Surgery Makes Dementia Patients Faster and Smarter

A new study demonstrates that a cerebrospinal fluid (CSF) shunt can improve gait and cognition in patients with dementia caused by white matter changes and hydrocephalus.

Researchers from the Sahlgrenska Academy at the University of Gothenburg (Sweden) and Sahlgrenska University Hospital (Gothenburg, Sweden) conducted a randomized controlled double-blind study involving 14 consecutive idiopathic normal pressure hydrocephalus (iNPH) patients with extensive vascular white matter disease and normal cerebrospinal fluid (CSF) dynamics. Once determined they would benefit from shunt surgery for CSF drainage, the patients were randomized to receive either open or closed shunts. At 3 months after surgery, the patients with initially ligated shunts had their shunts opened. Clinical evaluation consisting of seven quantitative psychometric and six continuous gait tests were performed preoperatively, and three and six months after surgery.

The results showed that the patients randomized to receive open shunts had improved motor (30% increase) and psychometric (23% increase) scores three months after shunt placement; there were no significant changes between the three- and six-month follow-up in these same patients. Conversely, those with initially ligated shunts were unchanged during the first three-month period, although they improved in both motor (28%) and cognitive (18%) functions following removal of the ligature. The study was published early online on January 14, 2011, in the American Journal of Neurosurgery.

"Shunt operations have long been used for hydrocephalus, but this study offers more scientifically conclusive results to support the effect of the treatment, and also shows that shunt operations can help far more patients than previously believed with their walking and memory,” said lead author Magnus Tisell, MD, PhD, docent at the Sahlgrenska Academy and consultant neurosurgeon at Sahlgrenska University Hospital.

Hydrocephalus is caused by excessive CSF collecting in the brain's cavities. Patients often have problems walking, and their ability to think and remember is also affected. The fluid can be drained through a shunt, a narrow plastic tube that is surgically inserted into one of the brain's cavities and linked to the stomach or heart. In some cases, laparoscopic surgery can make it possible for the fluid to be absorbed into the bloodstream.

Related Links:
Sahlgrenska Academy at the University of Gothenburg
Sahlgrenska University Hospital