System and method for outputting information regarding the likelihood of having idiopathic normal pressure hydrocephalus

Abstract

Provided is a technique whereby it becomes possible to demonstrate the possibility of having idiopathic normal pressure hydrocephalus. A system for outputting information associated with the possibility of having idiopathic normal pressure hydrocephalus is provided with: an acquisition unit for acquiring a value including at least one of an average value of amplitude and an average value of closing maximum rate in results obtained by performing such a finger tapping operation that a thumb and an index finger in one hand of a user are opened and closed repeatedly for a period of 5 seconds to 20 seconds inclusive at a frequency of 1.5 Hz to 2.5 Hz inclusive; and an output unit for outputting information demonstrating that, when the value is equal to or less than a predetermined cutoff value, the user is more likely to be affected by idiopathic normal pressure hydrocephalus compared with a case where the value is more than the cutoff value.

Description

[Technical Field]

[0001] The present disclosure relates to a system that outputs information regarding the likelihood of suffering from idiopathic normal pressure hydrocephalus. [Background technology]

[0002] Idiopathic normal pressure hydrocephalus (iNPH) generally presents with three major symptoms: gait disturbance, cognitive impairment, and urinary disturbance. iNPH is characterized by ventricular enlargement and normal cerebrospinal fluid pressure. Because symptoms can be improved with cerebrospinal fluid shunting, iNPH is sometimes referred to as "treatable dementia." The Japanese Society for Normal Pressure Hydrocephalus (JSNH) guidelines for the treatment of idiopathic normal pressure hydrocephalus define four stages: suspected iNPH, possible iNPH, probable iNPH, and definite iNPH. Possible iNPH is a candidate for treatment, but appropriate evaluation of clinical symptoms, in addition to evaluation with MRI or CT scans of the head, is crucial for appropriate treatment. The prevalence of possible iNPH has been reported to be at least 250 per 100,000 people, making it a potentially common disease. Furthermore, the prevalence of this disease is increasing in an aging society, making it increasingly necessary to diagnose and treat it early.

[0003] The diagnosis of iNPH is based on characteristic imaging findings of narrowing of the high convex and midline sulci and subarachnoid spaces, and on functional improvement demonstrated by a tap test (a cerebrospinal fluid drainage test) or drainage test (a continuous cerebrospinal fluid drainage test). The improvement of clinical symptoms here depends largely on the improvement of gait disturbances. However, while the improvement rate is low in mild cases, in severe cases, gait assessments are burdensome and the risk of falls is high. Furthermore, patients often fall frequently at the time of consultation, and depending on the injury, an appropriate gait assessment may be difficult.

[0004] Here, it has been reported that upper limb dysfunction is also a symptom presenting in addition to the iNPH triad. Non-Patent Document 1 measures the number of times finger tapping was performed with the thumb in order from the index finger to the little finger before and after a cerebrospinal fluid clearance test, and reports that improvement was observed in the right index finger after the test. Non-Patent Document 2 counts the number of times the maximum speed of index finger tapping was performed by an iNPH patient before and after a cerebrospinal fluid clearance test, and reports that improvement in right finger function was observed after the test. Non-Patent Document 3 counts the number of successful finger taps with the thumb in a complex sequence from the index finger to the little finger before and after shunt surgery, and reports that postoperative improvement was observed. [Prior art documents] [Non-patent literature]

[0005] [Non-Patent Document 1] Lenfeldt N. et al. Brain 2008; 131:2904‐12. [Non-patent document 2] Liouta E. et al. Acta Neurochirurgica 2017; 159:2301‐7. [Non-patent document 3] Behrens A. et al. Journal of Neurosurgery 2019; 132:733‐40. Summary of the Invention [Problem to be solved by the invention]

[0006] The above-mentioned non-patent literature reports evaluate the condition based on the number of finger tappings, and such evaluations are significantly influenced by the finger tapping speed. Therefore, the present inventors believed that the methods in the existing reports were difficult to quantitatively evaluate and lacked objectivity. Therefore, through extensive research, the present inventors have invented a technology that enables the quantitative evaluation of idiopathic normal pressure hydrocephalus. [Means for solving the problem]

[0007] The present invention can be realized as the following aspects.

[0008] (1) According to one aspect of the present invention, there is provided a system for outputting information relating to the possibility of idiopathic normal pressure hydrocephalus. The system includes an acquisition unit that acquires a value including at least one of an average amplitude and an average maximum closing velocity from a finger tapping action performed by a user, in which the user repeatedly opens and closes the thumb and index finger of one hand at a frequency of 1.5 Hz to 2.5 Hz for 5 seconds to 20 seconds, and an output unit that outputs information indicating that the user is more likely to have idiopathic normal pressure hydrocephalus when the value is equal to or less than a predetermined cutoff value, compared to when the value exceeds the cutoff value. This system uses at least one of the average amplitude and the average maximum closing velocity from the finger tapping action performed at a predetermined frequency, thereby enabling a quantitative assessment of the possibility of the user having idiopathic normal pressure hydrocephalus.

[0009] (2) In the system of the above aspect, the hand may be the user's non-dominant hand. According to this aspect, the system uses the results of finger tapping performed with the user's non-dominant hand, which can further increase the reliability of the cutoff value and, as a result, can further improve the accuracy of information regarding the possibility of having idiopathic normal pressure hydrocephalus.

[0010] (3) In the system of the above aspect, the value may include both the average value of the amplitude and the average value of the maximum closing velocity. According to the system of this aspect, since both the average value of the amplitude and the average value of the maximum closing velocity are used, the accuracy of the information regarding the possibility of suffering from idiopathic normal pressure hydrocephalus can be further improved.

[0011] (4) Another aspect of the present invention provides a method for assisting in the assessment of the likelihood of a user suffering from idiopathic normal pressure hydrocephalus. This method includes the steps of: acquiring a value including at least one of an average amplitude and an average maximum closing velocity from a finger tapping action performed by a user for 5 to 20 seconds at a frequency of 1.5 Hz to 2.5 Hz; and outputting information indicating that the user is more likely to suffer from idiopathic normal pressure hydrocephalus if the value is equal to or less than a predetermined cutoff value, compared with a value exceeding the cutoff value. This aspect of the method uses at least one of the average amplitude and the average maximum closing velocity from the finger tapping action performed at a predetermined frequency, thereby enabling a quantitative assessment of the likelihood of the user suffering from idiopathic normal pressure hydrocephalus.

[0012] The present disclosure can be realized in various forms, such as an evaluation device that evaluates the possibility of having idiopathic normal pressure hydrocephalus, or a method for assisting in determining whether or not a person has idiopathic normal pressure hydrocephalus. [Brief explanation of the drawings]

[0013] [Figure 1] FIG. 1 is a block diagram showing a schematic configuration of a system 100. [Figure 2] FIG. 1 is an explanatory diagram for explaining an overview of a measuring device for finger tapping motion. [Figure 3] FIG. 10 is an explanatory diagram showing an example of a waveform signal relating to the distance of a finger tapping motion. [Figure 4] FIG. 10 is an explanatory diagram showing an example of a waveform signal relating to the speed of a finger tapping motion. [Figure 5] FIG. 10 is an explanatory diagram for explaining the amplitude and maximum points of a finger tapping motion. [Figure 6] FIG. 10 is a flow chart showing the steps of a method according to another embodiment of the present disclosure. [Figure 7] FIG. 1 is an explanatory diagram showing a comparison of examples of finger tapping waveforms between a healthy elderly person and an iNPH patient. [Figure 8]Boxplots comparing the mean amplitudes of unilateral and bilateral finger tapping in healthy elderly subjects and iNPH patients. [Figure 9] Boxplot showing a comparison of the mean maximum closing velocity between unilateral and bilateral finger tapping in healthy elderly subjects and patients with iNPH. [Figure 10] Box plots comparing the mean amplitudes of unilateral and bilateral finger tapping in iNPH patients before and after shunt surgery. [Figure 11] Box plots comparing the mean maximum closing velocity between unilateral and bilateral finger tapping in iNPH patients before and after shunt surgery. [Figure 12] Box plots comparing the mean amplitudes between the non-dominant and dominant hands in healthy elderly subjects and iNPH patients. [Figure 13] Box plots comparing the mean maximum closing velocity between the non-dominant and dominant hands in healthy elderly subjects and iNPH patients. [Figure 14] Box plots comparing the mean amplitudes in the non-dominant and dominant hands of iNPH patients before and after shunt surgery. [Figure 15] Box plot showing a comparison of the mean maximum closing velocity between the non-dominant and dominant hands of iNPH patients before and after shunt surgery. [Figure 16] FIG. 1 is an explanatory diagram showing the correlation between the mean amplitude and the results of the TUG test in iNPH patients. [Figure 17] FIG. 1 is an explanatory diagram showing the correlation between the mean maximum closing velocity and the results of the TUG test in iNPH patients. [Figure 18] FIG. 1 is an explanatory diagram showing the correlation between the mean maximum closing velocity and MMSE results in iNPH patients. DETAILED DESCRIPTION OF THE INVENTION

[0014] As will be shown in the Examples below, the present inventors discovered that a predetermined cutoff value can be obtained when finger tapping is performed under specific conditions in patients with idiopathic normal pressure hydrocephalus (hereinafter also referred to as "iNPH") and healthy elderly people, and have arrived at the present invention.

[0015] A. System FIG. 1 is a block diagram showing a schematic configuration of a system 100 that outputs information regarding the possibility of a user having iNPH according to one embodiment of the present disclosure. The system 100 is an information processing device that outputs information indicating a high possibility that a user has iNPH based on the results of measuring finger-tapping movements. The system 100 is implemented by a central processing unit (CPU) of a computer that operates according to a program. The system 100 includes an acquisition unit 10, a storage unit 20, and an output unit 30. The system 100 of this embodiment is connected to a finger-tapping movement measurement device 50. In this embodiment, the term "finger-tapping movement" refers to the repeated opening and closing of the thumb and index finger of one hand of a user. In this specification, the term "user" refers to the subject of the finger-tapping movement. A detailed description of finger-tapping and the measurement device 50 will be provided below.

[0016] The acquisition unit 10 is realized by a processor (not shown) that executes a program. The acquisition unit 10 acquires values ​​measured by the measurement device 50. In this embodiment, the acquisition unit 10 acquires the values ​​from the measurement device 50 connected via a wired or wireless connection. This is not limiting, and the acquisition unit 10 may acquire, for example, finger tapping results that have been measured and stored in advance via a terminal device or a communication interface (not shown). Alternatively, for example, the system 100 may include the measurement device 50.

[0017] The storage unit 20 is realized by a ROM (Read Only Memory) that stores programs and data, etc., a RAM (Random Access Memory) that is used to store data, etc. when a program is executed, etc. The storage unit 20 stores a cutoff value related to a finger tapping motion.

[0018] In this embodiment, the cutoff value corresponds to a value that determines whether a user is likely to suffer from iNPH. The cutoff value is preferably determined in advance based on multiple measurements of finger tapping movements performed on healthy elderly people and iNPH patients. The cutoff value can be set, for example, using a receiver operating characteristic (ROC) curve that represents the relationship between sensitivity and specificity. The cutoff value may be determined, for example, using the Youden index, so as to maximize the distance from AUC=0.5 on the ROC curve, so as to minimize the distance from the upper left corner of the ROC curve, or so as to maximize the product of sensitivity and specificity. The cutoff value may also be determined, for example, by applying the minimum P-value method determined by the log-rank test, excluding the upper and lower 10%.

[0019] The output unit 30 is realized by a processor (not shown) that executes a program, an interface (not shown), and the like. When the value acquired by the acquisition unit 10 is equal to or less than a predetermined cutoff value, the output unit 30 outputs information indicating that the user is more likely to be suffering from iNPH than when the value exceeds the cutoff value. The information indicating that the user is more likely to be suffering from iNPH is not particularly limited, and may be, for example, information indicating whether or not the user is likely to be suffering from iNPH. Furthermore, this information may be, for example, information indicating the level of the possibility of suffering from iNPH, or information indicating the probability of the possibility of suffering from iNPH.

[0020] The output unit 30 may output information by including, for example, a monitor, a touch panel, etc., or by including a speaker, etc., or by including a communication interface for wireless or wired communication. Note that when the value acquired by the acquisition unit 10 exceeds a predetermined cutoff value, the output unit 30 may output information indicating that the user is less likely to be affected by iNPH than when the value acquired by the acquisition unit 10 is equal to or less than the cutoff value.

[0021] FIG. 2 is an explanatory diagram illustrating an overview of a measuring device 50 for finger tapping movements. For ease of explanation, the right side of FIG. 2 schematically illustrates a state in which a sensor unit 52 is worn on the user's left hand. The measuring device 50 has a main body unit 51 and a sensor unit 52. The main body unit 51 is connected to the sensor unit 52 via a signal line 53. The main body unit 51 acquires waveform signals corresponding to the movement of the sensor unit 52, and outputs values ​​of various parameters based on these waveform signals to the acquisition unit 10 of the system 100 shown in FIG. 1.

[0022] As shown in FIG. 2, the sensor unit 52 is worn on the user's fingers and detects the movement of the user's fingers. The sensor unit 52 of this embodiment includes a magnetic sensor and has a transmitter coil unit 54 and a receiver coil unit 55. The transmitter coil unit 54 generates a magnetic field, and the receiver coil unit 55 detects the magnetic field. In the example shown in FIG. 2, the transmitter coil unit 54 is worn near the nail of the user's thumb, and the receiver coil unit 55 is worn near the nail of the user's index finger. Alternatively, the receiver coil unit 55 may be worn near the nail of the thumb, and the transmitter coil unit 54 may be worn near the nail of the index finger. The sensor unit 52 is not limited to a magnetic sensor, and may include any sensor capable of measuring the distance between two fingers, such as an infrared sensor or a capacitance sensor.

[0023] The upper right corner of FIG. 2 shows a closing state (closed state) in the finger tapping motion, and the lower right corner of FIG. 2 shows an opening state (open state) in the finger tapping motion. The closing state corresponds to a state in which the user's thumb and index finger are in contact, and the opening state corresponds to a state in which the user's thumb and index finger are furthest apart. In the finger tapping motion, a closing motion that changes from the opening state to the closing state and an opening motion that changes from the closing state to the opening state are repeatedly performed. In this embodiment, the finger tapping motion is performed by a method known as a one-handed metronome, in which the closing motion and the opening motion are repeated at a constant pace with one hand. More specifically, the finger tapping motion is performed, for example, by tapping the fingers of one hand in time with a stimulus at a constant pace. The stimulus is not particularly limited, but examples include auditory stimulus, tactile stimulus, and visual stimulus.

[0024] FIG. 3 is an explanatory diagram showing an example of a waveform signal related to the distance of a finger tapping motion. In FIG. 3, the horizontal axis represents time (seconds), the vertical axis represents the distance (mm) between the thumb and index finger, and the horizontal dashed line represents the average of the minimum values. FIG. 4 is an explanatory diagram showing an example of a waveform signal related to the speed of a finger tapping motion. In FIG. 4, the horizontal axis represents time (seconds), the vertical axis represents the speed (m / s) of the thumb and index finger, and the horizontal dashed line represents a speed of 0 m / s. As shown in FIG. 3, a waveform signal related to the distance of a finger tapping motion is formed by a finger tapping motion in which a user repeatedly opens and closes the thumb and index finger of one hand. Furthermore, as shown in FIG. 4, a waveform signal related to the speed of a finger tapping motion is obtained by differentiating the waveform signal related to the distance of the finger tapping motion with respect to time. In FIGS. 3 and 4, the maximum points in each cycle are indicated by black circles, and the minimum points in each cycle are indicated by white circles. In this specification, the term "average value of minimum points" refers to the average value of minimum points measured within the time period during which the finger tapping action is performed.

[0025] FIG. 5 is an explanatory diagram illustrating the amplitude and maximum points of finger tapping motion. FIG. 5 corresponds to a schematic diagram showing an enlarged portion of FIG. 3. In FIG. 5, maximum points Pmax in the finger tapping distance are indicated by black circles, minimum points Pmin in the finger tapping distance are indicated by white circles, and the average value of minimum points Pmin in the finger tapping distance is indicated by a horizontal dashed line. The amplitude A of the finger tapping motion is a value calculated for each cycle of the finger tapping motion and is calculated as the difference between the maximum point Pmax in the finger tapping distance and the average value of minimum points Pmin. In this specification, the term "average amplitude" refers to the average value of the amplitude measured within the time during which the finger tapping motion is performed. Furthermore, the term "maximum amplitude" refers to the maximum value of the amplitude measured within the time during which the finger tapping motion is performed. Furthermore, the term "average value of maximum points in the finger tapping distance" refers to the average value of the maximum points in the distance measured within the time during which the finger tapping motion is performed.

[0026] 5 also shows the opening operation time T1, the closing operation time T2, the tap interval TI, and the tap period TC. The opening operation time T1 corresponds to the time required to reach the maximum point Pmax from the minimum point Pmin, and the closing operation time T2 corresponds to the time required to reach the minimum point Pmin from the maximum point Pmax. The tap interval TI is the time corresponding to one tap period TC and indicates the time from the minimum point Pmin to the next minimum point Pmin. In this specification, the "maximum closing speed" refers to the maximum speed during the closing operation, and the "average maximum closing speed" refers to the average value of the maximum closing speed measured within the time period during which the finger tapping operation is performed.

[0027] In this embodiment, the acquisition unit 10 of the system 100 acquires values ​​resulting from a finger tapping motion in which the user repeatedly opens and closes the thumb and index finger of one hand at a frequency of 1.5 Hz to 2.5 Hz for 5 seconds to 20 seconds. More specifically, a value including at least one of the average amplitude and the average maximum closing speed is acquired for the finger tapping motion performed under the above conditions. From the viewpoint of further improving the accuracy of information regarding the possibility of iNPH, such a value preferably includes the average amplitude, and more preferably includes both the average amplitude and the average maximum closing speed.

[0028] Finger tapping is performed using one of the user's hands. Using the results of finger tapping using one hand can increase the reliability of the cutoff value compared to using the results of simultaneous finger tapping using both hands. As a result, the accuracy of information regarding the possibility of iNPH can be improved. Furthermore, finger tapping is preferably performed using the user's non-dominant hand. Using the results of finger tapping using the user's non-dominant hand can increase the reliability of the cutoff value compared to using the results of finger tapping using the user's dominant hand. As a result, the accuracy of information regarding the possibility of iNPH can be improved. Although the mechanism behind this effect is unclear, it is presumed to be due to the fact that the non-dominant hand may reflect motor and cognitive function more than the dominant hand. Whether a user's dominant or non-dominant hand is right or left can be identified by calculating a handedness index using the Edinburgh Handedness Test.

[0029] A period of 1.5 Hz to 2.5 Hz means that the period of the finger tapping motion per second is 1.5 to 2.5 times. The period of the finger tapping motion is more preferably 1.75 Hz to 2.25 Hz, even more preferably 1.9 Hz to 2.1 Hz, and particularly preferably 2.0 Hz. By setting the period at or above the lower limit, the finger tapping speed can be prevented from becoming excessively slow, thereby preventing the results from being inconsistent between iNPH patients and healthy individuals. Furthermore, by setting the period at or below the upper limit, the finger tapping speed can be prevented from becoming excessively fast, thereby reducing the amplitude, thereby preventing an appropriate evaluation from being impossible. Therefore, by setting the period of the finger tapping motion within the above numerical range, the accuracy of information regarding the possibility of iNPH can be improved.

[0030] The duration of the finger tapping motion is preferably 5 to 18 seconds, more preferably 5 to 15 seconds, particularly preferably 7 to 15 seconds, and even more preferably 10 to 15 seconds. By setting the duration equal to or greater than the lower limit, the number of finger taps can be ensured, thereby preventing a decrease in reliability of the average amplitude and the average maximum closing speed. Furthermore, by setting the duration equal to or less than the upper limit, fatigue of the subject caused by an excessive number of finger taps can be prevented, thereby preventing an inability to perform an appropriate evaluation. Therefore, by setting the duration of the finger tapping motion within the above numerical range, the accuracy of information regarding the possibility of iNPH can be improved.

[0031] For example, when finger tapping is performed for 15 seconds at a frequency of 2.0 Hz, approximately 30 finger taps will be performed. In other words, when finger tapping is performed for 15 seconds at a frequency of 2.0 Hz, approximately 30 closing and opening movements will be performed. From the viewpoint of preventing a decrease in reliability of the average amplitude and the average maximum closing speed, the number of finger taps is preferably between 10 and 40, more preferably between 14 and 36, and particularly preferably between 18 and 32.

[0032] According to the system 100 of the present embodiment described above, the possibility of iNPH can be quantitatively evaluated by using at least one of the average amplitude and the average maximum closing velocity obtained by performing finger tapping, in which the user repeatedly opens and closes the thumb and index finger of one hand under the above conditions. In particular, since the results of finger tapping performed at a predetermined cycle are used, a more quantitative evaluation can be performed compared to configurations that use results related to the number of finger taps. As a result, the system 100 of the present embodiment can be used to screen for iNPH patients.

[0033] Furthermore, the system 100 of this embodiment uses the results of finger tapping, allowing for a simple method for evaluating the possibility of iNPH. For example, compared to performing a tap test (cerebrospinal fluid drainage test) or a drainage test (continuous cerebrospinal fluid drainage test), the burden on the user can be significantly reduced, and evaluation results can be obtained in a very short time. Furthermore, compared to performing a gait assessment, the risk of the user falling can be avoided.

[0034] Furthermore, as shown in the Examples below, when patients with iNPH and healthy elderly people performed finger tapping under the above conditions, a predetermined cutoff value was obtained, and therefore, by using the above conditions, the accuracy of information regarding the possibility of iNPH can be improved. Furthermore, as shown in the Examples below, the average amplitude and the average maximum closing velocity tend to correlate with the results of the Mini Mental State Examination (MMSE) used for cognitive function screening, the iNPHGS (iNPH grading scale) used for assessing the severity of iNPH, and the Timed Up and Go (TUG) test used for assessing walking function, thereby suppressing a decrease in reliability.

[0035] B. Method FIG. 6 is a flow chart showing the steps of a method according to another embodiment of the present disclosure. According to another embodiment of the present disclosure, a method for assisting in determining the likelihood of iNPH is provided. This method includes the steps of: acquiring a value including at least one of the average amplitude and the average maximum closing speed from a finger tapping motion in which a user repeatedly opens and closes the thumb and index finger of one hand at a frequency of 1.5 Hz to 2.5 Hz for 5 seconds to 20 seconds (step P110); and outputting information indicating that the user is more likely to have iNPH if the acquired value is below a predetermined cutoff value compared to when the acquired value exceeds the cutoff value (step P120). This method can assist in determining the likelihood of iNPH. [Example]

[0036] The present invention will be explained in more detail below with reference to examples, but the present invention is not limited to the following examples.

[0037] (1) Subjects As shown in Table 1, the study included 15 healthy elderly subjects (73.1 ± 5.1 years old) and 16 definite iNPH patients (hereafter simply referred to as "iNPH patients") (76.7 ± 5.9 years old). All subjects were right-handed, as determined by the Edinburgh Handedness Test. For iNPH patients, finger tapping measurements were performed before and approximately 24 hours after shunt surgery. Table 1 also shows the MMSE and iNPHGS scores, as well as the Evans Index (maximum width between the anterior horns of the lateral ventricles / intracranial cavity width at that site) and disease duration for iNPH patients. The MMSE was performed on healthy elderly subjects and iNPH patients before shunt surgery, and the iNPHGS was performed on iNPH patients before and after shunt surgery.

[0038] [Table 1]

[0039] (2) Measurement equipment and conditions Finger tapping was measured using a Hitachi Computer Peripherals UB-1 magnetic sensor-type finger tapping device. Tapping of the thumb and index finger was measured for 15 seconds under auditory stimulation at 2.0 Hz or 1.0 Hz, and values ​​including the mean amplitude and mean maximum closing velocity were obtained. Finger tapping was performed with the dominant hand (right hand), non-dominant hand (left hand), or both hands simultaneously.

[0040] Figure 7 is an explanatory diagram comparing examples of finger tapping waveforms between healthy elderly people and iNPH patients. Figure 7 shows the amplitude (mm) and velocity (m / sec) waveforms for finger tapping of the thumb and index finger of the dominant hand under 2.0 Hz conditions. As shown in Figure 7, iNPH patients tended to have smaller amplitudes and slower velocity during finger tapping under 2.0 Hz conditions compared to healthy elderly people.

[0041] (3) Checking various parameters with different tapping frequencies We compared various parameters at different tapping frequencies between healthy elderly people and iNPH patients before shunt surgery. Finger tapping was performed with the dominant hand at frequencies of 1.0 Hz and 2.0 Hz. Various parameters from the finger tapping results are shown in Table 2.

[0042] [Table 2]

[0043] As shown in Table 2, for finger tapping performed at 1.0 Hz, no significant differences were observed between healthy elderly subjects and iNPH patients in the maximum amplitude of distance, total distance traveled, mean distance maximum point, maximum amplitude of velocity, and mean opening maximum velocity. In contrast, for finger tapping performed at 2.0 Hz, significant differences were observed at the 1% level between healthy elderly subjects and iNPH patients in the distance ratio, maximum amplitude of distance, total distance traveled, mean distance maximum point, maximum amplitude of velocity, mean opening maximum velocity, and mean closing maximum velocity. Furthermore, a significant difference was observed at the 0.1% level for total energy. These results suggest that finger tapping performed at a 2.0 Hz frequency produced significantly different results between healthy elderly subjects and iNPH patients than at a 1.0 Hz frequency.

[0044] (4) Comparison of unilateral and bilateral finger tapping Unilateral and bilateral finger tapping at a frequency of 2.0 Hz were compared in healthy elderly subjects, patients with iNPH before shunt surgery, and patients with iNPH after shunt surgery. Unilateral finger tapping was performed by the dominant hand, and bilateral finger tapping was performed by both hands simultaneously. The mean amplitude and mean maximum closing velocity of the finger tapping results were compared.

[0045] FIG. 8 is a boxplot showing a comparison of the average amplitudes between unilateral and bilateral finger tapping in healthy elderly subjects and iNPH patients. FIG. 9 is a boxplot showing a comparison of the average maximum closing velocity between unilateral and bilateral finger tapping in healthy elderly subjects and iNPH patients. FIG. 10 is a boxplot showing a comparison of the average amplitudes between unilateral and bilateral finger tapping in iNPH patients before and after shunt surgery. FIG. 11 is a boxplot showing a comparison of the average maximum closing velocity between unilateral and bilateral finger tapping in iNPH patients before and after shunt surgery. In FIGS. 8 and 10, the vertical axis represents the average amplitude (mm), and in FIGS. 9 and 11, the vertical axis represents the average maximum closing velocity (m / sec). In FIGS. 8 to 11, the left side of the page shows the results of unilateral finger tapping, and the right side shows the results of bilateral finger tapping. 8 and 9, the results of healthy elderly people are shown in white, and the results of iNPH patients before shunt surgery are shown in hatched areas. Furthermore, in Figures 10 and 11, the results of iNPH patients before shunt surgery are shown in hatched areas, and the results of iNPH patients after shunt surgery are shown in white.

[0046] The results shown in Figure 8 indicate that the mean amplitude tended to decrease in iNPH patients compared to healthy elderly controls for both unilateral and bilateral finger tapping, with a significant difference at the 1% level. The results shown in Figure 9 indicate that the mean maximum closing velocity tended to decrease in iNPH patients compared to healthy elderly controls for both unilateral and bilateral finger tapping, with a significant difference at the 1% level. The results shown in Figure 10 indicate that the mean amplitude tended to increase after shunt surgery compared to before shunt surgery for both unilateral and bilateral finger tapping, with a significant difference at the 5% level. The results shown in Figure 11 indicate that the mean maximum closing velocity tended to increase after shunt surgery compared to before shunt surgery for both unilateral and bilateral finger tapping, with a significant difference at the 5% level.

[0047] (5) Identifying cutoff values ​​for unilateral and bilateral finger tapping Two-way ANOVA and logistic regression analysis were used for statistics. A receiver operating characteristic (ROC) curve was created for the mean amplitude, for which normality was confirmed by the Shapiro-Wilk test, and the cutoff value was determined using the Youden Index. Similarly, a receiver operating characteristic (ROC) curve was created for the mean maximum closing velocity, for which normality was confirmed by the Shapiro-Wilk test, and the cutoff value was determined using the Youden Index. Jump 10.0.2 was used as the statistical software, and the significance level was set at less than 5%. The results are shown in Table 3.

[0048] [Table 3]

[0049] Table 3 shows the area under the receiver operating characteristic curve (AUC), 95% confidence interval (CI), optimal cutoff value, sensitivity, and specificity. As shown in Table 3, unilateral thumb-index finger tapping enabled the calculation of statistically significant cutoff values ​​for the mean amplitude and mean maximum closing velocity. In contrast, bilateral thumb-index finger tapping did not result in statistically significant cutoff values ​​for the mean amplitude and mean maximum closing velocity. These results demonstrate that statistically significant cutoff values ​​can be obtained by performing finger tapping using only one hand.

[0050] (6) Comparison of unilateral finger tapping between healthy elderly people and iNPH patients The mean amplitude and mean maximum closing velocity were compared between healthy elderly subjects and iNPH patients before shunt surgery. Finger tapping was performed unilaterally at 2.0 Hz using both the non-dominant and dominant hands.

[0051] Figure 12 is a boxplot showing a comparison of the average amplitude between the non-dominant and dominant hands of healthy elderly subjects and iNPH patients. Figure 13 is a boxplot showing a comparison of the average maximum closing velocity between the non-dominant and dominant hands of healthy elderly subjects and iNPH patients. Figure 14 is a boxplot showing a comparison of the average amplitude between the non-dominant and dominant hands of iNPH patients before and after shunt surgery. Figure 15 is a boxplot showing a comparison of the average maximum closing velocity between the non-dominant and dominant hands of iNPH patients before and after shunt surgery. In Figures 12 and 14, the vertical axis represents the average amplitude (mm), and in Figures 13 and 15, the vertical axis represents the average maximum closing velocity (m / sec). In Figures 12 to 15, the left side of the page shows the results of finger tapping with the non-dominant hand, and the right side of the page shows the results of finger tapping with the dominant hand. 12 and 13, the results of healthy elderly people are shown in white, and the results of iNPH patients before shunt surgery are shown in hatched areas. Also, in Figures 14 and 15, the results of iNPH patients before shunt surgery are shown in hatched areas, and the results of iNPH patients after shunt surgery are shown in white.

[0052] The results shown in Figure 12 indicate that the mean amplitude tended to decrease in iNPH patients compared to healthy elderly subjects, for both the non-dominant and dominant hands, with a significant difference at the 1% level. The results shown in Figure 13 indicate that the mean maximum closing velocity tended to decrease in iNPH patients compared to healthy elderly subjects, for both the non-dominant and dominant hands, with a significant difference at the 1% level. The results shown in Figure 14 indicate that the mean amplitude tended to increase after shunt surgery compared to before shunt surgery, for both the non-dominant and dominant hands, with a significant difference at the 1% level. The results shown in Figure 15 indicate that the mean maximum closing velocity tended to increase after shunt surgery compared to before shunt surgery, for both the non-dominant and dominant hands, with a significant difference at the 1% level.

[0053] (7) Identifying cutoff values ​​for the non-dominant and dominant hands The cutoff values ​​were determined in the same manner as above, and the results are shown in Table 4.

[0054] [Table 4]

[0055] The AUC, 95% CI, optimal cutoff value, sensitivity, and specificity are shown in Table 4. As shown in Table 4, when unilateral finger tapping of the thumb and index finger was performed at 2.0 Hz, statistically significant cutoff values ​​could be calculated for the mean amplitude and mean maximum closing velocity in both the non-dominant and dominant hands.

[0056] (8) Correlation between the results of unilateral finger tapping under 2.0 Hz conditions and the results of the TUG test We investigated the correlation between the results of unilateral finger tapping at 2.0 Hz and the results of the TUG test in patients with iNPH before shunt surgery. The results of the finger tapping test were obtained using the non-dominant hand. The TUG test was performed by measuring the time it took to stand up from a seated position, walk, turn around 3 m, and sit down again. Spearman's correlation coefficient was used as the correlation coefficient.

[0057] FIG. 16 is an explanatory diagram showing the correlation between the mean amplitude and the results of the TUG test in iNPH patients. FIG. 17 is an explanatory diagram showing the correlation between the mean maximum closing velocity and the results of the TUG test in iNPH patients. In FIG. 16, the horizontal axis shows the mean amplitude (mm), and the vertical axis shows the results of the TUG test (seconds). In FIG. 17, the horizontal axis shows the mean maximum closing velocity (m / second), and the vertical axis shows the results of the TUG test (seconds). As shown in FIGS. 16 and 17, a correlation was observed between the results of unilateral finger tapping under the 2.0 Hz condition and the results of the TUG test. This suggests that unilateral finger tapping under the 2.0 Hz condition may be useful for screening iNPH patients, similar to the TUG test, which is commonly used to evaluate walking function.

[0058] (9) Correlation between the results of unilateral finger tapping under 2.0 Hz conditions and the results of MMSE We investigated the correlation between the results of unilateral finger tapping at 2.0 Hz and the results of the MMSE in patients with iNPH before shunt surgery. The results of the finger tapping test were obtained using the non-dominant hand. Spearman's correlation coefficient was used as the correlation coefficient.

[0059] FIG. 18 is an explanatory diagram showing the correlation between the average maximum closing speed and the MMSE results in iNPH patients. In FIG. 18, the horizontal axis shows the average maximum closing speed (m / s), and the vertical axis shows the MMSE results (points). As shown in FIG. 18, a correlation was observed between the results of unilateral finger tapping under 2.0 Hz conditions and the results of MMSE. This suggests that unilateral finger tapping under 2.0 Hz conditions may be useful for screening iNPH patients, similar to the MMSE, which is commonly used as a cognitive function test.

[0060] The present invention is not limited to the above-described embodiments and can be realized in various configurations without departing from the spirit of the present invention. For example, the technical features in the embodiments and examples corresponding to the technical features in each aspect described in the Summary of the Invention section can be appropriately replaced or combined to solve some or all of the above-described problems or achieve some or all of the above-described effects. Furthermore, if a technical feature is not described as essential in this specification, it can be deleted as appropriate. [Explanation of symbols]

[0061] 10...acquisition unit, 20...storage unit, 30...output unit, 50...measuring device, 51...main body unit, 52...sensor unit, 53...signal line, 54...transmitting coil unit, 55...receiving coil unit, 100...system, A...amplitude, Pmax...maximum value, Pmin...minimum value, TC...tap period, TI...tap interval, T1...opening operation time, T2...closing operation time

Claims

1. A method for assisting in determining the possibility of having idiopathic normal pressure hydrocephalus, comprising: A step of acquiring a value including at least one of an average amplitude and an average maximum closing speed as a result of a finger tapping action in which the user repeatedly opens and closes the thumb and index finger of one hand at a frequency of 1.5 Hz to 2.5 Hz for 10 seconds to 15 seconds; outputting information indicating that, when the value is equal to or less than a predetermined cutoff value, the user is more likely to be suffering from idiopathic normal pressure hydrocephalus than when the value exceeds the cutoff value; Equipped with the one hand is the user's non-dominant hand; method.

2. In the method according to claim 1, The values ​​include both the average value of the amplitude and the average value of the closing maximum velocity. method.

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