Frontiers in Neurology (Nov 2021)

Tap Test Can Predict Cognitive Improvement in Patients With iNPH—Results From the Multicenter Prospective Studies SINPHONI-1 and –2

  • Madoka Nakajima,
  • Shigeki Yamada,
  • Masakazu Miyajima,
  • Kaito Kawamura,
  • Chihiro Akiba,
  • Hiroaki Kazui,
  • Etsuro Mori,
  • Masatsune Ishikawa,
  • The SINPHONI-2 Investigators,
  • Masaaki Hashimoto,
  • Hideki Origasa,
  • Haruko Yamamoto,
  • Hajime Arai,
  • Koreaki Mori,
  • Shigenobu Nakamura,
  • Tamotsu Miki,
  • Kazunari Ishii,
  • Hiroji Miyake,
  • Nobumasa Kuwana,
  • Naoyuki Samejima,
  • Daisuke Kita,
  • Takahiko Tokuda,
  • Mitsuhito Mase,
  • Satoru Mori,
  • Yoshinaga Kajimoto,
  • Teiji Nakayama,
  • Osamu Hirai,
  • Masatoshi Takeda,
  • Chia-Cheng Chang,
  • Isao Date,
  • Masahiro Kameda,
  • Takaharu Okada,
  • Junichiro Hamada,
  • Mitsuya Watanabe,
  • Mitsunobu Kaijima,
  • Souichi Sunada,
  • Yoshihumi Hirata

DOI
https://doi.org/10.3389/fneur.2021.769216
Journal volume & issue
Vol. 12

Abstract

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Background: We analyzed the predictive value of the tap test (TT) on the outcome of cerebrospinal fluid (CSF) shunting in patients with idiopathic normal pressure hydrocephalus (iNPH) and cognitive impairment up to 12 months postoperatively.Methods: We analyzed the data of two prospective multicenter studies on ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS) use in iNPH patients. We selected patients with Mini-Mental State Examination (MMSE) scores ≤ 26 points as study subjects. We used a multivariate logistic regression model to obtain the optimal threshold of MMSE scores after TT to predict the score improvement at 12 months following shunting and that helped to control for confounding factors such as age and MMSE scores before TT. We used logistic regression models to identify variables with age-adjusted odds ratio (A-OR) and multivariate-adjusted OR (M-OR).Results: For an improvement of ≥3 points in the MMSE score cutoff 7 days following TT in VPS and LPS cohort studies, the MMSE scores improved by 6 points after 12 months. The VPS cohort had sensitivity, specificity, and area under the curve (AUC) of 69.2, 73.7, and 0.771%, respectively; however, for the LPS cohort, they were 86.2, 90.9, and 0.906%, respectively. For MMSE scores that improved by ≥3 points in patients after the TT, the possibility of an improvement by 6 points at 12 months following CSF shunt had A-OR 7.77 and M-OR 6.3 times for the VPS, and A-OR 62.3 and M-OR 59.6 times for the LPS cohort.Conclusion: CSF shunting contributes to improved cognitive function in iNPH patients. Furthermore, MMSE score evaluation at the TT can sensitively predict improvement in postoperative MMSE scores following LPS intervention.Clinical Trial Registration: SINPHONI-1 (ClinicalTrials.gov, no. NCT00221091), first posted: September 22, 2005.SINPHONI-2 [University Hospital Medical Information Network (UMIN) Clinical Trials no. UMIN000002730], the posted: February 1, 2010.

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