Diffusion tensor imaging in elderly patients with idiopathic normal pressure hydrocephalus or Parkinson’s disease: diagnosis of gait abnormalities

BACKGROUND: Gait abnormalities in the elderly, characterized by short steps and frozen gait, can be caused by several diseases, including idiopathic normal pressure hydrocephalus (INPH), and Parkinson’s disease (PD). We analyzed the relationship between these two conditions and their association with gait abnormalities using laboratory test data and findings from diffusion tensor imaging (DTI). METHODS: The study involved 10 patients with INPH, 18 with PD, and 10 healthy individuals (control group). Fractional anisotropy (FA) of five brain areas was measured and compared among the three groups. In addition, the association of INPH and PD with gait capability, frontal lobe function, and FA of each brain area was evaluated. RESULTS: The INPH group had significantly lower FA for anterior thalamic radiation (ATR) and forceps minor (Fmin) as compared to the PD group. The gait capability correlated with ATR FA in the INPH and PD groups. We found that adding DTI to the diagnosis assisted the differential diagnosis of INPH from PD, beyond what could be inferred from ventricular size alone. CONCLUSIONS: We expect that DTI will provide a useful tool to support the differential diagnosis of INPH and PD and their respective severities

The validation of a Japanese version of the New Freezing of Gait Questionnaire (NFOG-Q)

The version of record of this article, first published in Neurological Sciences, is available online at Publisher’s website: https://doi.org/10.1007/s10072-024-07405-y.Objective: This study aimed to develop a Japanese version of the New Freezing of Gait Questionnaire (NFOG-Q) and investigate its validity and reliability. Methods: After translating the NFOG-Q according to a standardised protocol, 56 patients with Parkinson’s disease (PD) were administered it. Additionally, the MDS-UPDRS parts II and III, Hoehn and Yahr (H&Y) stage, and number of falls over 1 month were evaluated. Spearman’s correlation coefficients (rho) were used to determine construct validity, and Cronbach’s alpha (α) was used to examine reliability. Results: The interquartile range of the NFOG-Q scores was 10.0–25.3 (range 0–29). The NFOG-Q scores were strongly correlated with the MDS-UPDRS part II, items 2.12 (walking and balance), 2.13 (freezing), 3.11 (freezing of gait), and 3.12 (postural stability) and the postural instability and gait difficulty score (rho = 0.515–0.669), but only moderately related to the MDS-UPDRS item 3.10 (gait), number of falls, disease duration, H&Y stage, and time of the Timed Up-and-Go test (rho = 0.319–0.434). No significant correlations were observed between age and the time of the 10-m walk test. The internal consistency was excellent (α = 0.96). Conclusions: The Japanese version of the NFOG-Q is a valid and reliable tool for assessing the severity of freezing in patients with PD

ΔHR/ΔWR derived from CPET; A novel predictor of ‘off’ symptom in Parkinson's disease

【Introduction】 Chronotropic incompetence (CI) is broadly defined as the inability of the heart to increase its rate commensurate with increased activity. In this study, we tried to clarify the link between CI and UPDRS part II (off-on), which was calculated by subtracting part II (on) from part II (off), in patients with Parkinson's disease (PD). 【Methods】 Thirty-six hospitalized patients were examined by using cardiopulmonary exercise testing (CPET) for exercise tolerance (ΔVO2/ΔWR and peak VO2/W) and the presence of CI (ΔHR/ΔWR), and using electrocardiogram for heart rate variability. 【Results】 We originally divided the patients into three groups; Group I (ΔHR/ΔWR x100 60) (N = 5). Since Group I and III were significantly smaller and older than Group II, we focused and divided into two groups; Group II CI (+), the PD patients with CI (15≤ ΔHR/ΔWR x100 <35), and Group II CI (−), those patients without that (35≤ ΔHR/ΔWR x100 <60). ΔVO2/ΔWR and peak VO2/W in CI (+) patients was lower than CI (−) (P = 0.022 and P = 0.096, respectively). HF power (parasympathetic activity) tends to be decreased, whereas LF/HF ratio (sympathetic activity) was increased in CI (+) patients as compared with CI (−). The UPDRS part II (off-on) of CI (+) patients was significantly higher than CI (−) (P = 0.023). 【Conclusions】 In PD patients, the difference between ‘on’ and ‘off’ in activities of daily living might be predicted by using ΔHR/ΔWR x100 obtained from CPET as an index