Apathy in idiopathic normal pressure hydrocephalus: A marker of reversible gait disorders

ObjectiveApathythe most common behavioral disturbance in idiopathic normal pressure hydrocephalus (iNPH)is associated with poor gait, but the role of apathy on gait improvement after cerebrospinal fluid (CSF) tapping has not been studied yet. This study aims to compare gait improvement after CSF tapping in iNPH patients with and without apathy. MethodsStride time variability (STV), a marker of higher level of gait control, was measured in 33 iNPH patients (78.45.7years; 36.4% women) with an optoelectronic system during usual walking (single task) and during walking while dual tasking of counting and verbal fluency before and 24hours after CSF tapping. Apathy was defined by a score 14 on the Starkstein apathy scale. ResultsApathy was present in 60.6% of patients. Cerebrospinal fluid tapping led to greater improvement of STV (ie, decrease) during dual-task walking (and more specifically categorical verbal fluency) in apathetic compared to nonapathetic patients (-44.7 +/- 58.1% versus +4.24 +/- 67.6%, respectively; P=.040), even after adjusting for age and depressive symptoms. More severe apathy was correlated with better STV improvement while dual tasking (categorical verbal fluency) after CSF tapping (r=-0.412; P-value=0.021), while it was not correlated with improvement on executive tests. ConclusionsOur findings suggest that the presence of apathy is a predictor of better outcomes of gait disorders after CSF tapping in patients with iNPH.