A computerized neuropsychological test battery designed for idiopathic normal pressure hydrocephalus

Anders Behrens, Anders Eklund, Eva Elgh, Cynthia Smith, Michael A Williams, Jan Malm, Anders Behrens, Anders Eklund, Eva Elgh, Cynthia Smith, Michael A Williams, Jan Malm

Abstract

Background: A tool for standardized and repeated neuropsychological assessments in patients with idiopathic normal pressure hydrocephalus (INPH) is needed. The objective of this study was to develop a computerized neuropsychological test battery designed for INPH and to evaluate its reliability, validity and patient's ability to complete the tests.

Methods: Based on a structured review of the literature on neuropsychological testing in INPH, the eight tests most sensitive to the INPH cognitive profile were implemented in a computerized format. The Geriatric Depression Scale (GDS) was also included. Tests were presented on a touch-screen monitor, with animated instructions and speaker sound. The battery was evaluated with the following cohorts: A. Test-retest reliability, 44 healthy elderly; B. Validity against standard pen and pencil testing, 28 patients with various cognitive impairments; C. Ability to complete test battery, defined as completion of at least seven of the eight tests, 40 investigated for INPH.

Results: A. All except the figure copy test showed good test-retest reliability, r = 0.67-0.90; B. A high correlation was seen between conventional and computerized tests (r = 0.66-0.85) except for delayed recognition and figure copy task; C. Seventy-eight percent completed the computerized battery; Patients diagnosed with INPH (n = 26) performed worse on all tests, including depression score, compared to healthy controls.

Conclusions: A new computerized neuropsychological test battery designed for patients with communicating hydrocephalus and INPH was introduced. Its reliability, validity for general cognitive impairment and completion rate for INPH was promising. After exclusion of the figure copy task, the battery is ready for clinical evaluation and as a next step we suggest validation for INPH and a comparison before and after shunt surgery.

Trial registration: ClinicalTrials.org NCT01265251.

Keywords: Dementia; Hydrocephalus, Normal pressure; Neuropsychological tests; Neuropsychology; Reliability and validity; Software.

Figures

Figure 1
Figure 1
The research plan for this study.
Figure 2
Figure 2
Recruitment and exclusions in the reliability study. The participants were confirmed healthy regarding medical history and clinical examination including ongoing medication, physical and neurological examinations, electrocardiography, blood pressure, body mass index, Mini-Mental State Examination (MMSE) and MRI. Exclusion criteria was disease of the nervous system, MMSE < 28, medications affecting nervous system (such as benzodiazepine or antidepressants), anticoagulants, ischemic heart disease, diabetes, and vascular risk factors (Two of either: hypertension, smoking or hyperlipidemia). The attempt to obtain equal numbers of men and women, resulted in the early exclusion of 19 women who responded to the ad i.e. the “Remain” group.
Figure 3
Figure 3
Performance of patients with INPH, as percentages of median performance in healthy individuals. Error bars indicate the interquartile range. To make impairments clear, results from tests with time scores were recalculated as units per time. Thus a lower score always mean impairment. The performance for the figure copy task is expressed as the ratio of correct response-ratios in the INPH and healthy groups. The INPH patients performed worse than healthy controls in all tests (Mann-Whitney, and Chi-square test for the figure copy task, p < 0.001).

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Source: PubMed

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