Objective: To analyze the effect of co-existing normal pressure hydrocephalus (NPH) on the clinical course of Parkinson’s disease (PD), we examined the disease progression and alpha synuclein (a-syn) levels when patients with PD suffer from comorbid NPH.

Background: We and others have reported that patients with NPH often suffer from neurodegenerative disorders such as Alzheimer’s disease and PD.  However, the effect of NPH on the features of these comorbid disorders, especially the outcome of Lumboperitoneal (LP) shunt surgery, remains to be elucidated. In this study, we focused on PD. We also investigated a-syn levels in serum and cerebrospinal fluid (CSF).

Method: Patients with PD and/or NPH who admitted to the Juntendo University Hospital for the past 10 years were recruited. The diagnosis of PD was defined as clinically established PD based on the MDS 2015 criteria¹ with small modifications. The diagnosis of NPH was made based on the criteria of 2005². Clinical features of 11 patients with PD were within 12 years from the onset, between the Hoehn and Yahr stage 2 to 3 and had not received device-aided therapy. Among them, 9 patients underwent LP-shunt surgery.  10 patients with PD were within 11 years from the onset.  The disease progression between two groups was compared using the iNPH grading scale. The levels of a-syn were measured by using the a-syn ELISA.

Results: While the total scores of the iNPH Grading Scale were not different when diagnosis of PD, they declined faster in patients having comorbid NPH.  At 1 year after the surgery, the score increased by 0.6 points for PD and by 2.5 point for PD with NPH (P = 0.019). At 3 years after the surgery, the score increased by 0.4 points for PD and by 2.6 point for PD with NPH (P = 0.021).  Among PD with NPH, the scores increased by 2.4 for patients who underwent LP-shunt surgery, whereas the scores increased by 3.5 for patients who did not. Ventriculus are more enlarged PD with NPH (Evans index; 0.363) compared to PD (0.286). The results from MIBG myocardial scintigraphy were not statistically significantly different.  The ratio of a-syn levels in CSF to those in serum tends to become higher when PD patients have comorbid NPH.

Conclusion: Although comorbid NPH significantly affects the clinical progression of PD, LP-shunt surgery can halt the deterioration of NPH even in the presence of PD. The ratio of a-syn levels can be a diagnostic marker for detecting co-existing NPH.

References: 1. Postuma RB, Berg D, Stern M, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord 2015;30:1591-1601. 2. Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 2005;57:S4-16; discussion ii-v.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-effect-of-comorbid-nph-on-the-clinical-feature-and-progression-of-parkinsons-disease/