Eric Morel1, Stéphane Armand2, Frédéric Assal3, Gilles Allali4. 1. Department of Internal Medicine, Regionalspital Emmental AG, Burgdorf, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland. Electronic address: eric.morel@etu.unige.ch. 2. Faculty of Medicine, University of Geneva, Geneva, Switzerland; Willy Taillard Laboratory of Kinesiology, University Geneva Hospitals, Geneva, Switzerland. 3. Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Clinical Neurosciences, Division of Neurology, University Geneva Hospitals, Geneva, Switzerland. 4. Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Clinical Neurosciences, Division of Neurology, University Geneva Hospitals, Geneva, Switzerland; Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA.
Abstract
BACKGROUND: Patients with idiopathic normal pressure hydrocephalus (iNPH) are considered to present a magnetic, slow, wide-based gait, also called frontal gait. However, this gait profile is not specific for iNPH and encountered in patients with other neurological conditions mimicking iNPH (i.e. iNPH mimics), such as vascular dementia. We aimed to characterize the gait profiles in iNPH and their mimics and to compare the prevalence of clinical gait abnormalities between both groups. METHODS: This retrospective study included 140 patients suspected of iNPH (76.3 ± 6.8 yo; 30.7% female). Eighty patients (57.1%) were diagnosed with iNPH according to the NPH consensus guidelines criteria; the remaining sixty patients were classified as mimics (23 neurodegenerative conditions, 12 multifactorial conditions, 9 vascular dementia, 7 mixed dementias, 6 toxic conditions, 2 psychiatric conditions, and 1 stroke). Two independent diagnosis-blinded clinicians (kappa, 0.73) evaluated gait according to four categories: frontal gait, parkinsonian gait, other clinical gait abnormalities, and normal gait. RESULTS: iNPH patients and mimics shared similar clinical characteristics. Frontal gait occurred in only 26% of patients (with a similar prevalence for the mimics). Parkinsonian gait was significantly more prevalent among the mimics (32% versus 15%; p-value: 0.032). This association between parkinsonian gait and mimics remained significant after adjusting for age, gender, comorbidities and white matter changes (OR: 2.404; 95% CI: [1.03-5.64]; p value: 0.044). CONCLUSION: Frontal gait is not the most prevalent gait abnormality in iNPH and does not discriminate iNPH from its mimics. Parkinsonian gait is more prevalent among the mimics.
BACKGROUND:Patients with idiopathic normal pressure hydrocephalus (iNPH) are considered to present a magnetic, slow, wide-based gait, also called frontal gait. However, this gait profile is not specific for iNPH and encountered in patients with other neurological conditions mimicking iNPH (i.e. iNPH mimics), such as vascular dementia. We aimed to characterize the gait profiles in iNPH and their mimics and to compare the prevalence of clinical gait abnormalities between both groups. METHODS: This retrospective study included 140 patients suspected of iNPH (76.3 ± 6.8 yo; 30.7% female). Eighty patients (57.1%) were diagnosed with iNPH according to the NPH consensus guidelines criteria; the remaining sixty patients were classified as mimics (23 neurodegenerative conditions, 12 multifactorial conditions, 9 vascular dementia, 7 mixed dementias, 6 toxic conditions, 2 psychiatric conditions, and 1 stroke). Two independent diagnosis-blinded clinicians (kappa, 0.73) evaluated gait according to four categories: frontal gait, parkinsonian gait, other clinical gait abnormalities, and normal gait. RESULTS: iNPH patients and mimics shared similar clinical characteristics. Frontal gait occurred in only 26% of patients (with a similar prevalence for the mimics). Parkinsonian gait was significantly more prevalent among the mimics (32% versus 15%; p-value: 0.032). This association between parkinsonian gait and mimics remained significant after adjusting for age, gender, comorbidities and white matter changes (OR: 2.404; 95% CI: [1.03-5.64]; p value: 0.044). CONCLUSION:Frontal gait is not the most prevalent gait abnormality in iNPH and does not discriminate iNPH from its mimics. Parkinsonian gait is more prevalent among the mimics.
Authors: Alberto Ferrari; David Milletti; Pierpaolo Palumbo; Giulia Giannini; Sabina Cevoli; Elena Magelli; Luca Albini-Riccioli; Paolo Mantovani; Pietro Cortelli; Lorenzo Chiari; Giorgio Palandri Journal: Fluids Barriers CNS Date: 2022-06-23
Authors: Maria Vittoria Mattoli; Giorgio Treglia; Maria Lucia Calcagni; Annunziato Mangiola; Carmelo Anile; Gianluca Trevisi Journal: Int J Mol Sci Date: 2020-09-07 Impact factor: 5.923