Uncovering the cognitive and mental impact of Hydrocephalus
WITH Mark Luciano, M.D., Ph.D
The Berry-Brem Professor in Neurosurgery Director, the Hydrocephalus and Cerebral Fluid Center
Matthew Peters, M.D. Associate Professor of Psychiatry & Behavioral Sciences Director, Clinical Services, Psychiatry, JH Bayview Medical Center &
The goal of the SCOUT-H study is to develop a comprehensive screening protocol with referral pathways for the early identification and treatment of the cognitive and psychiatric symptoms of Hydrocephalus.
Establishing Prevalence at Hopkins
Examine pre- and post-operative records of Hydrocephalus patients at Hopkins Search for patterns that may indicate neuropsychiatric complications
Why?
This data helps determine the frequency and severity of these symptoms and also identifies any gaps in the current screening process
Screening
Neurosurgery & neuropsychiatry create a new screening process based off of Phase 1 findings
Screening protocol may include self-report tools, observations from caregivers, and formalized testing
Why?
This will help patients understand what, if any, mood or cognitive symptoms they are experiencing as a result of this condition
These tests provide a baseline for doctors to refer to in the future
Treatment
Patients identified in Phase 2 in need of cognitive or mental care are offered three referral pathways:
The Acquired Brain Clinic
The Memory Center
The Neurorehabilitation program
Why?
These three referral pathways streamline the treatment process so patients’ symptoms are addressed in a timely manner
Before this study, little to no research had examined the cognitive and psychiatric effects of pressure on the brain
A systematic review of 1688 articles found only 8 studies mentioning the psychiatric impact of pressure on the brain
A systematic review of 1688 articles found only 9 studies mentioning the cognitive impact of pressure on the brain
829 (31%) of the 2,668 patients seen at the Johns Hopkins Hydrocephalus and Cerebral Fluid Center (JHHCFC) reported a psychiatric diagnosis (2013-now)
All types of Hydrocephalus are linked with psychiatric symptoms such as behavior change, irritability, depression, anxiety, and psychosis
JHHCFC patients who reported psychiatric symptoms were less likely to be married and/or full-time employed
Patients who develop psychiatric symptoms due to increased intracranial pressure often report more severe headaches and visual disturbances
Depression may hinder treatment adherence and exacerbate hydrocephalus symptoms and mental health issues, creating a vicious cycle for the patient
Hydrocephalus diagnosed at birth is linked with behavioral challenges in school as well as depression and anxiety
Patients who have psychiatric symptoms report poorer quality of life compared to patients without psychiatric symptoms
Normal Pressure Hydrocephalus (NPH) can cause short-term memory loss similar to Alzheimer’s, executive dysfunction, and impaired vision
Pressure on the brain is linked to cognitive deficits in processing speed, working memory, attention span, set-shifting, and confrontation naming
Patients who show signs of cognitive decline are struggling to receive care due to the extensive wait times for neurorehabilitation centers
Hydrocephalus at birth is associated with genetic syndromes and lower IQ
A systematic literature review uncovered a link between increased pressure on the brain and sleep-related disorders, like insomnia or obstructive sleep apnea
Any new patients of Dr. Luciano seen for Hydrocephalus or Idiopathic Intracranial Hypertension (IIH) are screened to collect key measures of cognitive performance, depression, and anxiety regardless of their surgical plan. The results of these various tests provide a baseline for doctors to refer to as the condition progresses.
for:
PERFORMANCE VALIDITY VISUOSPATIAL ATTENTION DEPRESSION SYMPTOMS
PREMORBID INTELLECT
AUDITORY WORKING MEMORY ANXIETY SYMPTOMS
FINE MOTOR DEXTERITY EXECUTIVE FUNCTIONING RECALL OF WORDS AND STORIES
GRAPHOMOTOR AND ORAL DECODING
PROCESSING SPEED
GRAPHOMOTOR SPEEDED SEQUENCING
SET SHIFTING
VERBAL FLUENCY
VERBAL MEMORY
CONFRONTATION NAMING WORKING & LOGICAL MEMORY
VISUOSPATIAL PROCESSING EXECUTIVE PLANNING
AUDITORY-VERBAL ATTENTION VERBAL LEARNING
The ultimate goal of SCOUT-H is to implement a proactive screening protocol with structured referral pathways for cognitive and psychiatric care at Johns Hopkins to create a scalable and replicable model for medical institutions worldwide.
We are grateful for the support this project has garnered thus far, which has made Phase I of SCOUT-H possible. If you’d like to learn more about opportunities to contribute to this work, you can contact Anna Dugan at adugan3@jh.edu and Amy Bortner at aborter1@jh.edu.
Further information about the project and our fundraising goals can be found by scanning the QR code above.