{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:01:23Z","timestamp":1791907283680,"version":"4.3.4"},"reference-count":39,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T00:00:00Z","timestamp":1689638400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAD"],"published-print":{"date-parts":[[2023,7,18]]},"abstract":"<jats:p>Background: Alzheimer\u2019s disease (AD) is the most common cause of dementia worldwide and a frequent comorbidity in idiopathic normal pressure hydrocephalus (iNPH). The presence of AD pathology is associated with worse outcomes after a shunt procedure in iNPH. Preoperative diagnosis of AD is challenging in patients with iNPH, which involves reduced concentrations of the cerebrospinal fluid (CSF) AD biomarkers. Objective: Our aim was to estimate the effect size of iNPH as a factor in CSF levels of AD biomarkers and to test if correction could be used to improve diagnostic value. Methods: Our cohort included 222 iNPH patients with data in the Kuopio NPH registry and brain biopsy and CSF samples available. We divided the patients into groups according to AD pathology per brain biopsy. For control cohorts, we had CSF samples from cognitively healthy individuals (n\u200a=\u200a33) and patients with diagnosed AD and no iNPH (n\u200a=\u200a39). *-31pt Results: Levels of all investigated biomarkers differed significantly between groups, with the exception of t-Tau levels between healthy individuals and iNPH patients with AD pathology. Applying a correction factor for each biomarker (0.842*A\u03b21\u00a0-\u00a042, 0.779*t-Tau, and 0.610*P-Tau181) for the effect of iNPH yielded a sensitivity of 2.4% and specificity of 100%. The ratio of P-Tau181 to A\u03b21\u00a0-\u00a042 was moderately effective in aiding recognition of AD pathology in iNPH patients (sensitivity 0.79, specificity 0.76, area under the curve 0.824). Conclusion: Correcting for iNPH as a factor failed to improve diagnostic effectiveness, but the P-Tau181\/A\u03b21\u00a0-\u00a042 ratio showed some utility in the diagnosis of AD in iNPH patients.<\/jats:p>","DOI":"10.3233\/jad-230144","type":"journal-article","created":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T10:22:39Z","timestamp":1686651759000},"page":"727-736","source":"Crossref","is-referenced-by-count":10,"title":["Cerebrospinal Fluid Diagnostics of Alzheimer\u2019s Disease in Patients with Idiopathic Normal Pressure Hydrocephalus"],"prefix":"10.1177","volume":"94","author":[{"given":"Aleksi","family":"Vanninen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland"},{"name":"Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heikki","family":"Lukkarinen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland"},{"name":"Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarja","family":"Kokkola","sequence":"additional","affiliation":[{"name":"Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"Koivisto","sequence":"additional","affiliation":[{"name":"Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland"},{"name":"Department of Neurology, Kuopio University Hospital, Kuopio, Finland"},{"name":"Department of Neurosciences, University of Helsinki, Helsinki, Finland"},{"name":"Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merja","family":"Kokki","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Eastern Finland, Kuopio, Finland"},{"name":"Department of Anaesthesia and Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadeusz","family":"Musialowicz","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikko","family":"Hiltunen","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Zetterberg","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, M\u00f6lndal, Sweden"},{"name":"Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, M\u00f6lndal, Sweden"},{"name":"Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK"},{"name":"UK Dementia Research Institute at UCL, London, UK"},{"name":"Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ville","family":"Leinonen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland"},{"name":"Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanna-Kaisa","family":"Herukka","sequence":"additional","affiliation":[{"name":"Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland"},{"name":"Department of Neurology, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuomas","family":"Rauramaa","sequence":"additional","affiliation":[{"name":"Department of Pathology, Kuopio University Hospital, Kuopio, Finland"},{"name":"Pathology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"key":"10.3233\/JAD-230144_ref1","first-page":"A2-4-S2-16","article-title":"INPH guidelines, part II: Diagnosing idio-pathic normal-pressure hydrocephalus","volume":"57","author":"Relktin","year":"2005","journal-title":"Neurosurgery"},{"key":"10.3233\/JAD-230144_ref2","doi-asserted-by":"crossref","first-page":"e0217705","DOI":"10.1371\/journal.pone.0217705","article-title":"Prevalence of idiopathic normal pressure hydrocephalus: A prospective, population based 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with idiopathic normal-pressure hydrocephalus \u2013 a 1-year follow-up study","volume":"24","author":"Junkkari","year":"2017","journal-title":"Eur J Neurol"},{"key":"10.3233\/JAD-230144_ref6","doi-asserted-by":"crossref","first-page":"e13249","DOI":"10.15252\/emmm.202013249","article-title":"Deletions in CWH43 cause idiopathic normal pressure hydrocephalus","volume":"13","author":"Yang","year":"2021","journal-title":"EMBO Mol Med"},{"key":"10.3233\/JAD-230144_ref7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1227\/NEU.0b013e31827414b3","article-title":"Poor cognitive outcome in shunt-responsive idiopathic normal pressure hydrocephalus","volume":"72","author":"Koivisto","year":"2013","journal-title":"Neurosurgery"},{"key":"10.3233\/JAD-230144_ref8","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1111\/ane.13200","article-title":"Negative predictors of shunt surgery outcome in normal pressure 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