Top

BMC Neurology

Published in:

Open Access 01-12-2024 | Alzheimer's Disease | Research

Association between cerebrospinal fluid pressure and cognition in patients with Alzheimer’s disease and Lewy body dementia

Authors: Xia Yang, Jinghuan Gan, Yong Ji

Published in: BMC Neurology | Issue 1/2024

Abstract

Background

The relationship between cerebrospinal fluid pressure (CSFP) and cognition has received little research attention. The purpose of this study was to explore the relationship between CSFP and cognition in patients with Alzheimer’s disease (AD) and patients with Lewy body dementia (LBD).

Method

We included 178 participants, including 137 patients with AD and 41 patients with LBD (including dementia with Lewy bodies (DLBs) and Parkinson’s disease dementia (PDD)). CSFP was measured by lumbar puncture, and a patient-reported history and laboratory test data were collected. Logistic and linear regression analyses were used to evaluate the associations between CSFP and cognition, the cerebrospinal fluid (CSF) / serum albumin ratio (Qalb), and CSF biomarkers of AD.

Results

The mean age of the included patients was 63.58 ± 8.77 years old, and the mean CSFP was 121 ± 33.72 mmH2O. A total of 76.9% of the patients had a CSFP distribution of [90–170) mmH2O, 46 patients (25.8%) had severe dementia, 83 patients (46.6%) had moderate dementia, 28 patients (15.7%) had mild dementia, and 21 patients (11.8%) had mild cognitive impairment (MCI) (including 16 patients with MCI due to AD and 5 patients with MCI due to LBD). In all patients (p value < 0.001) and in patients with AD (p value = 0.01), the mean cerebrospinal fluid pressure (CSFP) was higher in patients with MCI than in patients with dementia. In multivariate analysis, in all patients (OR: 6.37, 95% confidential interval (CI): 1.76–23.04, p = 0.005) and patients with AD (odds ratio (OR): 5.43, 95% CI: 1.41–20.87, p = 0.005), a CSFP in the lowest quartile ([50–90) mmH2O) was associated with a higher level of severe dementia than a CSFP in the highest quartile ([170–210) mmH2O). In addition, there was a significant linear correlation between CSFP and the Mini-Mental State Examination (MMSE) score in all patients with dementia (r = 0.43, p = 0.04, Durbin-Watson test (D-W test) = 0.75).

Conclusion

In patients with AD, the mean cerebrospinal fluid pressure was higher in patients with MCI than in patients with dementia, and the decrease in CSFP was related to a more serious dementia level. However, no such relationship was found in patients with LBD.

Available only for authorised users

2021 Alzheimer’s disease facts and figures. Alzheimers Dement. 2021;17(3):327–406. https://doi.org/10.1002/alz.12328.CrossRef

Jia L, Quan M, Fu Y, Zhao T, Li Y, Wei C, et al. Dementia in China: epidemiology, clinical management, and research advances. Lancet Neurol. 2020;19(1):81–92. https://doi.org/10.1016/S1474-4422(19)30290-X.CrossRefPubMed

Wostyn P. Intracranial pressure and Alzheimer’s Disease: a hypothesis. Med Hypotheses. 1994;43(4):219–22. https://doi.org/10.1016/0306-9877(94)90069-8.CrossRefPubMed

Wostyn P. Can chronic increased intracranial pressure or exposure to repetitive intermittent intracranial pressure elevations raise your risk for Alzheimer’s Disease? Med Hypotheses. 2004;62(6):925–30. https://doi.org/10.1016/j.mehy.2004.01.013.CrossRefPubMed

Grynspan F, Griffin WR, Cataldo A, Katayama S, Nixon RA. Active site-directed antibodies identify calpain II as an early-appearing and pervasive component of neurofibrillary pathology in Alzheimer’s Disease. Brain Res. 1997;763(2):145–58. https://doi.org/10.1016/s0006-8993(97)00384-3.CrossRefPubMed

Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial Hypertension. Neurology. 2002;59(10):1492–5. https://doi.org/10.1212/01.wnl.0000029570.69134.1b.CrossRefPubMed

Grech O, Clouter A, Mitchell JL, Alimajstorovic Z, Ottridge RS, Yiangou A, et al. Cognitive performance in idiopathic intracranial Hypertension and relevance of intracranial pressure. Brain Commun. 2021;3(3):fcab202. https://doi.org/10.1093/braincomms/fcab202.CrossRefPubMedPubMedCentral

Battle DE. Diagnostic and statistical Manual of Mental disorders (DSM). Codas. 2013;25(2):191–2. https://doi.org/10.1590/s2317-17822013000200017.CrossRefPubMed

Tamaoka A. [Alzheimer’s Disease: definition and National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA)]. Nihon Rinsho. 2011;69(Suppl 10 Pt):240–5.PubMed

10.

McKeith IG, Boeve BF, Dickson DW, Halliday G, Taylor JP, Weintraub D, et al. Diagnosis and management of Dementia with Lewy bodies: fourth consensus report of the DLB Consortium. Neurology. 2017;89(1):88–100. https://doi.org/10.1212/WNL.0000000000004058.CrossRefPubMedPubMedCentral

11.

Emre M, Aarsland D, Brown R, Burn DJ, Duyckaerts C, Mizuno Y, et al. Clinical diagnostic criteria for Dementia associated with Parkinson’s Disease. Mov Disord. 2007;22(12):1689–837. https://doi.org/10.1002/mds.21507.CrossRefPubMed

12.

Litvan I, Goldman JG, Tröster AI, Schmand BA, Weintraub D, Petersen RC, et al. Diagnostic criteria for mild cognitive impairment in Parkinson’s Disease: Movement Disorder Society Task Force guidelines. Mov Disord. 2012;27(3):349–56. https://doi.org/10.1002/mds.24893.CrossRefPubMedPubMedCentral

13.

Petersen RC. Clinical practice. Mild cognitive impairment. N Engl J Med. 2011;364(23):2227–34. https://doi.org/10.1056/NEJMcp0910237.CrossRefPubMed

14.

Liu C, Liu S, Wang X, Ji Y. Neuropsychiatric profiles in mild cognitive impairment with Lewy bodies. Aging & mental health. Aging Ment Health. 2021;25(11):2011–7. https://doi.org/10.1080/13607863.2020.1817311.CrossRefPubMed

15.

Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57(3 Suppl):4–v. https://doi.org/10.1227/01.neu.0000168185.29659.c5.CrossRef

16.

Beck J, Ulrich CT, Fung C, Fichtner J, Seidel K, Fiechter M, et al. Diskogenic microspurs as a major cause of intractable spontaneous intracranial hypotension. Neurology. 2016;87(12):1220–6. https://doi.org/10.1212/WNL.0000000000003122.CrossRefPubMed

17.

Chen ZC, Liu S, Gan J, Ma L, Du X, Zhu H, et al. The impact of the COVID-19 pandemic and lockdown on mild cognitive impairment, Alzheimer’s Disease and Dementia with Lewy Bodies in China: A 1-Year Follow-Up study. Front Psychiatry. 2021;12:711658. https://doi.org/10.3389/fpsyt.2021.711658.CrossRefPubMedPubMedCentral

18.

Zhao S, Zhong J, Sun C, Zhang J. Effects of aerobic exercise on TC, HDL-C, LDL-C and TG in patients with hyperlipidemia: a protocol of systematic review and meta-analysis. Med (Baltim). 2021;100(10):e25103. https://doi.org/10.1097/MD.0000000000025103.CrossRef

19.

Gan J, Yang X, Zhang G, Li X, Liu S, Zhang W, Ji Y. Alzheimer’s Disease pathology: pathways between chronic vascular risk factors and blood-brain barrier dysfunction in a cohort of patients with different types of Dementia. Front Aging Neurosci. 2023;15:1088140. https://doi.org/10.3389/fnagi.2023.1088140. Published 2023 May 4.CrossRefPubMedPubMedCentral

20.

Society CD. China guideline for type 2 Diabetes (. Chin J Diabetes. 2013;22:865–8.

21.

Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. https://doi.org/10.1016/0165-1781(89)90047-4.CrossRefPubMed

22.

Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5. https://doi.org/10.1093/sleep/14.6.540.CrossRefPubMed

23.

Stiasny-Kolster K, Mayer G, Schäfer S, Möller JC, Heinzel-Gutenbrunner M, Oertel WH. The REM sleep behavior disorder screening questionnaire–a new diagnostic instrument. Mov Disord. 2007;22(16):2386–93. https://doi.org/10.1002/mds.21740.CrossRefPubMed

24.

Luo J, Huang R, Zhong X, Xiao Y, Zhou J. STOP-Bang questionnaire is superior to Epworth sleepiness scales, Berlin questionnaire, and STOP questionnaire in screening obstructive sleep apnea hypopnea syndrome patients. Chin Med J (Engl). 2014;127(17):3065–70.CrossRefPubMed

25.

Ahmadi N, Chung SA, Gibbs A, Shapiro CM. The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance. Sleep Breath. 2008;12(1):39–45. https://doi.org/10.1007/s11325-007-0125-y.CrossRefPubMed

26.

Thompson E. Hamilton Rating Scale for Anxiety (HAM-A). Occup Med (Lond). 2015;65(7):601. https://doi.org/10.1093/occmed/kqv054.CrossRefPubMed

27.

Endicott J, Cohen J, Nee J, Fleiss J, Sarantakos S. Hamilton Depression Rating Scale: extracted from regular and change versions of the schedule for affective disorders and Schizophrenia. Arch Gen Psychiatry. 1981;38(1):98–103. https://doi.org/10.1001/archpsyc.1981.01780260100011.CrossRefPubMed

28.

Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98. https://doi.org/10.1016/0022-3956(75)90026-6.CrossRefPubMed

29.

Morris JC. The clinical Dementia rating (CDR): current version and scoring rules. Neurology. 1993;43(11):2412–4. https://doi.org/10.1212/wnl.43.11.2412-a.CrossRefPubMed

30.

Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9. https://doi.org/10.1111/j.1532-5415.2005.53221.x.CrossRefPubMed

31.

Wright BL, Lai JT, Sinclair AJ. Cerebrospinal fluid and lumbar puncture: a practical review. J Neurol. 2012;259(8):1530–45. https://doi.org/10.1007/s00415-012-6413-x.CrossRefPubMed

32.

Doherty CM, Forbes RB. Diagnostic lumbar puncture. Ulster Med J. 2014;83(2):93–102.PubMedPubMedCentral

33.

Nation DA, Sweeney MD, Montagne A, Sagare AP, D’Orazio LM, Pachicano M, et al. Blood-brain barrier breakdown is an early biomarker of human cognitive dysfunction. Nat Med. 2019;25(2):270–6. https://doi.org/10.1038/s41591-018-0297-y.CrossRefPubMedPubMedCentral

34.

Wostyn P, Audenaert K, De Deyn PP. More advanced Alzheimer’s Disease may be associated with a decrease in cerebrospinal fluid pressure. Cerebrospinal Fluid Res. 2009;6:14. https://doi.org/10.1186/1743-8454-6-14.CrossRefPubMedPubMedCentral

35.

Silverberg GD, Mayo M, Saul T, Rubenstein E, McGuire D. Alzheimer’s Disease, normal-pressure hydrocephalus, and senescent changes in CSF circulatory physiology: a hypothesis. Lancet Neurol. 2003;2(8):506–11. https://doi.org/10.1016/s1474-4422(03)00487-3.CrossRefPubMed

36.

Silverberg GD, Huhn S, Jaffe RA, Chang SD, Saul T, Heit G, Von Essen A, Rubenstein E. Downregulation of cerebrospinal fluid production in patients with chronic hydrocephalus. J Neurosurg. 2002;97(6):1271–5. https://doi.org/10.3171/jns.2002.97.6.1271.CrossRefPubMed

37.

Silverberg G, Mayo M, Saul T, Fellmann J, McGuire D. Elevated cerebrospinal fluid pressure in patients with Alzheimer’s Disease. Cerebrospinal Fluid Res. 2006;3:7. https://doi.org/10.1186/1743-8454-3-7.CrossRefPubMedPubMedCentral

38.

McKinnon SJ, Lehman DM, Kerrigan-Baumrind LA, Merges CA, Pease ME, Kerrigan DF, et al. Caspase activation and amyloid precursor protein cleavage in rat ocular Hypertension. Invest Ophthalmol Vis Sci. 2002;43(4):1077–87.PubMed

39.

McKinnon SJ. Glaucoma: ocular Alzheimer’s Disease? Front Biosci. 2003;8:1140–s1156. https://doi.org/10.2741/1172.CrossRef

40.

Tumani H, Huss A, Bachhuber F. The cerebrospinal fluid and barriers - anatomic and physiologic considerations. Handb Clin Neurol. 2017;146:21–32. https://doi.org/10.1016/B978-0-12-804279-3.00002-2.CrossRefPubMed

41.

Ueno M, Chiba Y, Murakami R, Matsumoto K, Kawauchi M, Fujihara R. Blood-brain barrier and blood-cerebrospinal fluid barrier in normal and pathological conditions. Brain Tumor Pathol. 2016;33(2):89–96. https://doi.org/10.1007/s10014-016-0255-7.CrossRefPubMed

42.

Skillbäck T, Delsing L, Synnergren J, Mattsson N, Janelidze S, Nägga K, et al. CSF/serum albumin ratio in Dementias: a cross-sectional study on 1861 patients. Neurobiol Aging. 2017;59:1–9. https://doi.org/10.1016/j.neurobiolaging.2017.06.028.CrossRefPubMed

43.

Wong YY, Wu CY, Yu D, Kim E, Wong M, Elez R, et al. Biofluid markers of blood-brain barrier disruption and neurodegeneration in Lewy body spectrum Diseases: a systematic review and meta-analysis. Parkinsonism Relat Disord. 2022;101:119–28. https://doi.org/10.1016/j.parkreldis.2022.06.004.CrossRefPubMed

44.

Sweeney MD, Sagare AP, Zlokovic BV. Blood-brain barrier breakdown in Alzheimer Disease and other neurodegenerative disorders. Nat Rev Neurol. 2018;14(3):133–50. https://doi.org/10.1038/nrneurol.2017.188.CrossRefPubMedPubMedCentral

45.

Schirinzi T, Di Lazzaro G, Sancesario GM, Colona VL, Scaricamazza E, Mercuri NB, Martorana A, Sancesario G. Levels of amyloid-beta-42 and CSF pressure are directly related in patients with Alzheimer’s Disease. J Neural Transm (Vienna). 2017;124(12):1621–5. https://doi.org/10.1007/s00702-017-1786-8.CrossRefPubMed

46.

Silverberg GD, Heit G, Huhn S, Jaffe RA, Chang SD, Bronte-Stewart H, Rubenstein E, Possin K, Saul TA. The cerebrospinal fluid production rate is reduced in Dementia of the Alzheimer’s type. Neurology. 2001;57(10):1763–6. https://doi.org/10.1212/wnl.57.10.1763.CrossRefPubMed

Title: Association between cerebrospinal fluid pressure and cognition in patients with Alzheimer’s disease and Lewy body dementia
Authors: Xia Yang
Jinghuan Gan
Yong Ji
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Alzheimer's Disease
Alzheimer's Disease
Dementia
Dementia
Mild Neurocognitive Disorder
Published in: BMC Neurology / Issue 1/2024
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-023-03502-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association between cerebrospinal fluid pressure and cognition in patients with Alzheimer’s disease and Lewy body dementia

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Psychiatric implications of anti-seizure medications in epileptic population

Impact of homocysteine on acute ischemic stroke severity: possible role of aminothiols redox status

Spinal adhesive arachnoiditis in an adult patient with spinal muscular atrophy type 3 treated with intrathecal therapy

Does visuospatial neglect contribute to standing balance within the first 12 weeks post-stroke? A prospective longitudinal cohort study

Progressive multifocal leukoencephalopathy in a patient with B-cell chronic lymphocytic leukemia after COVID-19 vaccination, complicated with COVID-19 and mucormycosis: a case report

Clinical variables influencing the perception of fatigue in people with multiple sclerosis: a cross-sectional study using FSIQ-RMS