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

Area of Science:

• Neurology
• Geriatrics
• Radiology

Background:

• Differentiating normal pressure hydrocephalus (NPH) from neurodegenerative disorders like Parkinson's disease presents diagnostic challenges.
• Parkinsonian symptoms can overlap with NPH, necessitating clearer diagnostic criteria and investigation methods.

Purpose of the Study:

• To determine the frequency of parkinsonian symptoms in individuals with and without NPH.
• To compare motor examination scores (UPDRS-m) between NPH and non-NPH groups.
• To investigate the relationship between UPDRS-m scores, NPH symptoms, and radiological findings.

Main Methods:

• A population-based study involving 168 individuals over 65 with and without self-reported NPH symptoms.
• Clinical examination including the Unified Parkinson's Disease Rating Scale motor (UPDRS-m) assessment.
• Computerized tomography (CT) scans of the brain to assess for radiological signs of NPH.

Main Results:

• Bradykinesia, rigidity, and postural instability were significantly more prevalent in the NPH group (79%, 43%, 71% respectively) compared to the non-NPH group (32%, 15%, 22%).
• Resting tremor was not significantly different between groups (5% vs. 6%).
• Higher UPDRS-m scores in the NPH group correlated with NPH symptom severity and ventriculomegaly.

Conclusions:

• Parkinsonian symptoms, excluding resting tremor, are frequent in NPH and correlate with disease severity.
• Asymmetric symptoms were uncommon in the NPH group.
• Recommend liberal use of neuroradiological imaging for patients presenting with parkinsonian features to rule out NPH.