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April 2022; 12 (2) ResearchOpen Access

CSF Biomarkers Predict Gait Outcomes in Idiopathic Normal Pressure Hydrocephalus

View ORCID ProfileJacqueline A. Darrow, Alexandria Lewis, View ORCID ProfileSeema Gulyani, Kristina Khingelova, Aruna Rao, Jiangxia Wang, Yifan Zhang, Mark Luciano, Sevil Yasar, View ORCID ProfileAbhay Moghekar
First published January 20, 2022, DOI: https://doi.org/10.1212/CPJ.0000000000001156
Jacqueline A. Darrow
Department of Neurology (JAD, AL, SG, KK, AR, AM), Johns Hopkins University School of Medicine; Department of Biostatistics (JW, YZ), Johns Hopkins University Bloomberg School of Public Health; Department of Neurosurgery (ML), and Department of Medicine (SY), Johns Hopkins University School of Medicine, Baltimore, MD.
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  • ORCID record for Jacqueline A. Darrow
  • For correspondence: jdarrow2@jhmi.edu
Alexandria Lewis
Department of Neurology (JAD, AL, SG, KK, AR, AM), Johns Hopkins University School of Medicine; Department of Biostatistics (JW, YZ), Johns Hopkins University Bloomberg School of Public Health; Department of Neurosurgery (ML), and Department of Medicine (SY), Johns Hopkins University School of Medicine, Baltimore, MD.
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  • For correspondence: alewis91@jhmi.edu
Seema Gulyani
Department of Neurology (JAD, AL, SG, KK, AR, AM), Johns Hopkins University School of Medicine; Department of Biostatistics (JW, YZ), Johns Hopkins University Bloomberg School of Public Health; Department of Neurosurgery (ML), and Department of Medicine (SY), Johns Hopkins University School of Medicine, Baltimore, MD.
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  • ORCID record for Seema Gulyani
  • For correspondence: sgulyan1@jhmi.edu
Kristina Khingelova
Department of Neurology (JAD, AL, SG, KK, AR, AM), Johns Hopkins University School of Medicine; Department of Biostatistics (JW, YZ), Johns Hopkins University Bloomberg School of Public Health; Department of Neurosurgery (ML), and Department of Medicine (SY), Johns Hopkins University School of Medicine, Baltimore, MD.
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  • For correspondence: kkhinge1@jhmi.edu
Aruna Rao
Department of Neurology (JAD, AL, SG, KK, AR, AM), Johns Hopkins University School of Medicine; Department of Biostatistics (JW, YZ), Johns Hopkins University Bloomberg School of Public Health; Department of Neurosurgery (ML), and Department of Medicine (SY), Johns Hopkins University School of Medicine, Baltimore, MD.
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  • For correspondence: arao10@jhmi.edu
Jiangxia Wang
Department of Neurology (JAD, AL, SG, KK, AR, AM), Johns Hopkins University School of Medicine; Department of Biostatistics (JW, YZ), Johns Hopkins University Bloomberg School of Public Health; Department of Neurosurgery (ML), and Department of Medicine (SY), Johns Hopkins University School of Medicine, Baltimore, MD.
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  • For correspondence: jwang135@jhu.edu
Yifan Zhang
Department of Neurology (JAD, AL, SG, KK, AR, AM), Johns Hopkins University School of Medicine; Department of Biostatistics (JW, YZ), Johns Hopkins University Bloomberg School of Public Health; Department of Neurosurgery (ML), and Department of Medicine (SY), Johns Hopkins University School of Medicine, Baltimore, MD.
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  • For correspondence: yzhan170@jhu.edu
Mark Luciano
Department of Neurology (JAD, AL, SG, KK, AR, AM), Johns Hopkins University School of Medicine; Department of Biostatistics (JW, YZ), Johns Hopkins University Bloomberg School of Public Health; Department of Neurosurgery (ML), and Department of Medicine (SY), Johns Hopkins University School of Medicine, Baltimore, MD.
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  • For correspondence: markluciano@jhu.edu
Sevil Yasar
Department of Neurology (JAD, AL, SG, KK, AR, AM), Johns Hopkins University School of Medicine; Department of Biostatistics (JW, YZ), Johns Hopkins University Bloomberg School of Public Health; Department of Neurosurgery (ML), and Department of Medicine (SY), Johns Hopkins University School of Medicine, Baltimore, MD.
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  • For correspondence: syasar1@jhmi.edu
Abhay Moghekar
Department of Neurology (JAD, AL, SG, KK, AR, AM), Johns Hopkins University School of Medicine; Department of Biostatistics (JW, YZ), Johns Hopkins University Bloomberg School of Public Health; Department of Neurosurgery (ML), and Department of Medicine (SY), Johns Hopkins University School of Medicine, Baltimore, MD.
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Citation
CSF Biomarkers Predict Gait Outcomes in Idiopathic Normal Pressure Hydrocephalus
Jacqueline A. Darrow, Alexandria Lewis, Seema Gulyani, Kristina Khingelova, Aruna Rao, Jiangxia Wang, Yifan Zhang, Mark Luciano, Sevil Yasar, Abhay Moghekar
Neurol Clin Pract Apr 2022, 12 (2) 91-101; DOI: 10.1212/CPJ.0000000000001156

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    Figure 1 The Plot Presents the ROC Curves Generated From the Univariate and the Multivariate Regression (Red) Models Listed in Table 2

    The multivariate model uses LRG, pTau, Aβ1–40, Evans index, and transependymal flow as predictors and has the greatest AUC of 0.64 (95% CI 0.58–0.70). Aβ1–40 = β-amyloid 40; AUC = area under the receiver operating curve; CI = confidence interval; LRG = leucine-rich alpha-2-glycoprotein; pTau = phosphorylated tau.

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    Figure 2 The Plot Presents the ROC Curves Generated From the Univariate and Multivariate (Red) Regression Models Listed in Table 3

    The multivariate model uses age, NfL, pTau, and LRG as predictors and has the greatest AUC of 0.76 (95% CI 0.66–0.86). Aβ1–40 = β-amyloid 40; AUC = area under the receiver operating curve; CI = confidence interval; LRG = leucine-rich alpha-2-glycoprotein; NfL = neurofilament light; pTau = phosphorylated tau; tTau = total tau.

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    Figure 3 Variable Importance Plot From Nonsupervised Random Forest Algorithm for Improvement After the TT Procedure

    The mean decrease in accuracy attributed to a variable is determined during the classification error calculation phase. The more the accuracy of the random forest decreases due to the exclusion (or permutation) of a single variable, the more important that variable is deemed, and therefore, variables with a large mean decrease in accuracy are more important for classification of the outcome. The mean decrease in Gini coefficient is a measure of how each variable contributes to the homogeneity (purity) of the nodes and leaves in the resulting random forest. The Gini coefficient is a measure of homogeneity from 0 (homogeneous) to 1 (heterogeneous). The changes in Gini are summed for each variable and normalized at the end of the calculation. Variables that result in nodes with higher homogeneity have a higher decrease in Gini coefficient. Aβ1–40 = β-amyloid 40; Aβ1–42 = β-amyloid 42; LRG = leucine-rich alpha-2-glycoprotein; MoCA = Montreal Cognitive Assessment; NfL = neurofilament light; pTau = phosphorylated tau; TT = tap test; tTau = total tau.

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    Figure 4 Variable Importance Plot From Nonsupervised Random Forest Algorithm for Improvement After Shunt Surgery

    Aβ1–40 = β-amyloid 40; Aβ1–42 = β-amyloid 42; LRG = leucine-rich alpha-2-glycoprotein; MoCA = Montreal Cognitive Assessment; NfL = neurofilament light; pTau = phosphorylated tau; TT = tap test; tTau = total tau; TUG = Timed Up and Go.

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