White matter involvement in idiopathic normal pressure hydrocephalus: A voxel-based diffusion tensor imaging study

Shigenori Kanno, Nobuhito Abe, Makoto Saito, Masahito Takagi, Yoshiyuki Nishio, Akiko Hayashi, Makoto Uchiyama, Risa Hanaki, Hirokazu Kikuchi, Kotaro Hiraoka, Hiroshi Yamasaki, Osamu Iizuka, Atsushi Takeda, Yasuto Itoyama, Shoki Takahashi, Etsuro Mori

Research output: Contribution to journalArticlepeer-review

70 Citations (Scopus)


The aim of this study was to characterise the white matter damage involved in idiopathic normal pressure hydrocephalus (INPH) using diffusion tensor imaging (DTI) and the relationship between this damage and clinical presentation. Twenty patients with INPH, 20 patients with Alzheimer's disease and 20 patients with idiopathic Parkinson's disease (as disease control groups) were enrolled in this study. Mean diffusivity (MD) and fractional anisotropy (FA) were determined using DTI, and these measures were analysed to compare the INPH group with the control groups and with certain clinical correlates. On average, the supratentorial white matter presented higher MD and lower FA in the INPH group than in the control groups. In the INPH group, the mean hemispheric FA correlated with some of the clinical measures, whereas the mean hemispheric MD did not. On a voxel-based statistical map, white matter involvement with high MD was localised to the periventricular regions, and white matter involvement with low FA was localised to the corpus callosum and the subcortical regions. The total scores on the Frontal Assessment Battery were correlated with the FA in the frontal and parietal subcortical white matter, and an index of gait disturbance was correlated with the FA in the anterior limb of the left internal capsule and under the left supplementary motor area. DTI revealed the presence of white matter involvement in INPH. Whereas white matter regions with high MD were not related to symptom manifestation, those with low FA were related to motor and cognitive dysfunction in INPH.

Original languageEnglish
Pages (from-to)1949-1957
Number of pages9
JournalJournal of Neurology
Issue number11
Publication statusPublished - 2011 Nov


  • Alzheimer's disease
  • Diffusion tensor imaging
  • Idiopathic normal pressure hydrocephalus
  • Parkinson's disease
  • White matter


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