Clinical Parkinsonism Related Disorders最新文献

{"title":"Confirmation of biallelic VPS11 variants as a cause of complex dystonic syndrome","authors":"Arnaud Storck , Marie Thérèse Abiwarde , Gaelle Hardy , Anne-Sophie Lebre , Sophie Scheidecker , Maria Cristina Antal , Mathieu Anheim , Thomas Wirth","doi":"10.1016/j.prdoa.2025.100419","DOIUrl":"10.1016/j.prdoa.2025.100419","url":null,"abstract":"","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100419"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parkinsonism-dystonia syndrome due to a PARK7 gene mutation","authors":"Alexander Calvano ,&nbsp;Dilara Bingoel ,&nbsp;Laura Beccaria ,&nbsp;Fabian Bodlee ,&nbsp;Lars Timmermann ,&nbsp;Natalia Kurka ,&nbsp;David J. Pedrosa","doi":"10.1016/j.prdoa.2025.100412","DOIUrl":"10.1016/j.prdoa.2025.100412","url":null,"abstract":"<div><div>We describe a young woman with a novel homozygous PARK7 mutation causing an early-onset and progressive parkinsonism-dystonia syndrome with poor dopaminergic response. Clinical heterogeneity among homozygous mutation carriers emphasises that molecular characterisation of novel variants and detailed phenotyping remain indispensable for enhancing early diagnosis and the understanding of the multifaceted role of DJ1 in the context of neurodegeneration.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100412"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of repetitive transcranial magnetic stimulation on motor function, depression, and cognitive dysfunction in Parkinson’s disease: A systematic review and meta-analysis of randomized controlled trials","authors":"Wenming Lu ,&nbsp;Longxiang Yan ,&nbsp;Chuangguo Li,&nbsp;Kai Wang,&nbsp;Qijing Wang,&nbsp;Sisi Xu,&nbsp;Benguo Wang","doi":"10.1016/j.prdoa.2026.100422","DOIUrl":"10.1016/j.prdoa.2026.100422","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Parkinson’s disease (PD) is a multifactorial neurodegenerative disease with a high prevalence worldwide, leading to motor and non-motor symptoms. Moreover, PD presents a progressive aggravation alongside time, the middle and late patients in PD requires the use of a variety of anti-Parkinson’s drugs with obvious side effects, which bring serious impact on the quality of life of patients. In recent years, repetitive transcranial magnetic stimulation (rTMS), as a kind of non-invasive neuromodulation therapy, has drawn increasing interest from neurologists, and has been effectively utilized to alleviate both motor and non-motor symptoms of PD. However, the treatment protocols and therapeutic effects of rTMS for PD patients are inconsistent. This meta-analysis aims to systematically evaluate the safety and efficacy of rTMS therapy in patients with PD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We will perform a comprehensive search in the following electronic databases: PubMed/Medline, Web of Science, EMBASE, and Cochrane, without language restrictions, from their inception to September 2024. This review protocol was formulated according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The Cochrane risk of bias tool is utilized to assess the risk of bias. Finally, the effect size was expressed by a standardized mean difference (SMD) with a 95% confidence interval (CI).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 45 randomized controlled trials were included. The results of enrolled studies indicated that both primary and secondary indicators had improved. Subgroup analysis showed that high-frequency rTMS (HF-rTMS) targeting the supplementary motor area (SMD =  − 0.56; 95 %CI = [−0.77, −0.36]; &lt;em&gt;p&lt;/em&gt; &lt; 0.00001), primary motor cortex (SMD: −1.65; 95 %CI = [−2.35, −0.95]; &lt;em&gt;p&lt;/em&gt; &lt; 0.00001), and dorsolateral prefrontal cortex (DLPFC) (SMD: −0.68; 95 %CI = [−1.16, −0.21]; &lt;em&gt;p&lt;/em&gt; = 0.005) yielded a significant reduction in motor UPDRS-III scores, compared to the sham group. In addition, HF‐rTMS over left DLPFC or intermittent theta burst stimulation over left DLPFC may benefit cognition. Furtherly, the subgroup analysis of the Beck Depression Inventory scores indicated HF-rTMS over the left DLPFC was a beneficial treatment for depressive symptoms in PD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The meta-analysis showed that rTMS was effective and safe in the treatment of PD, improving motor function (such as a decrease in UPDRS-III total scores, subscores of UPDRS-III, and FOG-Q scores) in patients with PD and leading to improvement in cognitive function and depression (such as an increase in MocA scores and a decrease BDI scores). Although the results of the subgroup analysis provide a valuable reference for the selection of rTMS for clinical application, further larger multicenter, randomized, placebo-controlled studies with a large number of participants ","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100422"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging neurotechnological approaches to management of sleep disturbances in Parkinson’s disease","authors":"Mason Dallegge ,&nbsp;Sanjana Murthy ,&nbsp;Don M. Tucker ,&nbsp;Emmanuel During ,&nbsp;Shannon O’Neill ,&nbsp;Rachel Fremont ,&nbsp;Joohi Jimenez-Shahed ,&nbsp;Allison C. Waters","doi":"10.1016/j.prdoa.2025.100413","DOIUrl":"10.1016/j.prdoa.2025.100413","url":null,"abstract":"<div><div>Among non-motor symptoms of Parkinson’s disease (PD), sleep disruption is highly prevalent and may be a target for emerging neurotechnological approaches to treatment. Neuroanatomical and chemical changes in PD significantly impact sleep regulation, affecting both REM and non-REM sleep stages. These disturbances contribute to cognitive decline and disease progression, underscoring the critical need for effective management strategies. Sleep-focused neurotechnological advancements offer promising avenues for enhancing treatment of PD. Cognitive Behavioral Therapy for Insomnia (CBT-I) successfully addresses maladaptive sleep behaviors exacerbated by PD and may be further enhanced with the use of sleep tracking technologies. At-home EEG-based monitoring complements CBT-I by facilitating real-time adjustments and optimizations and provides insights into personalized sleep management strategies. Additionally, neuromodulation techniques using direct stimulation aim to restore deep sleep (N3) by targeting specific brain regions affected by PD-related neurodegeneration. This article reviews the presentation of sleep disturbances in PD, explores the potential role for physiological tracking and neuromodulation in treatment of PD, and explores the use of consumer technologies to support personalized sleep management for patients and clinicians.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100413"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal patterns of motor and nonmotor symptom emergence in Parkinson’s disease: a cluster analysis","authors":"Yoko Sugimura ,&nbsp;Toru Baba ,&nbsp;Tomoko Totsune ,&nbsp;Hideki Oizumi ,&nbsp;Takafumi Hasegawa ,&nbsp;Kyoko Suzuki ,&nbsp;Atsushi Takeda","doi":"10.1016/j.prdoa.2026.100423","DOIUrl":"10.1016/j.prdoa.2026.100423","url":null,"abstract":"<div><h3>Background</h3><div>Parkinson’s disease is a heterogeneous disorder characterized by a broad spectrum of motor and nonmotor symptoms. Recent studies suggest that the order of motor and nonmotor symptom development may indicate different subtypes of Parkinson’s disease. However, the temporal occurrence patterns of these symptoms remain unclear.</div></div><div><h3>Objectives</h3><div>This study aims to identify progression patterns of nonmotor symptoms and assess their relationships with the clinical characteristics of Parkinson’s disease.</div></div><div><h3>Methods</h3><div>We evaluated the prevalence and onset time of motor and nonmotor symptoms in 78 non-demented patients with Parkinson’s disease with a disease duration of less than 10 years, all of whom completed questionnaires regarding the presence of these symptoms and the timing of their appearance. We performed a hierarchical cluster analysis based on onset age and the relative onset times of motor and nonmotor symptoms. We then compared clinical characteristics, and cortical morphological changes among the resulting subgroups. Cortical morphology was analyzed in a subset of patients with available brain imaging and was treated as a sub-analysis.</div></div><div><h3>Results</h3><div>We identified three core clusters that exhibited different temporal patterns of symptom emergence in Parkinson’s disease. Cluster 1 was an older-onset group with early sleep problems, poor cognitive function. Cluster 2 was a younger-onset group with typical prodromal nonmotor symptom, mostly constipation. Cluster 3 was another older-onset group with poor cognitive function and many nonmotor symptoms present after the onset of motor symptoms. Structural brain imaging was available for most participants (58/78), and a subset of Cluster 1 showed more pronounced cortical atrophy.</div></div><div><h3>Conclusions</h3><div>Temporal patterns of nonmotor symptom emergence are heterogeneous and are highly influenced by onset age. Older-onset patients showed a higher burden of nonmotor symptoms and worse cognitive function, with symptom emergence occurring either before or after motor symptom onset. Characterizing these symptom-emergence patterns may help refine the clinical classification of Parkinson’s disease and support more individualized evaluation and management.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100423"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The electric brain: approach to suboptimal DBS parameters","authors":"Ananda Carolina Moraes de Falcone ,&nbsp;Carina França ,&nbsp;Thiago Gonçalves Guimarães ,&nbsp;Rubens Gisbert Cury","doi":"10.1016/j.prdoa.2025.100418","DOIUrl":"10.1016/j.prdoa.2025.100418","url":null,"abstract":"<div><div>Deep Brain Stimulation (DBS) has revolutionized Parkinson’s disease treatment, yet post-operative challenges persist, including reversible programming errors caused by insufficient clinician training. Approximately 40 % of suboptimal outcomes referred to tertiary centers stem from correctable programming errors, highlighting the need for standardized approaches <span><span>[1]</span></span>. This article addresses chronic overstimulation syndrome in Subthalamic DBS(STN-DBS), where patients with sustained high-energy stimulation leads poorly tolerated rebound effects when abruptly adjusted. We present a structured, image-guided algorithm combining gradual energy titration with advanced volume of tissue activated (VTA) modeling to optimize therapeutic windows. Three characteristic scenarios are detailed: (1)<!--> <!-->suboptimal lead placement, managed via directional steering to refine stimulation focus; (2)<!--> <!-->excessive stimulation energy, addressed through decremental total electrical energy delivered (TEED) reduction; and (3)<!--> <!-->misplaced leads, requiring systematic deactivation and candidacy assessment for surgical revision. Our tolerance-optimized framework emphasizes spatial precision (leveraging imaging reconstruction) and temporal adaptation (gradual parameter adjustments), offering a paradigm shift for managing chronic DBS complications. While focused on STN-DBS, these principles may extend to other targets facing analogous challenges. The integration of advanced imaging with clinician expertise underscores the dual importance of technology and specialized training in improving DBS outcomes.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100418"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explore thyself: is it time for metacognition screening in clinical trials?","authors":"Andrew McGarry ,&nbsp;Scott Y.H. Kim ,&nbsp;Peggy Auinger ,&nbsp;Charles Venuto ,&nbsp;John Gaughan","doi":"10.1016/j.prdoa.2026.100424","DOIUrl":"10.1016/j.prdoa.2026.100424","url":null,"abstract":"<div><div>Participant self-report has become increasingly important in the design of clinical trials for Parkinson’s Disease (PD), resonating with the general sense that a person’s account of their experience should be a prime consideration in evaluating the effects of therapeutics. Typical study designs look to minimize the effects of comorbidities like substantial behavioral or cognitive disturbances that are expected to put accurate self-report at risk. However, little attention has been paid to the anticipated or actual ability of otherwise eligible PD study participants to accurately convey their experiences during participation. Metacognition, the ability to identify and reflect on one’s thought processes and output, would seem to be instrumental for the careful evaluation of therapeutics using self-report but is not directly assessed during screening for clinical studies. Evidence suggests metacognition may be impaired in participants expected to be enrolled, suggesting the assessment of metacognitive ability during screening or even study conduct may be a worthwhile evolution in study design. Future directions include modeling performance of participants with a range of metacognitive capabilities to understand its influence on outcomes in both active and placebo groups, and possibly simple tools or tests to assess study candidates at risk for poor metacognitive performance in trials that prioritize self-report.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100424"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Parkinson’s disease – Global burden of disease research from 1990 to 2021 and future trend predictions","authors":"Sen Wang ,&nbsp;Yujie Che ,&nbsp;Yiqun Lin,&nbsp;Yukang Zhang,&nbsp;Wen He ,&nbsp;Wei Zhang","doi":"10.1016/j.prdoa.2026.100421","DOIUrl":"10.1016/j.prdoa.2026.100421","url":null,"abstract":"<div><h3>Background</h3><div>Parkinson’s disease (PD), a common neurodegenerative disorder, severely affects patients’ quality of life. This study aims to update the assessment of PD’s prevalence, incidence, mortality, and disability–adjusted life years (DALYs) from 1990 to 2021. Analyses were conducted at Socio-demographic Index (SDI), global, regional, and national levels, stratified by gender and age.</div></div><div><h3>Methods</h3><div>PD data from the Global Burden of Disease (GBD) 2021 database was extracted. Trends in age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of PD were assessed, and estimated annual percentage change (EAPC) was calculated during the study period. Analyses were done by gender, age, GBD region, and SDI quintiles, using R statistical software for analyses and mapping.</div></div><div><h3>Results</h3><div>In 2021, the global burden of PD remained substantial. The number of prevalent PD cases grew from 3,148,394.56 in 1990 to 11,767,271.97 in 2021 (a 2.74-fold increase). Incident cases rose from 417,134.69 to 1,335,142.12 (a 2.20-fold increase). Males exhibited higher prevalence, incidence, and mortality rates than females across almost all age groups. High-SDI regions had higher ASPR, ASIR, and ASDR values than low-SDI regions. Countries and regions in Asia, particularly China and Japan, exhibited among the highest ASPR and ASIR globally. Projections indicate global ASPR and ASIR will continue to rise substantially over the next three decades (to 2050), with males exhibiting a faster rate of increase than females, while the ASMR is predicted to remain essentially stable.</div></div><div><h3>Conclusion</h3><div>This study systematically delineates the epidemiological landscape, temporal trends, and burden profiles of Parkinson’s disease across global, regional, gender-stratified, and age-specific populations, providing an evidence-based framework to guide precision prevention strategies and optimize healthcare resource prioritization.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100421"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the Norwegian version of the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale","authors":"Guido Alves ,&nbsp;Yvonne Stavland Sørenes ,&nbsp;Veslemøy Hamre Frantzen ,&nbsp;Michaela Dreetz Gjerstad ,&nbsp;Anders Ledaal Bjørnestad ,&nbsp;Jodi Maple-Grødem ,&nbsp;Elin Bjelland Forsaa ,&nbsp;Ylva Hivand Hiorth ,&nbsp;Karen Herlofson ,&nbsp;Espen Benjaminsen ,&nbsp;Kari Anne Bjørnarå ,&nbsp;Espen Dietrichs ,&nbsp;Roberta Balestrino ,&nbsp;Carmen Gasca-Salas ,&nbsp;Chi-Ying R. Lin ,&nbsp;Alvaro Sanchez-Ferro ,&nbsp;Michelle H.S. Tosin ,&nbsp;Tiago A. Mestre ,&nbsp;Monica M. Kurtis ,&nbsp;Pablo Martinez-Martin ,&nbsp;Christopher G. Goetz","doi":"10.1016/j.prdoa.2025.100420","DOIUrl":"10.1016/j.prdoa.2025.100420","url":null,"abstract":"<div><h3>Introduction</h3><div>The Movement Disorder Society-revised version of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) is the gold standard assessment for evaluating Parkinson’s disease (PD) symptoms and severity, but a validated Norwegian version is not yet available. We translated the original English MDS-UPDRS into Norwegian and tested the clinimetrics of the translated version following the MDS-established protocol for non-English language translations.</div></div><div><h3>Methods</h3><div>Two independent teams translated the English version of the MDS-UPDRS into Norwegian. After review of the back-translated English version, cognitive pretesting was performed in twelve PD patients at one study site. This was followed by large-scale testing completed by 351 native Norwegian-speaking PD patients at six centers across Norway. We applied confirmatory and exploratory factor analyses to determine the validity of the Norwegian version. Additional analyses were performed to test the reliability of the translated scale.</div></div><div><h3>Results</h3><div>Confirmatory factor analysis demonstrated that the factor structure of the Norwegian version was consistent with that of the English version, as indicated by comparative fit indexes of ≥0.90 for all four MDS-UPDRS parts. Exploratory factor analysis showed the same number of factors in each MDS-UPDRS part, compared to the English version, with some differences in item loadings. Cronbach’s α values were &gt;0.70 for all four MDS-UPDRS parts.</div></div><div><h3>Conclusion</h3><div>The Norwegian language MDS-UPDRS has good construct validity and internal consistency, meeting the requirements to be designated as the Official Norwegian Version of the MDS-UPDRS. We recommend using this validated version in both research and clinical practice.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100420"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CSF tap test parameters and Short-Term outcomes in operated and non-operated patients with idiopathic normal pressure Hydrocephalus: A cohort study","authors":"Sagar Poudel ,&nbsp;Deepa Dash ,&nbsp;Aparna Wagle Shukla ,&nbsp;Ajay Garg ,&nbsp;Ashish Dutt Upadhyay ,&nbsp;Naveet Wig ,&nbsp;Roopa Rajan ,&nbsp;Animesh Das ,&nbsp;Divya MR ,&nbsp;Manjari Tripathi ,&nbsp;Achal K. Srivastava ,&nbsp;SS Kale ,&nbsp;Poodipedi Sarat Chandra ,&nbsp;Ashish Suri ,&nbsp;Pramod K Pal ,&nbsp;Hrishikesh Kumar ,&nbsp;Sakoon Saggu ,&nbsp;Deepti Vibha ,&nbsp;Rajesh Kumar Singh ,&nbsp;Jasmine Parihar ,&nbsp;Arunmozhimaran Elavarasi","doi":"10.1016/j.prdoa.2026.100425","DOIUrl":"10.1016/j.prdoa.2026.100425","url":null,"abstract":"<div><h3>Background</h3><div>Normal Pressure hydrocephalus (NPH) is treated by ventriculoperitoneal shunting. The cerebrospinal fluid tap test (CSF-TT) is widely used to identify candidates for shunt surgery in idiopathic NPH (iNPH). This study aimed to compare the CSF tap test responses and 24-week functional outcomes between patients with probable iNPH who underwent surgery and those who did not.</div></div><div><h3>Methods</h3><div>This Ambispective cohort study included 40 patients with probable iNPH, as defined by the 2019 Japanese guidelines, from 2019 to 2024. All patients underwent a large-volume CSF-TT, and they were offered surgery based on the clinico-radiologic profile.</div></div><div><h3>Results</h3><div>Twenty-four patients underwent ventriculoperitoneal shunt surgery, and 16 did not for various reasons. No significant differences were found in the baseline or 24-hour post-CSF tap test parameters between the groups. However, at 24 weeks, 62.5% of the operated patients showed at least a 1-point improvement in mRS. In contrast, only 14.3% in the non-operated group did, indicating the beneficial role of VP shunting in NPH. Those who were operated had a 10 times higher odds (95% CI 1.6–105) of achieving at least one point improvement in mRS at 24 weeks. Interestingly, 46.7% of patients whose mRS did not improve after CSF-TT but who underwent surgery still benefited from shunting.</div></div><div><h3>Conclusion</h3><div>Shunt surgery leads to a favorable short-term functional outcome in patients with probable iNPH. However, the CSF-TT alone lacks sufficient discriminatory power to guide surgical decisions in a cohort of patients with clinico-radiological probable iNPH. A negative tap test should not preclude surgery in patients with supportive clinical and imaging features.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100425"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}