AUTHOR=Schirinzi Tommaso , Sancesario Giulia Maria , Ialongo Cristiano , Imbriani Paola , Madeo Graziella , Toniolo Sofia , Martorana Alessandro , Pisani Antonio 

TITLE=A Clinical and Biochemical Analysis in the Differential Diagnosis of Idiopathic Normal Pressure Hydrocephalus

JOURNAL=Frontiers in Neurology

VOLUME=Volume 6 - 2015

YEAR=2015

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2015.00086

DOI=10.3389/fneur.2015.00086

ISSN=1664-2295

ABSTRACT=Introduction. Idiopathic normal pressure hydrocephalus iNPH can be misdiagnosed with other neurodegenerative diseases, especially in the early disease stages. Considering the opportunity of the shunt surgery, iNPH should be diagnosed with accuracy. Here we evaluate the utility of CSF biomarkers and their relationship with clinical features in the diagnosis of iNPH.
Methods: We performed a multivariate analysis of the levels of Aβ42, t-tau and p-tau CSF levels collected from three groups of patients: 14 iNPH, 14 Progressive Supranuclear Palsy (PSP), 14 Alzheimer’s Disease (AD), 14 controls (CTL). Diagnostic accuracy of biomarkers was determined by the receiver operating characteristic (ROC) curve analysis. Statistical correlation was calculated between each CSF biomarker and single clinical items of iNPH. 
Results: Aβ42 levels in iNPH were lower than controls, although not as low as in AD. Likewise, CSF t-tau and p-tau were lower in iNPH than in controls. Of interest, t-tau and p-tau were higher in AD than in controls and hence both t-tau and p-tau were significantly lower in iNPH than in AD. No differences were found between iNPH and PSP.
CSF biomarkers levels did not correlate to clinical features of iNPH, whereas two significant correlations emerged within clinical parameters: cognitive impairment was related to gait difficulties, whilst ventricular enlargement correlated with continence disturbances.  
Conclusions: Measurement of CSF biomarker levels may be helpful in the differential diagnosis between iNPH and AD but not between iNPH and PSP. Both Aβ42 and tau levels appear unrelated to main clinical features of iNPH.