Neurological Surgery 脳神経外科40巻11号

2012年11月発行

総説

特発性正常圧水頭症

著者： 新井一¹ 宮嶋雅一¹ 中島円¹

所属機関： ¹順天堂大学脳神経外科

ページ範囲：P.959 - P.965

Ⅰ．はじめに

　人口の高齢化が進む本邦においては，アルツハイマー病などの認知症患者の数は年々増加しており，介護にたずさわる患者家族の身体的・経済的負担，さらには介護保険などの社会が負うべき責任の増大が大きな問題となってきている．一方で，認知症と診断された患者のなかに，外科的治療によって症状の改善をみる一群の疾患があることが知られている．これらの疾患のうち，最近“治療可能な認知症”として注目されているのが特発性正常圧水頭症（idiopathic normal pressure hydrocephalus：iNPH）である．“治療可能な認知症”との文言が若干強調され過ぎの感は否めないが，本疾患を的確に診断・治療することにより，上述の患者家族ならびに社会の負担を軽減することが可能になるものと期待されている．

参考文献

1）Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH：Symptomatic occult hydrocephalus with “normal” cerebrospinal-fluid pressure. A treatable syndrome. N Engl J Med 273：117-126, 1965

2）Agren-Wilsson A, Lekman A, Sjoberg W, Rosengren L, Blennow K, Bergenheim AT, Malm J：CSF biomarkers in the evaluation of idiopathic normal pressure hydrocephalus. Acta Neurol Scand 116：333-339, 2007

3）Anderson RC, Grant JJ, de la Paz R, Frucht S, Goodman RR：Volumetric measurements in the detection of reduced ventricular volume in patients with normal-pressure hydrocephalus whose clinical condition improved after ventriculoperitoneal shunt placement. J Neurosurg 97：73-79, 2002

4）新井　一，橋本正明，宮嶋雅一：特発性正常圧水頭症アンケート調査の結果─特発性正常圧水頭症の前向き臨床観察研究の設立に向けて─厚生労働省科学研究費補助金　難治性疾患克服研究事業「正常圧水頭症の疫学・病態と治療に関する研究」平成20年度　総括・分担研究報告書：57, 2009

5）Bech RA, Waldemar G, Gjerris F, Klinken L, Juhler M：Shunting effects in patients with idiopathic normal pressure hydrocephalus；correlation with cerebral and leptomeningeal biopsy findings. Acta Neurochir (Wien) 141：633-639, 1999

6）Bech-Azeddine R, Waldemar G, Knudsen GM, Hogh P, Bruhn P, Wildschiodtz G, Gjerris F, Paulson OB, Juhler M：Idiopathic normal-pressure hydrocephalus：evaluation and findings in a multidisciplinary memory clinic. Eur J Neurol 8：601-611, 2001

7）Brean A, Eide PK：Prevalence of probable idiopathic normal pressure hydrocephalus in a Norwegian population. Acta Neurol Scand 118：48-53, 2008

8）DeLand FH, James AE Jr, Ladd DJ, Konigsmark BW：Normal pressure hydrocephalus：a histologic study. Am J Clin Pathol 58：58-63, 1972

9）Hashimoto M, Ishikawa M, Mori E, Kuwana N；Study of INPH on neurological improvement (SINPHONI)：Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme：a prospective cohort study. Cerebrospinal Fluid Res 7：18, 2010

10）Iseki C, Kawanami T, Nagasawa H, Wada M, Koyama S, Kikuchi K, Arawaka S, Kurita K, Daimon M, Mori E, Kato T：Asymptomatic ventriculomegaly with features of idiopathic normal pressure hydrocephalus on MRI (AVIM) in the elderly：a prospective study in a Japanese population. J Neurol Sci 277：54-57, 2009

11）Ishikawa M；Guideline Committe for Idiopathic Normal Pressure Hydrocephalus, Japanese Society of Normal Pressure Hydrocephalus：Clinical guidelines for idiopathic normal pressure hydrocephalus. Neurol Med Chir (Tokyo) 44：222-223, 2004

12）Kapaki EN, Paraskevas GP, Tzerakis NG, Sfagos C, Seretis A, Kararizou E, Vassilopoulos D：Cerebrospinal fluid tau, phospho-tau181 and beta-amyloid1-42 in idiopathic normal pressure hydrocephalus：a discrimination from Alzheimer's disease. Eur J Neurol 14：168-173, 2007

13）Kitagaki H, Mori E, Ishii K, Yamaji S, Hirono N, Imamura T：CSF spaces in idiopathic normal pressure hydrocephalus：morphology and volumetry. AJNR Am J Neuroradiol 19：1277-1284, 1998

14）Klinge P, Marmarou A, Bergsneider M, Relkin N, Black PM：Outcome of shunting in idiopathic normal-pressure hydrocephalus and the value of outcome assessment in shunted patients. Neurosurgery 57：40-52, 2005

15）Knopman DS, Petersen RC, Cha RH, Edland SD, Rocca WA：Incidence and causes of nondegenerative nonvascular dementia：a population-based study. Arch Neurol 63：218-221, 2006

16）Krauss JK, Droste DW, Vach W, Regel JP, Orszagh M, Borremans JJ, Tietz A, Seeger W：Cerebrospinal fluid shunting in idiopathic normal-pressure hydrocephalus of the elderly：effect of periventricular and deep white matter lesions. Neurosurgery 39：292-299；discussion 299-300, 1996

17）Leinonen V, Koivisto AM, Savolainen S, Rummukainen J, Tamminen JN, Tillgren T, Vainikka S, Pyykko OT, Molsa J, Fraunberg M, Pirttila T, Jaaskelainen JE, Soininen H, Rinne J, Alafuzoff I：Amyloid and tau proteins in cortical brain biopsy and Alzheimer's disease. Ann Neurol 68：446-453, 2010

18）Li X, Miyajima M, Mineki R, Taka H, Murayama K, Arai H：Analysis of potential diagnostic biomarkers in cerebrospinal fluid of idiopathic normal pressure hydrocephalus by proteomics. Acta Neurochir (Wien) 148：859-864, 2006

19）Mori K：Management of idiopathic normal-pressure hydrocephalus；A multiinstitutional study conducted in Japan. J Neurosurg 95：970-973, 2001

20）Nakajima M, Miyajima M, Ogino I, Watanabe M, Miyata H, Karagiozov KL, Arai H, Hagiwara Y, Segawa T, Kobayashi K, Hashimoto Y：Leucine-rich alpha-2-glycoprotein is a marker for idiopathic normal pressure hydrocephalus. Acta Neurochir (Wien) 153：1339-1346, 2011

21）日本正常圧水頭症研究会特発性正常圧水頭症診療ガイドライン作成委員会：特発性正常圧水頭症診療ガイドライン．メディカルレビュー社，大阪，2004

22）日本正常圧水頭症研究会特発性正常圧水頭症診療ガイドライン作成委員会：特発性正常圧水頭症診療ガイドライン第2版．メディカルレビュー社，大阪，2011

23）Patel S, Lee EB, Xie SX, Law A, Jackson EM, Arnold SE, Clark CM, Shaw LM, Grady MS, Trojanowski JQ, Hamilton RH：Phosphorylated tau/amyloid beta 1-42 ratio in ventricular cerebrospinal fluid reflects outcome in idiopathic normal pressure hydrocephalus. Fluids Barriers CNS 9：7, 2012

24）Raftopoulos C, Deleval J, Chaskis C, Leonard A, Cantraine F, Desmyttere F, Clarysse S, Brotchi J：Cognitive recovery in idiopathic normal pressure hydrocephalus：a prospective study. Neurosurgery 35：397-404；discussion 404-405, 1994

25）Ray B, Reyes PF, Lahiri DK：Biochemical studies in Normal Pressure Hydrocephalus (NPH) patients：change in CSF levels of amyloid precursor protein (APP), amyloid-beta (Abeta) peptide and phospho-tau. J Psychiatr Res 45：539-547, 2011

26）Tarnaris A, Toma AK, Chapman MD, Keir G, Kitchen ND, Watkins LD：Use of cerebrospinal fluid amyloid-beta and total tau protein to predict favorable surgical outcomes in patients with idiopathic normal pressure hydrocephalus. J Neurosurg 115：145-150, 2011

27）Tullberg M, Rosengren L, Blomsterwall E, Karlsson JE, Wikkelso C：CSF neurofilament and glial fibrillary acidic protein in normal pressure hydrocephalus. Neurology 50：1122-1127, 1998

28）Weiner HL, Constantini S, Cohen H, Wisoff JH：Current treatment of normal-pressure hydrocephalus：comparison of flow-regulated and differential-pressure shunt valves. Neurosurgery 37：877-884, 1995