Normal Pressure Hydrocephalus Associated with Alzheimer's Disease

Objective The aim was to investigate whether neurodegenerative biomarkers in cerebrospinal fluid (CSF) differentiate patients with suspected normal pressure hydrocephalus (NPH) who respond to CSF drainage from patients who do not respond. Methods Data from 62 consecutive patients who presented with magnetic resonance imaging changes indicative of NPH were studied with regard to cognitive and gait functions before and after drainage of 40–50ml of CSF. Additionally, S100 protein, neuron‐specific enolase, β‐amyloid protein, tau protein and phospho‐tau were determined in CSF. Statistical analyses were carried out with ANOVA and multiple linear regression. Results Patients with CSF constellations typical for Alzheimer's disease (n = 28) improved significantly in cognitive and gait‐related functions after CSF drainage. In contrast, those patients without a CSF constellation typical for Alzheimer's disease (n = 34) did not improve in cognitive and gait‐related functions after CSF drainage. In addition, positive CSF biomarkers for Alzheimer's disease predicted these improvements. Interpretation Our data suggest an association between Alzheimer's disease and NPH changes, supporting the recently suggested dichotomy of a neurodegenerative NPH and a true idiopathic NPH, with the latter appearing to be rare. ANN NEUROL 2020;88:703–711