nasalance scores among normal adult speakers","volume":"25","author":"Litzaw","year":"1992"},{"key":"b23-focus16183","series-title":"Evaluation and Treatment of Swallowing Disorders","author":"Logemann","year":"1998"},{"key":"b24-focus16183","series-title":"Clin Neurol Neurosurg","first-page":"192","article-title":"How active are patients with idiopathic normal pressure hydrocephalus and does activity improve after shunt surgery? A controlled actigraphic study","volume":"115","author":"Lundin","year":"2013"},{"key":"b25-focus16183","series-title":"Siriraj Hosp Gaz","first-page":"155","article-title":"Applicability of Thai nasality test","volume":"52","author":"Manochiopinig","year":"2000"},{"key":"b26-focus16183","series-title":"Siriraj Hosp Gaz","first-page":"763","article-title":"[The Articulation Characteristics of Normal Thai Children age 3\u201310 years Assessing by Using the Thai Articulation Test (TAT).]","volume":"50","author":"Manochiopinig","year":"1998"},{"key":"b27-focus16183","series-title":"Disabil Rehabil Assist Technol","first-page":"332","article-title":"Dysarthric speech characteristics of Thai stroke patients","volume":"3","author":"Manochiopinig","year":"2008"},{"key":"b28-focus16183","series-title":"Acta Neurochir Suppl","first-page":"237","article-title":"Guidelines for management of idiopathic normal pressure hydrocephalus: progress to date","volume":"95","author":"Marmarou","year":"2005"},{"key":"b29-focus16183","series-title":"J Neurosurg","first-page":"987","article-title":"Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patients","volume":"102","author":"Marmarou","year":"2005"},{"key":"b30-focus16183","series-title":"Neurosurgery","first-page":"699","article-title":"Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus","volume":"57","author":"McGirt","year":"2005"},{"key":"b31-focus16183","series-title":"Acta Neurochir (Wien)","first-page":"1241","article-title":"Restoration of sexual activity in patients with chronic hydrocephalus after shunt placement","volume":"151","author":"Missori","year":"2009"},{"key":"b32-focus16183","series-title":"Brain","first-page":"965","article-title":"Pattern of white matter regional cerebral blood flow and autoregulation in normal pressure hydrocephalus","volume":"127","author":"Momjian","year":"2004"},{"key":"b33-focus16183","series-title":"Neurol Med Chir (Tokyo)","first-page":"775","article-title":"Guidelines for management of idiopathic normal pressure hydrocephalus: second edition","volume":"52","author":"Mori","year":"2012"},{"key":"b34-focus16183","series-title":"Arq Neuropsiquiatr","first-page":"435","article-title":"Psychiatric symptoms are present in most of the patients with idiopathic normal pressure hydrocephalus","volume":"72","author":"Oliveira","year":"2014"},{"key":"b35-focus16183","series-title":"J Neurosurg","first-page":"832","article-title":"Evaluation of ventriculomegaly using diffusion tensor imaging: correlations with chronic hydrocephalus and atrophy","volume":"112","author":"Osuka","year":"2010"},{"key":"b36-focus16183","series-title":"AJNR Am J Neuroradiol","first-page":"1274","article-title":"Somatotopic organization of motor pathways in the internal capsule: a probabilistic diffusion tractography study","volume":"33","author":"Pan","year":"2012"},{"key":"b37-focus16183","series-title":"J Plast Reconstr Aesthet Surg","first-page":"173","article-title":"Nasalance scores for normal Korean-speaking adults and children","volume":"67","author":"Park","year":"2014"},{"key":"b38-focus16183","series-title":"Brain","first-page":"389","article-title":"Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation","volume":"60","author":"Penfield","year":"1937"},{"key":"b39-focus16183","series-title":"Int Psychogeriatr","first-page":"465","article-title":"Psychiatric manifestations of normal-pressure hydrocephalus: a short review and unusual case","volume":"9","author":"Pinner","year":"1997"},{"key":"b40-focus16183","series-title":"Neurochirurgie","first-page":"216","article-title":"Deformation of the corona radiata and internal capsule in normal pressure hydrocephalus","volume":"60","author":"Rogers","year":"2014"},{"key":"b41-focus16183","series-title":"J Am Med Dir Assoc","first-page":"697","article-title":"Dysphagia in dementia: influence of dementia severity and food texture on the prevalence of aspiration and latency to swallow in hospitalized geriatric patients","volume":"16","author":"R\u00f6sler","year":"2015"},{"key":"b42-focus16183","series-title":"Ann Nucl Med","first-page":"39","article-title":"Cerebral perfusion pattern of idiopathic normal pressure hydrocephalus studied by SPECT and statistical brain mapping","volume":"21","author":"Sasaki","year":"2007"},{"key":"b43-focus16183","series-title":"Acta Neurochir (Wien)","first-page":"849","article-title":"Prevalence of Alzheimer's disease in patients investigated for presumed normal pressure hydrocephalus: a clinical and neuropathological study","volume":"141","author":"Savolainen","year":"1999"},{"key":"b44-focus16183","series-title":"Curr Opin Neurobiol","first-page":"15","article-title":"The laryngeal motor cortex: its organization and connectivity","volume":"28","author":"Simonyan","year":"2014"},{"key":"b45-focus16183","series-title":"Clin Neurophysiol","first-page":"1678","article-title":"Gait analysis in idiopathic normal pressure hydrocephalus\u2014which parameters respond to the CSF tap test?","volume":"111","author":"Stolze","year":"2000"},{"key":"b46-focus16183","series-title":"Cleft Palate Craniofac J","first-page":"168","article-title":"Nasalance scores for normal-speaking Irish children","volume":"41","author":"Sweeney","year":"2004"},{"key":"b47-focus16183","series-title":"Neurosurg Rev","first-page":"433","article-title":"Natural history of idiopathic normal-pressure hydrocephalus","volume":"34","author":"Toma","year":"2011"},{"key":"b48-focus16183","series-title":"Siriraj Hosp Gaz","first-page":"359","article-title":"[Thai Mental State Examination (TMSE).]","volume":"45","author":"Train The Brain Forum Committee","year":"1993"},{"key":"b49-focus16183","series-title":"Cleft Palate Craniofac J","first-page":"112","article-title":"Nasometric values for normal nasal resonance in the speech of young Flemish adults","volume":"38","author":"Van Lierde","year":"2001"},{"key":"b50-focus16183","series-title":"AJNR Am J Neuroradiol","first-page":"2311","article-title":"Preoperative prognostic value of MRI findings in 108 patients with idiopathic normal pressure hydrocephalus","volume":"35","author":"Virhammar","year":"2014"},{"key":"b51-focus16183","series-title":"Cleft Palate Craniofac J","first-page":"119","article-title":"Nasalance measures in Cantonese-speaking women","volume":"38","author":"Whitehill","year":"2001"},{"key":"b52-focus16183","series-title":"J Comput Assist Tomogr","first-page":"531","article-title":"In patients with idiopathic normal pressure hydrocephalus postoperative cerebral perfusion changes measured by dynamic susceptibility contrast magnetic resonance imaging correlate with clinical improvement","volume":"39","author":"Ziegelitz","year":"2015"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/41\/3\/article-pE15.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/41\/3\/article-pE15.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/41\/3\/article-pE15.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T08:58:15Z","timestamp":1779526695000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/41\/3\/article-pE15.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9]]},"references-count":104,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2016.6.focus16183","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,9]]}}}