Objective: To compare the subjective presenting motor (MS) and nonmotor symptoms (NMS) in subjects with idiopathic normal pressure hydrocephalus (iNPH) with and without striatal degeneration (SD).

Background: iNPH is commonly identified with the clinical triad of gait dysfunction, memory impairment, and urinary incontinence. This population may also exhibit many NMS, including depression, anxiety, apathy and sleep disorders.^1,2 While MRI is used for radiologic diagnosis of iNPH, dopamine transporter scan (DaTscan) is utilized to evaluate for mimics or co-pathologies.³ Recent studies have highlighted SD can be present in 60% of cases of iNPH and most often involve the caudate more than putamen.⁴ Limited data is available exploring the difference in patient reported symptoms based on DaTscan findings.

Method: This is a retrospective study comparing the patient-reported MS and NMS in DaTscan-positive (D+) and DaTscan-negative (D-) patients who met the Japanese guidelines criteria for probable and definite iNPH and were seen at the University of Connecticut Health Center’s interdisciplinary NPH clinic between January 2020 and June 2023.

Results: Out of 54 patients who met the criteria for probable and definite iNPH, 21 patients underwent DaTscan. Two were excluded for non-diagnostic studies. Of the 19 patients included in analysis, 7 were D+ and 12 were D-. In the D+ cohort, 4 (57%) were male, with a mean age of 82.6 years ± 3.6 and age at time of symptom onset of 78.6 yrs ± 2.9. In the D- cohort, 9 (75%) were male, with a mean age of 76.8 years ± 5.6 and age at time of symptom onset of 72.5 yrs ± 6.4. The mean age and age at symptom onset were found to be statistically higher in the D+ cohort. Among MS, the prevalence of near falls was found to be statistically higher in D+ (100%) than D-(42%) cohort. All other MS and NMS compared, including gait issues, abnormal movements, cognition and mood, sleep, orthostasis, urinary changes, REM sleep disorder, constipation and hyposmia did not show statistical significance between the two cohorts.

Conclusion: Our study shows that iNPH cases with SD tend to manifest at an older age than those without, with higher prevalence of near falls, which may be confounded by older age and symptom onset. Limited subject numbers constraint statistical power. Further studies are needed to elucidate the association and impact of striatal health on presentation and treatment response.

References: 1. Kito, Y., Kazui, H., Kubo, Y., Yoshida, T., Takaya, M., Wada, T., … & Takeda, M. (2009). Neuropsychiatric symptoms in patients with idiopathic normal pressure hydrocephalus. Behavioural neurology, 21(3-4), 165-174.
2. Román, G. C., Verma, A. K., Zhang, Y. J., & Fung, S. H. (2018). Idiopathic normal-pressure hydrocephalus and obstructive sleep apnea are frequently associated: a prospective cohort study. Journal of the neurological sciences, 395, 164-168.
3. Lee SM, Kwon KY. Clinical tips in diagnosing idiopathic normal pressure hydrocephalus: a new concept beyond the cerebrospinal fluid tap test. J Integr Neurosci. 2021 Jun 30;20(2):471–5.
4. Pozzi NG, Brumberg J, Todisco M, Minafra B, Zangaglia R, Bossert I, et al. Striatal Dopamine Deficit and Motor Impairment in Idiopathic Normal Pressure Hydrocephalus. Mov Disord. 2021 Jan;36(1):124–32.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-striatal-degeneration-on-patient-reported-symptoms-in-idiopathic-normal-pressure-hydrocephalus/