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정상압 수두증의 평가와 치료에서의 뇌척수액 생체지표의 역할
| DC Field | Value | Language |
|---|---|---|
| dc.contributor.advisor | 문소영 | - |
| dc.contributor.author | Lim, Tae Sung | - |
| dc.date.accessioned | 2019-10-21T07:18:20Z | - |
| dc.date.available | 2019-10-21T07:18:20Z | - |
| dc.date.issued | 2012-08 | - |
| dc.identifier.other | 12748 | - |
| dc.identifier.uri | https://dspace.ajou.ac.kr/handle/2018.oak/17976 | - |
| dc.description | 학위논문(박사)아주대학교 일반대학원 :의학과,2012. 8 | - |
| dc.description.tableofcontents | ABSTRACT ⅰ TABLE OF CONTENTS iv LIST OF FIGURES vi LIST OF TABLES vii PART I. Repetitive Lumbar Punctures as Treatment for Normal Pressure Hydrocephalus: A Retrospective Study Ⅰ. INTRODUCTION 2 Ⅱ. MATERIALS AND METHODS 4 A. Subjects 4 B. Evaluation of NPH Symptoms 5 C. Classification of Patients 6 D. Magnetic Resonance Image 7 E. Statistical Analysis 9 F. Representative Cases of Prolonged Responders 10 Ⅲ. RESULTS 13 A. Demographic and Clinical Characteristics of the Subject Groups 13 B. Demographic and Clinical Characteristics of the Subject Subgroups 15 C. Logistic Regression Analysis 17 Ⅳ. DISCUSSION 19 PART II. Evaluation of Coexistence of Alzheimer?s Disease Pathology in Normal Pressure Hydrocephalus using CSF ELISA analyses: A Prospective Study Ⅰ. INTRODUCTION 23 Ⅱ. MATERIALS AND METHODS 25 A. Subjects 25 B. Evaluation of NPH Symptoms 27 C. Sample Collection 28 D. ELISA Methods 29 E. Magnetic Resonance Image 31 F. Neuropsychological Tests 33 G. Statistical Analysis 34 Ⅲ. RESULTS 35 A. Demographic and Clinical Characteristics of the Subject Groups 35 B. Classification of NPH Patients According to Response to Lumbar Puncture 38 C. Classification of NPH Patients According to ELISA Results 40 D. Demographic and Clinical Characteristics of the NPH Patient Subgroups 43 E. Neuropsychological Tests Results 45 Ⅳ. DISCUSSION 48 REFERENCES 52 국문 요약 60 | - |
| dc.language.iso | eng | - |
| dc.publisher | The Graduate School, Ajou University | - |
| dc.rights | 아주대학교 논문은 저작권에 의해 보호받습니다. | - |
| dc.title | 정상압 수두증의 평가와 치료에서의 뇌척수액 생체지표의 역할 | - |
| dc.title.alternative | Tae Sung Lim | - |
| dc.type | Thesis | - |
| dc.contributor.affiliation | 아주대학교 일반대학원 | - |
| dc.contributor.alternativeName | Tae Sung Lim | - |
| dc.contributor.department | 일반대학원 의학과 | - |
| dc.date.awarded | 2012. 8 | - |
| dc.description.degree | Master | - |
| dc.identifier.localId | 570342 | - |
| dc.identifier.url | http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000012748 | - |
| dc.subject.keyword | normal pressure hydrocephalus | - |
| dc.subject.keyword | lumbar puncture | - |
| dc.subject.keyword | cerebrospinal fluid | - |
| dc.subject.keyword | neuropsychological test | - |
| dc.subject.keyword | Alzheimer''s disease | - |
| dc.description.alternativeAbstract | Normal pressure hydrocephalus (NPH) is characterized by slowly progressive gait disturbance, cognitive impairment and urinary incontinence. It is a well-known potentially reversible cause of dementia by the shunt operation. However, it is not simple to select candidates for the shunt operation due to combined pathology and poor general medical conditions in the aged population and the high complication rate of the procedure. In PART I, a retrospective study, we reported patients with NPH whose symptomatic response to repetitive lumbar puncture (LP) was maintained for longer than one year without the need for the shunt operation and analyzed the predictor for the prolonged symptomatic response to repetitive LP in patients with NPH. In PART II, a prospective study, we investigated levels of the β-amyloid 1-42 (Aβ42), total tau protein (T-tau) and tau phosphorylated at position threonine 181 (P-tau) in cerebrospinal fluid (CSF) of NPH patients and tried to find their clinical implications in the evaluation and treatment of NPH. PART I: A retrospective study Thirty-one NPH patients were retrospectively evaluated. Gait disturbance, urinary incontinence, and cognitive impairment were semi-quantified. We divided the patients into three groups (non-responders, temporary responders, and prolonged responders) according to their responses after LP. We analyzed the characteristics of the groups. Gait disturbance (p= 0.046) and urinary incontinence (p= 0.040) scores and total NPH symptom score (p= 0.007) immediate after CSF drainage were more significantly improved in prolonged responders than in temporary responders. On multiple logistic regression analysis, total NPH score improvement immediate after LP was the only predictor of the prolonged responders (p= 0.038, odds ratio= 9.718). Our study showed that some NPH patients could maintain favorable courses for at least one year after LP without the shunt operation. Repetitive LP could be an alternative treatment in selected NPH patients. PART II: A prospective study Twenty-five possible NPH patients were prospectively enrolled and their CSF were collected to analyze levels of Aβ42, T-tau and P-tau using ELISA method. Gait disturbance, urinary incontinence, and cognitive impairment were semi-quantified and detailed neuropsychological test was performed. The CSF of 17 Alzheimer's disease (AD) patients and 10 normal control subjects were tested to determine a cutoff level of the possible coexistence of AD pathology in NPH patients. Eight NPH patients were classified into NPH with lower CSF Aβ42 group and 17 patients were classified into NPH with higher CSF Aβ42 group (cutoff value = 490.13 pg/ml, Aβ42). There was no difference in the NPH grading score and improvement rate after LP between the two groups. In the evaluation of 18 patients who underwent the detailed neuropsychological tests (7 with lower CSF Aβ42 and 11 with high), the NPH with lower CSF Aβ42 group had more deficit in attention (p=0.018), visuospatial function (p=0.043) and verbal memory (p=0.009). In the evaluation of 10 patients who underwent NP test twice before and after LPs, with lower CSF Aβ42 group showed less improvement in phonemic categorical naming (p=0.008) and frontal inhibitory function (p=0.018) after LP compared to NPH with higher CSF Aβ42 group. Our study suggested that the incidence of Aβ42 pathology in NPH patients was not different from normal elderly population and the coexistence of Aβ42 pathology in NPH patients might be a contributing factor for lumbar puncture or shunt unresponsiveness especially in the field of cognitive dysfunction. | - |
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