AUTHOR=Nakajima Madoka , Yamada Shigeki , Miyajima Masakazu , Kawamura Kaito , Akiba Chihiro , Kazui Hiroaki , Mori Etsuro , Ishikawa Masatsune ,  The SINPHONI-2 Investigators , Hashimoto Masaaki , Origasa Hideki , Yamamoto Haruko , Arai Hajime , Mori Koreaki , Nakamura Shigenobu , Miki Tamotsu , Ishii Kazunari , Miyake Hiroji , Kuwana Nobumasa , Samejima Naoyuki , Kita Daisuke , Tokuda Takahiko , Mase Mitsuhito , Mori Satoru , Kajimoto Yoshinaga , Nakayama Teiji , Hirai Osamu , Takeda Masatoshi , Chang Chia-Cheng , Date Isao , Kameda Masahiro , Okada Takaharu , Hamada Junichiro , Watanabe Mitsuya , Kaijima Mitsunobu , Sunada Souichi , Hirata Yoshihumi 

TITLE=Tap Test Can Predict Cognitive Improvement in Patients With iNPH—Results From the Multicenter Prospective Studies SINPHONI-1 and –2

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.769216

DOI=10.3389/fneur.2021.769216

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> We analyzed the predictive value of the tap test (TT) on the outcome of cerebrospinal fluid (CSF) shunting in patients with idiopathic normal pressure hydrocephalus (iNPH) and cognitive impairment up to 12 months postoperatively.</p><p><bold>Methods:</bold> We analyzed the data of two prospective multicenter studies on ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS) use in iNPH patients. We selected patients with Mini-Mental State Examination (MMSE) scores ≤ 26 points as study subjects. We used a multivariate logistic regression model to obtain the optimal threshold of MMSE scores after TT to predict the score improvement at 12 months following shunting and that helped to control for confounding factors such as age and MMSE scores before TT. We used logistic regression models to identify variables with age-adjusted odds ratio (A-OR) and multivariate-adjusted OR (M-OR).</p><p><bold>Results:</bold> For an improvement of ≥3 points in the MMSE score cutoff 7 days following TT in VPS and LPS cohort studies, the MMSE scores improved by 6 points after 12 months. The VPS cohort had sensitivity, specificity, and area under the curve (AUC) of 69.2, 73.7, and 0.771%, respectively; however, for the LPS cohort, they were 86.2, 90.9, and 0.906%, respectively. For MMSE scores that improved by ≥3 points in patients after the TT, the possibility of an improvement by 6 points at 12 months following CSF shunt had A-OR 7.77 and M-OR 6.3 times for the VPS, and A-OR 62.3 and M-OR 59.6 times for the LPS cohort.</p><p><bold>Conclusion:</bold> CSF shunting contributes to improved cognitive function in iNPH patients. Furthermore, MMSE score evaluation at the TT can sensitively predict improvement in postoperative MMSE scores following LPS intervention.</p><p><bold>Clinical Trial Registration:</bold> SINPHONI-1 (<ext-link ext-link-type="uri" xlink:href="https://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, no. NCT00221091), first posted: September 22, 2005.</p><p>SINPHONI-2 [University Hospital Medical Information Network (UMIN) Clinical Trials no. UMIN000002730], the posted: February 1, 2010.</p>