• Klara Brgić Mandić, Goran Mrak, Hrvoje Barić, Sergej Marasanov, Goran Šimić, Ena Španić Popovački, and Marijan Klarica.
• Marijan Klarica, Department of Pharmacology and Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Šalata 2, 10000 Zagreb, Croatia, mklarica@mef.hr.
• Croat. Med. J. 2024 Aug 31; 65 (4): 328338328-338.

AimTo examine whether changes in biomarker concentrations in patients with idiopathic normal-pressure hydrocephalus (iNPH) during 72 h of external lumbar drainage (ELD) can differentiate between responders and non-responders.MethodsTwenty patients with clinical and neuroradiological signs of iNPH underwent ELD over a period of 72 h. During this period, changes in cerebrospinal fluid (CSF) concentrations of biomarkers (amyloid-β, total and phosphorylated tau proteins) and intracranial pressure were monitored, and the volume of drained CSF was measured. Changes in the concentrations of selected biomarkers at three time points (0, 36, and 72 h) during ELD were tested for association with changes in clinical condition.ResultsTen patients showed significant clinical improvement after ELD, quantified as a difference of two or more points on the Mini-Mental State Examination and/or Japanese iNPH grading scale. The concentration of all tested biomarkers increased during the first 36 h. Respondents had higher Aβ 1-42 at all time points, with a significant difference seen after 72 h. They also had a significantly higher Aβ1-42/Aβ1-40 ratio at all time points.ConclusionA gradual increase in Aβ 1-42 concentration during three-day ELD represents a possible positive prognostic factor for the placement of permanent CSF drainage in patients with iNPH.

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