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BMC Psychiatry
Published in: BMC Psychiatry 1/2020

Open Access 01-12-2020 | Schizophrenia | Research article

Prevalence of possible idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia: a replication study

Authors: Yuta Yoshino, Taku Yoshida, Hideo Morino, Masayuki Nakamura, Masao Abe, Hokuto Omachi, Saori Inoue, Yukiyo Miyoshi, Yumina Tachibana, Noriko Yamauchi, Naoya Takeda, Mutsuhiko Mizobuchi, Yuki Ozaki, Shinichiro Ochi, Junichi Iga, Shu-ichi Ueno

Published in: BMC Psychiatry | Issue 1/2020

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Abstract

Background

We recently reported that older patients with schizophrenia (SZ) show possible idiopathic normal pressure hydrocephalus (iNPH) more frequently than the general population. In this study, we estimated the prevalence of iNPH in a larger number of older SZ patients and explored useful examination values for diagnosis in the SZ population.

Methods

We enrolled older inpatients with SZ (n = 39, mean age = 68.6 ± 7.7 years) from several psychiatric hospitals in Ehime, Japan and acquired brain imaging data using computed tomography. We evaluated three iNPH symptoms (dementia, gait disturbance, and urinary incontinence). In addition, we combined these data with our previous data to elucidate the relationship between iNPH and characteristics of SZ symptoms.

Results

In total, five (12.8%) patients were diagnosed with possible iNPH. Evans’ index for patients with iNPH was significantly higher than for those without iNPH (p = 0.002). The number of disproportionately enlarged subarachnoid space hydrocephalus (DESH) findings was significantly higher in patients with iNPH than in those without iNPH (p <  0.001). Using combined data, Drug-Induced Extra-pyramidal Symptoms Scale (DIEPSS) subscales of gait and bradykinesia showed an increasing trend in the SZ with iNPH group.

Conclusions

We reconfirmed that older inpatients with SZ experienced possible iNPH more frequently than the general population. We should pay attention to the DIEPSS subscales of gait and bradykinesia and DESH findings in addition to the three main symptoms of iNPH and Evans’ index so as to not miss SZ patients with iNPH.
Literature
1.
Carney CP, Jones L, Woolson RF. Medical comorbidity in women and men with schizophrenia: a population-based controlled study. J Gen Intern Med. 2006;21(11):1133–7.PubMedPubMedCentralCrossRef
2.
Mitchell AJ, Vancampfort D, Sweers K, van Winkel R, Yu W, De Hert M. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders--a systematic review and meta-analysis. Schizophr Bull. 2013;39(2):306–18.PubMedCrossRef
3.
De Hert M, Schreurs V, Sweers K, Van Eyck D, Hanssens L, Sinko S, Wampers M, Scheen A, Peuskens J, van Winkel R. Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: a retrospective chart review. Schizophr Res. 2008;101(1–3):295–303.PubMedCrossRef
4.
Velligan DI, Weiden PJ, Sajatovic M, Scott J, Carpenter D, Ross R, Docherty JP. Expert consensus panel on adherence problems in S, persistent mental I: The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry. 2009;70(Suppl 4):1–46 quiz 47-48.PubMed
5.
Vanhala V, Junkkari A, Korhonen VE, Kurki MI, Hiltunen M, Rauramaa T, Nerg O, Koivisto AM, Remes AM, Perala J, et al. Prevalence of schizophrenia in idiopathic Normal pressure hydrocephalus. Neurosurgery. 2019;84(4):883–9.PubMedCrossRef
6.
Agrawal A, Tiwari AM, Tiple P, Chauhan MK, Nagarale M. Normal pressure hydrocephalus in a case of schizophrenia. Indian J Psychiatry. 2012;54(4):385–6.PubMedPubMedCentralCrossRef
7.
Mishra BR, Sarkar S, Mishra S, Praharaj SK, Mahapatra P, Sinha VK. Antipsychotic sensitivity in normal pressure hydrocephalus. Gen Hosp Psychiatry. 2011;33(1):83 e11–83.CrossRef
8.
Maurizi CP. The pathophysiology of enlarged ventricles in normal pressure communicating hydrocephalus and schizophrenia: a possible therapeutic role for melatonin. Med Hypotheses. 1987;23(1):61–6.PubMedCrossRef
9.
Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci. 1965;2(4):307–27.PubMedCrossRef
10.
11.
Green MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry. 1996;153(3):321–30.PubMedCrossRef
12.
Heinrichs RW, Zakzanis KK. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology. 1998;12(3):426–45.PubMedCrossRef
13.
Ishikawa M, Hashimoto M, Mori E, Kuwana N, Kazui H. The value of the cerebrospinal fluid tap test for predicting shunt effectiveness in idiopathic normal pressure hydrocephalus. Fluids Barriers CNS. 2012;9(1):1.PubMedPubMedCentralCrossRef
14.
Ishikawa M, Yamada S, Yamamoto K. Early and delayed assessments of quantitative gait measures to improve the tap test as a predictor of shunt effectiveness in idiopathic normal pressure hydrocephalus. Fluids Barriers CNS. 2016;13(1):20.PubMedPubMedCentralCrossRef
15.
Wikkelso C, Andersson H, Blomstrand C, Lindqvist G. The clinical effect of lumbar puncture in normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry. 1982;45(1):64–9.PubMedPubMedCentralCrossRef
16.
Picascia M, Minafra B, Zangaglia R, Gracardi L, Pozzi NG, Sinforiani E, Pacchetti C. Spectrum of cognitive disorders in idiopathic normal pressure hydrocephalus. Funct Neurol. 2016;31(3):143–7.PubMedPubMedCentral
17.
Junkkari A, Hayrinen A, Rauramaa T, Sintonen H, Nerg O, Koivisto AM, Roine RP, Viinamaki H, Soininen H, Luikku A, et al. Health-related quality-of-life outcome in patients with idiopathic normal-pressure hydrocephalus - a 1-year follow-up study. Eur J Neurol. 2017;24(1):58–66.PubMedCrossRef
18.
Brautigam K, Vakis A, Tsitsipanis C. Pathogenesis of idiopathic Normal pressure hydrocephalus: a review of knowledge. J Clin Neurosci. 2019;61:10–3.PubMedCrossRef
19.
Shepherd AM, Laurens KR, Matheson SL, Carr VJ, Green MJ. Systematic meta-review and quality assessment of the structural brain alterations in schizophrenia. Neurosci Biobehav Rev. 2012;36(4):1342–56.PubMedCrossRef
20.
Huhtaniska S, Jaaskelainen E, Heikka T, Moilanen JS, Lehtiniemi H, Tohka J, Manjon JV, Coupe P, Bjornholm L, Koponen H, et al. Long-term antipsychotic and benzodiazepine use and brain volume changes in schizophrenia: the northern Finland birth cohort 1966 study. Psychiatry Res Neuroimaging. 2017;266:73–82.PubMedCrossRef
21.
Jaraj D, Agerskov S, Rabiei K, Marlow T, Jensen C, Guo X, Kern S, Wikkelso C, Skoog I. Vascular factors in suspected normal pressure hydrocephalus: a population-based study. Neurology. 2016;86(7):592–9.PubMedPubMedCentralCrossRef
22.
Israelsson H, Carlberg B, Wikkelso C, Laurell K, Kahlon B, Leijon G, Eklund A, Malm J. Vascular risk factors in INPH: a prospective case-control study (the INPH-CRasH study). Neurology. 2017;88(6):577–85.PubMedPubMedCentralCrossRef
23.
Suvisaari J, Keinanen J, Eskelinen S, Mantere O. Diabetes and schizophrenia. Curr Diab Rep. 2016;16(2):16.PubMedCrossRef
24.
Casmiro M, Benassi G, Cacciatore FM, D'Alessandro R. Frequency of idiopathic normal pressure hydrocephalus. Arch Neurol. 1989;46(6):608.PubMedCrossRef
25.
Graff-Radford NR, Godersky JC. Idiopathic normal pressure hydrocephalus and systemic hypertension. Neurology. 1987;37(5):868–71.PubMedCrossRef
26.
Krauss JK, Regel JP, Vach W, Droste DW, Borremans JJ, Mergner T. Vascular risk factors and arteriosclerotic disease in idiopathic normal-pressure hydrocephalus of the elderly. Stroke. 1996;27(1):24–9.PubMedCrossRef
27.
Iseki C, Kawanami T, Nagasawa H, Wada M, Koyama S, Kikuchi K, Arawaka S, Kurita K, Daimon M, Mori E, et al. Asymptomatic ventriculomegaly with features of idiopathic normal pressure hydrocephalus on MRI (AVIM) in the elderly: a prospective study in a Japanese population. J Neurol Sci. 2009;277(1–2):54–7.PubMedCrossRef
28.
Yoshino Y, Yoshida T, Mori T, Hirota S, Iga J, Ueno S. Risk of idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia. Int Psychogeriatr. 2016;28(5):863–8.PubMedCrossRef
29.
Mori E, Ishikawa M, Kato T, Kazui H, Miyake H, Miyajima M, Nakajima M, Hashimoto M, Kuriyama N, Tokuda T, et al. Guidelines for management of idiopathic normal pressure hydrocephalus: second edition. Neurol Med Chir (Tokyo). 2012;52(11):775–809.CrossRef
30.
Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261–76.PubMedCrossRef
31.
Leucht S, Rothe P, Davis JM, Engel RR. Equipercentile linking of the BPRS and the PANSS. Eur Neuropsychopharmacol. 2013;23(8):956–9.PubMedCrossRef
32.
Inada T. DIEPSS : a second generation rating scale for antipsychotic induced extrapyramidal symptoms Drug induced Extrapyramidal Symptoms Scale. Tokyo: Seiwa Shoten; 2009.
33.
Kubo Y, Kazui H, Yoshida T, Kito Y, Kimura N, Tokunaga H, Ogino A, Miyake H, Ishikawa M, Takeda M. Validation of grading scale for evaluating symptoms of idiopathic normal-pressure hydrocephalus. Dement Geriatr Cogn Disord. 2008;25(1):37–45.PubMedCrossRef
34.
Podsiadlo D, Richardson S. The timed "up & go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–8.PubMedCrossRef
35.
Miyoshi N, Kazui H, Ogino A, Ishikawa M, Miyake H, Tokunaga H, Ikejiri Y, Takeda M. Association between cognitive impairment and gait disturbance in patients with idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Disord. 2005;20(2–3):71–6.PubMedCrossRef
36.
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.CrossRefPubMed
37.
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308–14.PubMedCrossRef
38.
Guo H, Tabara Y, Igase M, Yamamoto M, Ochi N, Kido T, Uetani E, Taguchi K, Miki T, Kohara K. Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study. Hypertens Res. 2010;33(1):32–6.PubMedCrossRef
39.
Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.CrossRefPubMed
40.
Hiraoka K, Meguro K, Mori E. Prevalence of idiopathic normal-pressure hydrocephalus in the elderly population of a Japanese rural community. Neurol Med Chir (Tokyo). 2008;48(5):197–9 discussion 199-200.CrossRef
41.
Tanaka N, Yamaguchi S, Ishikawa H, Ishii H, Meguro K. Prevalence of possible idiopathic normal-pressure hydrocephalus in Japan: the Osaki-Tajiri project. Neuroepidemiology. 2009;32(3):171–5.PubMedCrossRef
42.
Dworkin RH. Pain insensitivity in schizophrenia: a neglected phenomenon and some implications. Schizophr Bull. 1994;20(2):235–48.PubMedCrossRef
43.
Goldman LS. Medical illness in patients with schizophrenia. J Clin Psychiatry. 1999;60(Suppl 21):10–5.PubMed
44.
Raftopoulos C, Deleval J, Chaskis C, Leonard A, Cantraine F, Desmyttere F, Clarysse S, Brotchi J. Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study. Neurosurgery. 1994;35(3):397–404 discussion 404-395.PubMedCrossRef
45.
Apostolova LG, Green AE, Babakchanian S, Hwang KS, Chou YY, Toga AW, Thompson PM. Hippocampal atrophy and ventricular enlargement in normal aging, mild cognitive impairment (MCI), and Alzheimer disease. Alzheimer Dis Assoc Disord. 2012;26(1):17–27.PubMedPubMedCentralCrossRef
46.
DeLisi LE, Sakuma M, Tew W, Kushner M, Hoff AL, Grimson R. Schizophrenia as a chronic active brain process: a study of progressive brain structural change subsequent to the onset of schizophrenia. Psychiatry Res. 1997;74(3):129–40.PubMedCrossRef
47.
Garcia-Armengol R, Domenech S, Botella-Campos C, Goncalves FJ, Menendez B, Teixidor P, Munoz-Narbona L, Rimbau J. Comparison of elevated intracranial pressure pulse amplitude and disproportionately enlarged subarachnoid space (DESH) for prediction of surgical results in suspected idiopathic normal pressure hydrocephalus. Acta Neurochir. 2016;158(11):2207–13.PubMedCrossRef
48.
Hashimoto M, Ishikawa M, Mori E, Kuwana N. Study of Ioni: Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study. Cerebrospinal Fluid Res. 2010;7:18.PubMedPubMedCentralCrossRef
49.
Craven CL, Toma AK, Mostafa T, Patel N, Watkins LD. The predictive value of DESH for shunt responsiveness in idiopathic normal pressure hydrocephalus. J Clin Neurosci. 2016;34:294–8.PubMedCrossRef
50.
Cagnin A, Simioni M, Tagliapietra M, Citton V, Pompanin S, Della Puppa A, Ermani M, Manara R. A simplified Callosal angle measure best differentiates idiopathic-Normal pressure hydrocephalus from neurodegenerative dementia. J Alzheimers Dis. 2015;46(4):1033–8.PubMedCrossRef
51.
Ishii K, Kanda T, Harada A, Miyamoto N, Kawaguchi T, Shimada K, Ohkawa S, Uemura T, Yoshikawa T, Mori E. Clinical impact of the callosal angle in the diagnosis of idiopathic normal pressure hydrocephalus. Eur Radiol. 2008;18(11):2678–83.PubMedCrossRef
52.
Grahnke K, Jusue-Torres I, Szujewski C, Joyce C, Schneck M, Prabhu VC, Anderson DE. The quest for predicting sustained shunt response in Normal-pressure hydrocephalus: an analysis of the Callosal Angle's utility. World Neurosurg. 2018;115:e717–22.PubMedCrossRef
53.
Virhammar J, Laurell K, Cesarini KG, Larsson EM. The callosal angle measured on MRI as a predictor of outcome in idiopathic normal-pressure hydrocephalus. J Neurosurg. 2014;120(1):178–84.PubMedCrossRef
54.
Virhammar J, Laurell K, Cesarini KG, Larsson EM. Increase in callosal angle and decrease in ventricular volume after shunt surgery in patients with idiopathic normal pressure hydrocephalus. J Neurosurg. 2018;130(1):130–5.PubMedCrossRef
55.
Green MF, Kern RS, Heaton RK. Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophr Res. 2004;72(1):41–51.PubMedCrossRef
56.
Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Avezaat CJ, de Jong DA, Gooskens RH, Hermans J. Dutch normal-pressure hydrocephalus study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg. 1997;87(5):687–93.PubMedCrossRef
57.
Ogino A, Kazui H, Miyoshi N, Hashimoto M, Ohkawa S, Tokunaga H, Ikejiri Y, Takeda M. Cognitive impairment in patients with idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Disord. 2006;21(2):113–9.PubMedCrossRef
58.
Kristensen B, Malm J, Fagerland M, Hietala SO, Johansson B, Ekstedt J, Karlsson T. Regional cerebral blood flow, white matter abnormalities, and cerebrospinal fluid hydrodynamics in patients with idiopathic adult hydrocephalus syndrome. J Neurol Neurosurg Psychiatry. 1996;60(3):282–8.PubMedPubMedCentralCrossRef
59.
Momjian S, Owler BK, Czosnyka Z, Czosnyka M, Pena A, Pickard JD. Pattern of white matter regional cerebral blood flow and autoregulation in normal pressure hydrocephalus. Brain. 2004;127(Pt 5):965–72.PubMedCrossRef
60.
Saito M, Nishio Y, Kanno S, Uchiyama M, Hayashi A, Takagi M, Kikuchi H, Yamasaki H, Shimomura T, Iizuka O, et al. Cognitive profile of idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Dis Extra. 2011;1(1):202–11.PubMedPubMedCentralCrossRef
61.
Kim SJ, Jung D, Shim JC, Moon JJ, Jeon DW, Kim YN, Seo YS, Jung SS, Seo BJ, Kim JE. The effect of anticholinergic burden on cognitive and daily living functions in patients with schizophrenia. Asian J Psychiatr. 2019;46:111–7.PubMedCrossRef
62.
Minzenberg MJ, Poole JH, Benton C, Vinogradov S. Association of anticholinergic load with impairment of complex attention and memory in schizophrenia. Am J Psychiatry. 2004;161(1):116–24.PubMedCrossRef
63.
Kitajima R, Miyamoto S, Tenjin T, Ojima K, Ogino S, Miyake N, Fujiwara K, Funamoto Y, Arai J, Tsukahara S, et al. Effects of tapering of long-term benzodiazepines on cognitive function in patients with schizophrenia receiving a second-generation antipsychotic. Prog Neuro-Psychopharmacol Biol Psychiatry. 2012;36(2):300–6.CrossRef
64.
Ogino S, Miyamoto S, Miyake N, Yamaguchi N. Benefits and limits of anticholinergic use in schizophrenia: focusing on its effect on cognitive function. Psychiatry Clin Neurosci. 2014;68(1):37–49.PubMedCrossRef
65.
Hsu WY, Muo CH, Ma SP, Kao CH. Association between schizophrenia and urinary incontinence: a population-based study. Psychiatry Res. 2017;248:35–9.PubMedCrossRef
66.
Faure Walker N, Brinchmann K, Batura D. Linking the evidence between urinary retention and antipsychotic or antidepressant drugs: a systematic review. Neurourol Urodyn. 2016;35(8):866–74.PubMedCrossRef
67.
Gareri P, Segura-Garcia C, Manfredi VG, Bruni A, Ciambrone P, Cerminara G, De Sarro G, De Fazio P. Use of atypical antipsychotics in the elderly: a clinical review. Clin Interv Aging. 2014;9:1363–73.PubMedPubMedCentral
68.
Cabral D, Beach TG, Vedders L, Sue LI, Jacobson S, Myers K, Sabbagh MN. Frequency of Alzheimer's disease pathology at autopsy in patients with clinical normal pressure hydrocephalus. Alzheimers Dement. 2011;7(5):509–13.PubMedPubMedCentralCrossRef
69.
Kimura T, Shono M, Yokota S, Ishizuka K, Watanabe M, Takamatsu J, Miyakawa T. Apolipoprotein E epsilon4 and tardive dyskinesia in a Japanese population. J Psychiatr Res. 2000;34(4–5):329–32.PubMedCrossRef
70.
Kimura T, Yokota S, Igata-Yi R, Shono M, Takamatsu J, Miyakawa T. Apolipoprotein E epsilon2 allele and early onset schizophrenia. Neurosci Lett. 1997;231(1):53–5.PubMedCrossRef
71.
Igata-Yi R, Igata T, Ishizuka K, Kimura T, Sakamoto S, Katsuragi S, Takamatsu J, Miyakawa T. Apolipoprotein E genotype and psychosis. Biol Psychiatry. 1997;41(8):906–8.PubMedCrossRef
72.
Czubowicz K, Glowacki M, Fersten E, Kozlowska E, Strosznajder RP, Czernicki Z. Levels of selected pro- and anti-inflammatory cytokines in cerebrospinal fluid in patients with hydrocephalus. Folia Neuropathol. 2017;55(4):301–7.PubMedCrossRef
73.
Pyykko OT, Lumela M, Rummukainen J, Nerg O, Seppala TT, Herukka SK, Koivisto AM, Alafuzoff I, Puli L, Savolainen S, et al. Cerebrospinal fluid biomarker and brain biopsy findings in idiopathic normal pressure hydrocephalus. PLoS One. 2014;9(3):e91974.PubMedPubMedCentralCrossRef
74.
Orlovska-Waast S, Kohler-Forsberg O, Brix SW, Nordentoft M, Kondziella D, Krogh J, Benros ME. Cerebrospinal fluid markers of inflammation and infections in schizophrenia and affective disorders: a systematic review and meta-analysis. Mol Psychiatry. 2019;24(6):869–87.PubMedCrossRef
75.
Del Bigio MR, Cardoso ER, Halliday WC. Neuropathological changes in chronic adult hydrocephalus: cortical biopsies and autopsy findings. Can J Neurol Sci. 1997;24(2):121–6.PubMedCrossRef
76.
Golomb J, Wisoff J, Miller DC, Boksay I, Kluger A, Weiner H, Salton J, Graves W. Alzheimer's disease comorbidity in normal pressure hydrocephalus: prevalence and shunt response. J Neurol Neurosurg Psychiatry. 2000;68(6):778–81.PubMedPubMedCentralCrossRef
Metadata
Title
Prevalence of possible idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia: a replication study
Authors
Yuta Yoshino
Taku Yoshida
Hideo Morino
Masayuki Nakamura
Masao Abe
Hokuto Omachi
Saori Inoue
Yukiyo Miyoshi
Yumina Tachibana
Noriko Yamauchi
Naoya Takeda
Mutsuhiko Mizobuchi
Yuki Ozaki
Shinichiro Ochi
Junichi Iga
Shu-ichi Ueno
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2020
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-020-02690-1

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