The prevalence and clinical associations of disproportionately enlarged subarachnoid space hydrocephalus (DESH), an imaging feature of idiopathic normal pressure hydrocephalus in community and memory clinic based Singaporean cohorts

• Published in: Journal of the neurological sciences Vol. 408; p. 116510
• Main Authors: Akiba, Chihiro, Gyanwali, Bibek, Villaraza, Steven, Nakajima, Madoka, Miyajima, Masakazu, Cheng, Ching-Yu, Wong, Tien Yin, Venketasubramanian, Narayanaswamy, Hilal, Saima, Chen, Christopher
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.01.2020
• Subjects: Aged; Aged, 80 and over; Cohort Studies; Community Health Centers - trends; Community-based cohort; Cross-Sectional Studies; Dementia; Disproportionately enlarged subarachnoid space hydrocephalus (DESH); Female; Humans; Hydrocephalus, Normal Pressure - diagnostic imaging; Hydrocephalus, Normal Pressure - epidemiology; Hydrocephalus, Normal Pressure - psychology; Idiopathic normal pressure hydrocephalus (iNPH); Magnetic Resonance Imaging - methods; Magnetic Resonance Imaging - trends; Male; Memory clinic-based cohort; Memory Disorders - diagnostic imaging; Memory Disorders - epidemiology; Memory Disorders - psychology; Middle Aged; Neurology; Prevalence; Singapore - epidemiology; Subarachnoid Space - diagnostic imaging; Singapore; Disproportionately enlarged subarachnoid space hydrocephalus (DESH); AD; Idiopathic normal pressure hydrocephalus (iNPH); CSF; Memory clinic-based cohort; DESH; Community-based cohort; iNPH; Dementia; Disproportionately Enlarged Subarachnoid space Hydrocephalus; cerebrospinal fluid; idiopathic normal pressure hydrocephalus; Alzheimer's disease
• DOI: 10.1016/j.jns.2019.116510
• ISSN: 0022-510X; 1878-5883

Disproportionately Enlarged Subarachnoid space Hydrocephalus (DESH) is considered as an important imaging feature of idiopathic normal pressure hydrocephalus (iNPH). Subjects aged 60 and over in a memory clinic and a community-based cohort were assessed for the presence of ventriculomegaly, Sylvian dilatation, and high convexity tightness by neuroimaging, and a clinical triad of iNPH symptoms, i.e. cognitive, gait and urinary symptoms. In the memory clinic-based study (548 subjects), the prevalence of DESH was 1.1% and increased with age. The clinical triad was significantly more frequent in subjects with DESH (50%) compared to those with normal images (none), Sylvian dilatation (7%), and ventriculomegaly (12%). Gait disturbance was also significantly more frequent in DESH (83%) compared to those with normal images (2%), Sylvian dilatation (14%), and ventriculomegaly (26%). In the community-based cohort (946 subjects), the prevalence of DESH was 1.0% and increased with age. The clinical triad (11%) was significantly more common in subjects with DESH compared to those with normal images (none), Sylvian dilatation (2%), and ventriculomegaly (7%). Gait disturbance was also significantly more common in DESH (33%) compared to those with normal images (1%), Sylvian dilatation (4%), and ventriculomegaly (10%). The reported prevalence of DESH was approximately 1%, and increased with age. DESH and high convexity tightness were specifically associated with the clinical triad of iNPH. Of the triad, gait disturbance was associated to DESH and high convexity tightness. •Prevalence of DESH in a memory clinic-based cohort was 1.1% and increased with age.•Prevalence of DESH in a community-based cohort was 1.0% and increased with age.•Presence of high convexity tightness is a highly predictive feature of DESH.•Gait disturbance seemed to be the most specific symptom to DESH.•Prevalence of DESH in subjects with dementia was 2.2% in the memory clinic and 6.5% in the community-based cohort.