uation using a comprehensive neuropsychological protocol including eval- uation of memory, attention, language, praxias, orientation and executive function; neuropsychiatric exam; functional evaluation using Pfeffer’s scale of daily living activities and neuroimaging evaluation (cranial com- puterized tomography - CT - and/or magnetic resonance imaging - MRI). Conclusions: All of the patients presented with cognitive and behavioral alterations, but in different degrees, dependent upon the following vari- ables: intensity of the structural abnormalities in neuroimage exams; la- tency until the beginning of specific treatment with aciclovir, and others. Memory deficit pattern found in herpetic encephalitis resembles that ob- served in Korsakoff syndrome and in Alzheimer’s disease. Behavioral symptoms were compatible with Kluver-Bucy syndrome and resembled that observed in frontotemporal dementia. Neuroimaging exams showed asymmetric mesial temporal pathology in most of the cases with extension to the orbitofrontal areas in some cases. P4-134 VENTRICULO-PERITONEAL SHUNTING FOR NORMAL PRESSURE HYDROCEPHALUS: A PROSPECTIVE STUDY George Razay 1 , Anthea Vreugdenhil 1 , John Liddell 2 , 1 Launceston General Hospital, University of Tasmania, Launceston, Australia; 2 Royal Hobart Hospital, University of Tasmania, Hobart, Australia. Contact e-mail: george.razay@dhhs.tas.gov.au Introduction: Normal pressure hydrocephalus is one of the few potentially treatable forms of dementia, however research into the condition remains scanty. Its diagnosis is difficult, especially at early stages of the disease, and the response to treatment by decompression shunting is reported as variable. Objective: To investigate the clinical outcomes of ventriculo- peritoneal shunting for patients with normal pressure hydrocephalus. Methods: We investigated 20 consecutive patients from a Memory Dis- orders Clinic who were diagnosed with normal pressure hydrocephalus and underwent ventriculo-peritoneal shunt surgery. Normal pressure hydro- cephalus was diagnosed if patients had: cognitive impairment, gait distur- bance or urinary disturbance; enlarged ventricles on brain imaging; and impaired clearance in cerebrospinal fluid study over 48 hours. Clinical outcomes were measured at baseline and 3-4 months post-surgery. Change in global, cognitive, balance and gait, and urinary functioning was assessed using Clinician’s Interview Based Impression of Change (CIBIC) rating scale with carer input. Cognitive functioning was assessed using the Mini Mental State Examination and balance and gait were assessed using the timed Get Up and Go and 10 Metre Walk tests. Results: There were 10 women and 10 men, mean age 78.6 years (58-92 years). The mean duration of symptoms was 4.3 years (3 months-14 years). Most patients had mild cognitive dysfunction, with 64% having MMSE scores above 20, and 57% of patients walked independently or with a stick. Post-surgery, based on CIBIC+, 94% of patients improved on global functioning, with 71% improving on cognitive functioning (85% had MMSE scores above 20), 94% on balance and gait (71% walked independently or with a stick), and 73% on urinary functioning. Compared to pre-surgery, MMSE scores increased by 2.5 points or 14% (p=0.005); patients were 4 seconds or 19% faster on the Get Up and Go test (p=0.023) and 5 seconds or 20% faster on the 10 Metre Walk (p=0.027). Conclusion: We conclude that ventri- culo-peritoneal shunting may improve clinical outcomes for patients with normal pressure hydrocephalus. P4-135 DISTURBANCE OF CELL-SURFACE CHOLESTEROL LOCALIZATION AND INTRA- AXONAL TRANSPORTS IN CULTURED NIEMANN-PICK DISEASE TYPE C MODEL NEURONS Yuichi Tashiro 1 , Tsuneo Yamazaki 1 , Yukiko Shimada 2 , Yoshiko Ohono-Iwashita 2 , Koichi Okamoto 1 , 1 Gunma University, Graduate School of Medicine, Maebashi, Japan; 2 Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan. Contact e-mail: ytashiro@med.gunma-u.ac.jp Background: There is growing evidence showing the important roles of cholesterol in maintaining neuronal function. In particular, much attention has been paid to the role of the cholesterol-rich microdomains called lipid rafts. Furthermore, it has been known that cholesterol plays important roles for the formation and function of synapses. However, the cholesterol distribution on neurons is not clear. Niemann-Pick type C (NPC) disease is caused by the disruption of intracellular cholesterol transport and is known to induce formation of neurofibrillary tangles observed in Alzheimer dis- ease. Thus, studying NPC neurons might shed a light on elucidating mechanisms causing AD. Objective(s): We investigated to know the localization of free cholesterol in cultured hippocampal neurons and NPC model neurons. Distribution of synaptic proteins, and uptake of a fluores- cent dye (FM 1-43) and cholera toxin subunit B (CTB) were also exam- ined. Methods: Free cholesterol was labeled by filipin and BC. Distribu- tions of both pre- and post-synaptic proteins were examined by immunocytochemistry. Live neurons were labeled by FM1-43 and CTB. Cultured neurons were treated with class 2 amphiphile (U18666A) to prepare NPC model cells. Results: (1) BC detects only cell-surface cholesterol, whereas filipin stains both intracellular and cell-surface cho- lesterol. BC staining appeared visible in a maturation-dependent manner and showed axon-dominant distribution of cell-surface cholesterol in ma- tured neurons. This cholesterol on axons was detergent resistant at 4°C, and thus might be involved in lipid rafts. (2) NPC neurons lost the cell-surface but not the intracellular cholesterol staining. (3) The distribution of syn- aptic proteins was not altered, but the appearance of the internalized dye was changed in NPC model neurons, suggesting that recycling and trans- port of synaptic vesicles were distorted. (4) The transport of CTB was also disturbed in NPC neurons. Conclusions: Our observations suggest impor- tant roles of axonal-surface cholesterol in maintaining functional mem- branes and indicate that the observed defect in axonal surface cholesterol might lead to the neurodegeneration observed in NPC. The disturbance of intracellular cholesterol transport might induce the abnormal trafficking of synaptic vesicles and CTB in NPC neurons. P4-136 VENTRICULO-PERITONEAL SHUNTING FOR DEMENTIA: CASE STUDIES George Razay 1 , Anthea Vreugdenhil 1 , John Liddell 2 , 1 Launceston General Hospital, University of Tasmania, Launceston, Australia; 2 Royal Hobart Hospital, University of Tasmania, Hobart, Australia. Contact e-mail: george.razay@dhhs.tas.gov.au Introduction: Studies of normal pressure hydrocephalus, characterized by dementia, gait disorder and urinary disturbance, have been scanty. Objec- tive: We present two case studies as part of a larger prospective study investigating the role of ventriculo-peritoneal shunting in the treatment of normal pressure hydrocephalus. Methods: Case studies of two patients who presented at a Memory Disorders Clinic with cognitive dysfunction and gait disorder and were listed for nursing home placement. They had enlarged ventricles on brain CT scan and impaired clearance in cerebro- spinal fluid study. Both underwent ventriculo-peritoneal shunt surgery. Results: Case 1. A 69 year old woman with a previous diagnosis of dementia presented with an 18 month history of cognitive dysfunction, balance and gait disturbance and falls. She had a Mini Mental State Examination (MMSE) score of 21/30 and walked with a frame. A month after shunt surgery, she was living at home, thinking clearly with an MMSE of 29, and was walking independently. Four years after surgery, she had an MMSE score of 29/30, remained independent in activities of daily living and was walking unaided. Case 2. A 71 year old woman, previously diagnosed with Alzheimer’s disease, presented with a 4 year history of deterioration in cognitive function and a 12 month history of decline in balance and walking. She had an MMSE score of 20/30, was very un- steady, walked with a frame and needed assistance with all activities of S555 Poster P4: Wednesday Posters