Deficits of Language and Speech in Idiopathic Normal Pressure Hydrocephalus

Abstract

Title: Deficits of Language and Speech in Idiopathic Normal Pressure Hydrocephalus Esther H. Chung, BA, Thu-Trang Hickman, MPH, Mary-Ellen Meadows, PhD and Mark D. Johnson, MD, PhD Purpose: Idiopathic normal pressure hydrocephalus (iNPH) is a disorder of unknown etiology characterized by gait instability, incontinence and dementia. Symptoms can be ameliorated by shunt placement for cerebrospinal fluid drainage. Although language and speech impairments have not traditionally been associated with iNPH, anecdotal reports commonly indicate otherwise. This study’s objective was to determine the prevalence and nature of language and speech difficulties in iNPH, and whether these deficits improve after shunt placement. Methods: We analyzed the medical records of 529 patients who underwent shunt placement for iNPH at our institution between July 2001 and March 2015 for deficits in language or speech at initial presentation. A subset of 71 patients underwent formal pre-operative neurocognitive assessments, and thirteen of these patients also underwent post-operative testing at least 6 months after shunt insertion. Improvement was assessed using the Reliable Change Index. Results: In the retrospective study of 529 patients, language deficits were identified in 23.1%, speech deficits in 12.9% and writing deficits in 4% of patients. Analysis of 71 prospectively collected pre-operative neurocognitive evaluations revealed semantic verbal fluency and fine motor impairments in more than two-thirds of patients. Of the 13 patients who underwent both pre- and post-operative testing, 84.6% experienced significant improvements in language and executive function. Conclusions: We demonstrate that 70.4% and 67.6% of patients with shunt-responsive iNPH originally present with language and fine motor difficulties respectively. Improvement in these symptoms after shunting indicates that deficits in language are an integral component of iNPH pathology and should be considered during the diagnosis and management of this disorder.