title: Asymmetric and Upper Body Parkinsonism in Patients with Idiopathic Normal-Pressure Hydrocephalus.
abstract: OBJECTIVE
  Our aims were to analyze the characteristics of parkinsonian features and to characterize changes in parkinsonian motor symptoms before and after the cerebrospinal fluid tap test (CSFTT) in idiopathic normal-pressure hydrocephalus (INPH) patients.
  
  
  METHODS
  INPH subjects were selected in consecutive order from a prospectively enrolled INPH registry. Fifty-five INPH patients (37 males) having a positive response to the CSFTT constituted the final sample for analysis. The mean age was 73.7±4.7 years. The pre-tap mean Unified Parkinson's Disease Rating Scale motor (UPDRS-III) score was 24.5±10.2.
  
  
  RESULTS
  There was no significant difference between the upper and lower body UPDRS-III scores (p=0.174). The parkinsonian signs were asymmetrical in 32 of 55 patients (58.2%). At baseline, the Timed Up and Go Test and 10-meter walking test scores were positively correlated with the total motor score, global bradykinesia score, global rigidity score, upper body score, lower body score, and postural instability/gait difficulties score of UPDRS-III. After the CSFTT, the total motor score, global bradykinesia score, upper body score, and lower body score of UPDRS-III significantly improved (p<0.01). There was a significant decrease in the number of patients with asymmetric parkinsonism (p<0.05).
  
  
  CONCLUSIONS
  In the differential diagnosis of elderly patients presenting with asymmetric and upper body parkinsonism, we need to consider a diagnosis of INPH. The association between gait function and parkinsonism severity suggests the involvement of similar circuits producing gait and parkinsonian symptoms in INPH.
authors.affiliation: Department of Neurology, Kyungpook National University School of Medicine, Daegu, Korea.|Brain Science & Engineering Institute, Kyungpook National University, Daegu, Korea.
authors.forename: Kyunghun
authors.initials: K
authors.lastname: Kang
authors.affiliation: Department of Neurology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Ji Su
authors.initials: JS
authors.lastname: Jeon
authors.affiliation: Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Taegyeong
authors.initials: T
authors.lastname: Kim
authors.affiliation: Department of Neurology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Dongho
authors.initials: D
authors.lastname: Choi
authors.affiliation: Department of Neurology, Kyungpook National University School of Medicine, Daegu, Korea.|Brain Science & Engineering Institute, Kyungpook National University, Daegu, Korea.
authors.forename: Pan Woo
authors.initials: PW
authors.lastname: Ko
authors.affiliation: Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Sung Kyoo
authors.initials: SK
authors.lastname: Hwang
authors.affiliation: Department of Neurology, Kyungpook National University School of Medicine, Daegu, Korea.|Brain Science & Engineering Institute, Kyungpook National University, Daegu, Korea. neuromd@knu.ac.kr.
authors.forename: Ho Won
authors.initials: HW
authors.lastname: Lee
keywords: Parkinson's disease; normal pressure hydrocephalus; parkinsonism