Objective: To assess differences in quantitative gait parameters and motility during standardized tasks between idiopathic Normal Pressure Hydrocephalus associated with Parkinsonism (iNPH-P) and Parkinson’s Disease (PD).

Background: iNPH can be associated with parkinsonism. iNPH-P and PD are commonly characterized by hypokinetic gait disorders, with decreased walking speed and short stride length.

Method: We selected a group of 21 patients with clinical diagnosis of “possible iNPH” by adapted Relkin criteria and the simultaneous presence of parkinsonism in accordance with the MDS diagnostic definition. We enrolled another group of 21 patients of newly diagnosed “clinically probable” PD based on current MDS diagnostic criteria, who were untreated with dopaminergic medication. Both iNPH-P and PD patients performed the instrumented Timed Up and Go (iTUG) test at the time of the diagnosis, wearing an inertial sensor.

Results: The mean age was significantly higher (71.4 ± 10.7 vs 60.6 ± 10; p = 0.007) while MMSE score was significantly lower (23.9 ± 4.3 vs 27.9 ± 1.3; p = 0.003) in iNPH-P as compared to PD. There were no significant differences in disease duration (2.7 ± 2.3 vs 2.9 ± 2.1; p = 0.788) and UPDRS-ME score (23.8 ± 8.6 vs 28.5 ± 10.3; p = 0.154) between the two groups. Concerning iTUG performances, both turning tasks showed significantly longer duration in iNPH-P, while peak and average angular speeds were lower. Vertical variation in acceleration during the sit-to-stand phase was lower in iNPH-P patients while duration of the stand-to-sit phase was significantly longer. iNPH-P showed smaller stride length and longer gait cycle duration with more represented swing and single support phases. At multivariate analysis adjusting for age and MMSE score as potential confounders, average angular speed on turning-before-sitting was the discriminating parameter between the two groups. Appling ROC curve analysis, an average angular speed cut-off of 49°/s on turning-before-sitting discriminated iNPH-P from PD with a sensitivity of 67% and a specificity of 91%.

Conclusion: Patients with iNPH-P showed specific abnormal balance performances with respect to untreated PD, specifically during adaptation manoeuvres and postural changes.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/differences-in-kinematic-and-spatio-temporal-parameters-assessed-by-instrumented-timed-up-and-go-test-between-idiopathic-normal-pressure-hydrocephalus-associated-with-parkinsonism-an/