원발성 정상압수두증 환자의 국소 뇌혈류 변화 : Statistical Parametric Mapping을 이용한 SPECT 분석
Analysis of Regional Cerebral Blood Flow Changes with SPECT in Idiopathic Normal Pressure Hydrocephalus : Statistical Parametric Mapping analysis
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Background and Objectives: Idiopathic normal pressure hydrocephalus (iNPH) is a reversible condition characterized by gait disturbance, urinary incontinence, and dementia. This study investigates the neuropsychological characteristics and changes of regional cerebral blood flow (CBF) in patients with iNPH. Methods: Ten patients with iNPH and thirteen normal control subjects were evaluated. The general cognitive function and detailed neuropsychological functions were measured by the Korean mini-mental status examination (K-MMSE) and a comprehensive neuropsychological battery. Patients who showed clinical improvement in at least one clinical domain after CSF drainage were included. 99mTc-ECD(ethyl cysteinate dimmer) SPECT was performed to measure the regional CBF and the statistical parametric mapping (SPM) 99 software was applied for the objective analysis of SPECT data. Results: On the neuropsychological examination, all patients showed abnormalities in memory, psychomotor speed, and frontal executive function. SPM analysis of SPECT images revealed significantly decreased CBF in the bilateral thalami, right prefrontal area, anterior and posterior cingulate gyri, right caudate nucleus, and left parahippocampal gyrus in patients with iNPH compared to those of normal controls (uncorrected p=0.005). Conclusions: Neuropsychological abnormalities and CBF changes suggest that the prefrontal and subcortical areas may be associated with cognitive dysfunctions in patients with iNPH.
Abstract
Background and Objectives: Idiopathic normal pressure hydrocephalus (iNPH) is a reversible condition characterized by gait disturbance, urinary incontinence, and dementia. This study investigates the neuropsychological characteristics and changes of regional cerebral blood flow (CBF) in patients with iNPH. Methods: Ten patients with iNPH and thirteen normal control subjects were evaluated. The general cognitive function and detailed neuropsychological functions were measured by the Korean mini-mental status examination (K-MMSE) and a comprehensive neuropsychological battery. Patients who showed clinical improvement in at least one clinical domain after CSF drainage were included. 99mTc-ECD(ethyl cysteinate dimmer) SPECT was performed to measure the regional CBF and the statistical parametric mapping (SPM) 99 software was applied for the objective analysis of SPECT data. Results: On the neuropsychological examination, all patients showed abnormalities in memory, psychomotor speed, and frontal executive function. SPM analysis of SPECT images revealed significantly decreased CBF in the bilateral thalami, right prefrontal area, anterior and posterior cingulate gyri, right caudate nucleus, and left parahippocampal gyrus in patients with iNPH compared to those of normal controls (uncorrected p=0.005). Conclusions: Neuropsychological abnormalities and CBF changes suggest that the prefrontal and subcortical areas may be associated with cognitive dysfunctions in patients with iNPH.