Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
J Neurol. 2017 Oct;264(10):2141-2148. doi: 10.1007/s00415-017-8598-5. Epub 2017 Sep 6.
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.
常压性脑积水（NPH）与帕金森病等神经退行性疾病的鉴别可能具有挑战性。在这项基于人群的研究中，我们旨在描述有和无 NPH 的个体中帕金森症状的频率，以及帕金森病统一评定量表（UPDRS-m）评分的运动检查部分在这些组之间是否存在差异。此外，我们还想了解 UPDRS-m 评分、NPH 症状和 NPH 的放射学征象之间是否存在关系。一个由 168 名年龄在 65 岁以上的有或无自述 NPH 症状的个体组成的样本接受了脑部计算机断层扫描和临床检查，包括 UPDRS-m 以评估帕金森症状。根据诊断标准，38 人符合 NPH 标准，而 130 人不太可能患有 NPH。有 NPH 的个体中运动迟缓明显更为常见（79%），而不太可能有 NPH 的个体中运动迟缓为 32%（p<0.001）。僵硬的相应数字为 43%比 15%（p<0.001），姿势不稳为 71%比 22%（p<0.001），静止性震颤为 5%比 6%（无统计学意义）。有 NPH 的个体的 UPDRS-m 总分明显高于无 NPH 的个体（中位数=12），且与 NPH 症状的严重程度（r=-0.72）和脑室扩大（r=0.31）显著相关。在这项研究中，除静止性震颤外，NPH 个体中帕金森症状较为常见，且与 NPH 症状的严重程度相关。不对称症状不常见。我们建议在对有帕金森特征的患者进行检查时，放宽神经影像学的使用。
