Parkinsonian symptoms in normal pressure hydrocephalus: a population-based study

Abstract

It may be challenging to differentiate normal pressure hydrocephalus (NPH) from neurodegenerative disorders such as Parkinson’s disease. In this population-based study, we wanted to describe the frequency of parkinsonian symptoms among individuals with and without NPH, and whether the motor examination part of the Unified Parkinson’s Disease Rating Scale (UPDRS-m) score differs between these groups. Furthermore, we wanted to find out whether there was a relationship between UPDRS-m score, NPH symptoms, and radiological signs of NPH. A sample of 168 individuals over the age of 65 with and without self-reported symptoms of NPH underwent a computerized tomography of the brain and clinical examination, including UPDRS-m to grade parkinsonian symptoms. According to diagnostic guidelines, 38 fulfilled criteria for NPH, whereas 130 had unlikely NPH. Bradykinesia was significantly more common among those with NPH (79%) compared to those with unlikely NPH (32%) (p < 0.001). The corresponding figures for rigidity were 43 vs. 15% (p < 0.001), for postural instability 71 vs. 22% (p < 0.001), and for tremor at rest 5 vs. 6% (not significant). The total UPDRS-m score was significantly higher among individuals with NPH (median = 12) than without (median = 1) and correlated significantly with the degree of NPH symptoms (r = −0.72) and ventriculomegaly (r = 0.31). In this study, parkinsonian symptoms, except resting tremor, were frequent in individuals with NPH and correlated with the severity of NPH symptoms. Asymmetric symptoms were uncommon. We recommend a liberal use of neuroradiological imaging when investigating a patient with parkinsonian features.

Cerebrospinal fluid levels of amyloid-beta oligomers in patients with idiopathic normal pressure hydrocephalus are elevated before shunt surgery but decrease afterward

“…According to past reports, ADrelated pathology can be observed in 18-75% of patients with iNPH, (23,24) and 11-86% of patients with iNPH exhibit parkinsonism. (25)(26)(27)(28) Our results indicate that Aβ oligomers are not good diagnostic biomarkers for differentiating iNPH from AD but are useful for differentiating iNPH from PD and PSP.…”

Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery

“…Some patients with iNPH are later diagnosed with comorbidities, such as parkinsonism or neurodegenerative dementia, or have evidence of "dual pathology" at the time of shunting [10,45,46]. For example, cerebral pathology with β-amyloid in patients undergoing shunt surgery for iNPH were linked with a poorer improvement after operation [47,48].…”

Detailed visual assessment of striatal dopaminergic depletion in patients with idiopathic normal pressure hydrocephalus: Unremarkable or not?

“…FP-CIT bindings in each striatal subregion were graded by visual comparison to a normal striatal subregion as reference: 0, no significant reduction; 1, mild reduction; 2, moderate reduction; and 3, severe reduction or sparse radioactivity [11]. Results were then dichotomized into normal (0) and abnormal (1,2,3) in each subregion of the striatum for the following reasons. Firstly, most of abnormal regions were graded as mild reduction.…”