Category: Parkinsonism (Other)
Objective: To understand if there is co-existence of parkinsonism and normal pressure hydrocephalus (NPH) in a US VA cohort.
Background: NPH poses diagnostic challenges in clinical practice. It is especially challenging to identify in the presence of comorbidities, such as idiopathic Parkinson’s Disease (iPD). We reviewed imaging features in a cohort of US veterans who were diagnosed with Parkinsonism to understand the prevalence of potential NPH in veterans diagnosed with Parkinsonism.
Method: A cohort of US veterans who visited the East Orange VA Medical Center in New Jersey between 2019-2023 that carried the diagnostic codes for Parkinson’s Disease or Unspecified Parkinsonism (ICD-9 332.*/ ICD-10 G20) were reviewed. A retrospective chart review was completed to identify the age, sex, diagnosis, service era, brain imaging study availability, and results. Chi-square test was conducted for categorical variables.
Results: Two hundred veterans were included in the cohort, 117 (58.5%) were diagnosed with iPD. Among those diagnosed with iPD, 93 (79.4%) served during the Vietnam era and had potential Agent Orange exposure. Twenty-nine veterans (14.5%, 29/200) had brain imaging performed, either CT head or MRI brain. None reported suspected features of NPH. Among those who had brain imaging, 1 (3.4%) was reported as normal, 11 (37.9%) had mild generalized volume loss and microangiopathy, 14 (48.3%) had moderate generalized volume loss and microangiopathy, 1 (3.4%) had severe volume loss, and 2 (6.9%) reported other findings. There was no statistically significant difference (p=0.059) in imaging finding categories between veterans who served in the Vietnam era and those who served in other eras.
Conclusion: In veterans who seeks care at East Orange VA Medical Center, those with parkinsonism diagnosis and brain imaging had no overlapping imaging features of suspected NPH. Due to low ratio of brain imaging available, further studies are required to understand the overlap between parkinsonism and NPH in US veterans.
References: Cucca A, Biagioni MC, Sharma K, et al. Comorbid Normal Pressure Hydrocephalus with Parkinsonism: A Clinical Challenge and Call for Awareness. Case Rep Neurol Med. 2018;2018:2513474.
To cite this abstract in AMA style:
Y. Xu, J. Acquaviva, B. Puccio, T. Nygaard, W. Husar. The Absence of Normal Pressure Hydrocephalus Imaging Features in US Veterans with Parkinsonism: A Retrospective Imaging Study [abstract]. Mov Disord. 2025; 40 (suppl 1). https://www.mdsabstracts.org/abstract/the-absence-of-normal-pressure-hydrocephalus-imaging-features-in-us-veterans-with-parkinsonism-a-retrospective-imaging-study/. Accessed November 20, 2025.« Back to 2025 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/the-absence-of-normal-pressure-hydrocephalus-imaging-features-in-us-veterans-with-parkinsonism-a-retrospective-imaging-study/