Kyum-Yil Kwon

Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurological condition prevalent in the elderly, characterized by gait disturbance, cognitive decline, and urinary incontinence. Distinguishing iNPH from neurodegenerative mimics such as Alzheimer’s or Parkinson’s disease is critical to prevent missed treatment opportunities. This narrative review synthesizes current literature on the clinical presentation and diagnostic strategies for iNPH. Gait disturbance, often described as a magnetic gait, is typically the earliest sign and shows the most significant improvement following shunt surgery. Cognitive impairment manifests as frontal-subcortical dysfunction, distinct from the cortical memory deficits of Alzheimer’s disease. Diagnosis relies on integrating clinical history with specific magnetic resonance imaging findings, including disproportionately enlarged subarachnoid space hydrocephalus (DESH) and high-convexity tightness. While the cerebrospinal fluid (CSF) tap test is a valuable predictor for shunt responsiveness, clinicians must be wary of false-negative results. In addition, dopamine transporter imaging and amyloid imaging could be helpful to rule out other neurological disorders. Accurate diagnosis of iNPH requires a multidisciplinary approach combining clinical assessment, neuroimaging, and CSF dynamic evaluation. Timely identification and exclusion of comorbidities allow for effective surgical intervention, significantly reversing symptoms and improving the long-term quality of life for affected older adults.

Objective Sleep disturbances are common and debilitating nonmotor symptoms (NMS) in Parkinson’s disease (PD) patients and profoundly affect quality of life. Despite emerging evidence suggesting that monoamine oxidase B (MAO-B) and catechol-O-methyltransferase (COMT) inhibitors may alleviate NMS, their specific effects on sleep remain unclear. The aim of this network meta-analysis (NMA) was to compare the efficacy of these inhibitors related to sleep problems in PD patients.Methods Following a systematic search of PubMed, Cochrane, and Embase, studies comparing MAO-B or COMT inhibitors and assessing sleep outcomes in PD patients were identified. An NMA was conducted using data from the seven studies that met our inclusion criteria. The outcomes included subjective sleep quality, daytime sleepiness, and objective polysomnography (PSG) parameters.Results No statistically significant differences were found between the effects of the MAO-B and COMT inhibitors on improving subjective sleep quality or daytime sleepiness. However, analyses of objective PSG data revealed that, compared with rasagiline and placebo, safinamide significantly increased rapid eye movement sleep duration (mean difference, 5.70 min [95% CI, 2.26 to 9.14]) and decreased wake time after sleep onset (mean difference, -10.20 min [-19.38 to -1.02]).Conclusion These findings suggest that safinamide may offer additional value for managing sleep disruptions beyond its known motor benefits in patients with PD. Given the limited number and small scale of available trials, the overall evidence should be interpreted cautiously. Nonetheless, this analysis highlights the need for future high-quality trials focused on sleep outcomes to guide the personalized use of MAO-B and COMT inhibitors for sleep disturbances in PD patients.

Objective Cognitive impairment is common in patients with Parkinson’s disease (PD), and few pharmacological options are available for treating this condition. We evaluated the effects of a digital cognitive training program (SUPERBRAIN), which was previously shown to be effective in populations at risk of Alzheimer’s disease, on cognitive function in individuals with PD.Methods Twenty-three individuals with PD and mild cognitive impairment (PD-MCI) from four clinics were randomized to the intervention (n=16) or control (n=7) groups. The intervention group completed a 12-week, home-based, tablet-based cognitive training program (25–30 min/day, 7 days/week). Cognitive outcomes were assessed using the Seoul Neuropsychological Screening Battery pre- and post-intervention.Results The adherence rate was 79.36%. The intervention group showed significant improvements in the Seoul Verbal Learning Test (SVLT) delayed recall and the Controlled Oral Word Association Test, while no changes were observed in the control group. Analysis of covariance confirmed greater SVLT improvement in the intervention group (F statistic=7.15, p=0.015, partial η2=0.28).Conclusion SUPERBRAIN is feasible and can improve cognitive function in individuals with PD-MCI.

Background: Parkinson’s disease (PD) is increasingly being diagnosed in older adults. Despite this trend, the clinical features of geriatric patients with PD are not thoroughly defined. This study aimed to compare the clinical characteristics of geriatric patients (aged ≥75 years) with de novo PD against those of non-geriatric patients (aged <75 years) newly diagnosed with PD. Methods: This retrospective analysis enrolled 110 patients aged 50 years or older with de novo PD from our hospital’s Parkinsonism registry between 2017 and 2023. Clinical evaluations included motor assessment via the Unified Parkinson’s Disease Rating Scale Part III and global cognitive function was measured using the Montreal Cognitive Assessment (MoCA). Nonmotor symptoms, including depression, anxiety, and fatigue, were assessed using other scales and autonomic dysfunction was assessed using the Scale for Outcomes in Parkinson’s Disease–Autonomic (SCOPA-AUT). Results: Geriatric patients with PD (n = 37) exhibited significantly lower cognitive performance (lower MoCA scores, p < 0.001) and more pronounced autonomic dysfunction (higher SCOPA-AUT scores, p = 0.0103) in comparison with non-geriatric PD patients (n = 73). In multivariate logistic regression analysis, lower MoCA scores (odds ratio [OR]: 0.7642, 95% confidence interval [CI]: 0.6712–0.8701, p < 0.001) and elevated SCOPA-AUT scores (OR: 1.0640, 95% CI: 1.0031–1.1286, p = 0.0391) emerged as significant independent predictors of geriatric PD. Conclusions: These findings reveal a distinct clinical phenotype among geriatric patients with de novo PD, underscoring the value of early detection and proactive management of cognitive and autonomic impairments in this group. The results further emphasize the need for individualized assessment and therapeutic interventions tailored to the specific requirements of geriatric patients with PD.

You J, et al. J Clin Neurol. 2026 ;22:e40. https://doi.org/10.3988/jcn.2025.0584

Objective The Huntington’s Disease Quality of Life Battery for Carers (HDQoL-C) is used to evaluate caregiver quality of life. This study aimed to develop and validate the Korean version of the HDQoL-C (K-HDQoL-C) to assess the burden on Korean caregivers of Huntington’s disease (HD) patients.Methods A total of 19 HD caregivers (7 females, mean age 55.4±14.6 years) participated in this study. The K-HDQoL-C, a translation of the English version, consisted of demographic information, caring aspects, life satisfaction, and feelings about life. It was administered twice, 2 weeks apart. Internal consistency was evaluated using Cronbach’s α, and test-retest reliability was assessed with intraclass correlation coefficients. The relationship with the Zarit Burden Interview-12 (ZBI-12) was analyzed.Results The internal consistencies of the K-HDQoL-C were 0.771 (part 2), 0.938 (part 3), and 0.891 (part 4). The test-retest reliability ranged from 0.908 to 0.936. Part 3 was negatively correlated with the ZBI-12, and part 4 was positively correlated with the ZBI-12 (r=-0.780, 0.923; p<0.001).Conclusion The K-HDQoL-C effectively evaluates the challenges faced by HD caregivers, particularly in terms of care aspects and life satisfaction.

Cognitive decline is a common issue in Parkinson’s disease (PD) and significantly affects patients’ quality of life. This study explored the relationship between cognitive functions and dysautonomia in de novo PD. We reviewed records of newly diagnosed PD patients from July 2017 to September 2023 who underwent cognitive and autonomic assessments. Cognitive functions were measured using the Korean version of the Montreal Cognitive Assessment (MoCA-K) and the Seoul Neuropsychological Screening Battery, while autonomic functions were evaluated with the SCOPA-AUT questionnaire. Among 155 patients, 82 with de novo PD were included. The mild cognitive impairment (MCI) group exhibited higher SCOPA-AUT scores, particularly in gastrointestinal dysfunction. Multivariable logistic regression identified total SCOPA-AUT scores as significant predictors of MCI, even after adjusting for demographic and clinical factors. Partial correlation analysis showed significant negative associations between SCOPA-AUT scores and cognitive functions, such as memory and executive function. This study highlights a strong link between autonomic dysfunction, including gastrointestinal issues, and cognitive impairment in de novo PD. Monitoring dysautonomia in early-stage PD may aid in identifying patients at risk of cognitive decline.

Aim: Patients with Parkinson's disease (PD) present with both motor and non‐motor symptoms, and understanding the interplay between these symptoms is crucial for individualized patient care. This study aims to investigate the relationship between motor features and non‐motor symptoms in patients with de novo PD.Methods: A total of 105 patients were analyzed, focusing on motor subtypes or subscores and their impact on cognition, depression, anxiety, fatigue, and dysautonomia. We utilized the Unified Parkinson's Disease Rating Scale–part III (UPDRS‐III) for motor assessment, and various validated scales for non‐motor symptoms.Results: Compared with tremor‐dominant (TD) patients, non‐TD patients showed severe scores in fatigue and dysautonomia, but no difference in other non‐motor symptoms, including global cognition, depression, and anxiety. Linear regression analysis revealed that the total motor score of UPDRS‐III was negatively related to global cognition (β = −0.4454, P = 0.0121). As a post‐hoc analysis, partial correlation analysis showed that rigidity and bradykinesia subscores were associated with global cognition (r = −0.3527, P = 0.0004; r = −0.2206, P = 0.0299, respectively), whereas the postural instability/gait difficulty subscore was associated with depression, anxiety, fatigue, and dysautonomia (r = 0.2181, P = 0.0319; r = 0.2371, P = 0.0194; r = 0.3659, P = 0.0002; r = 0.3968, P = 0.0001, respectively) but not with global cognition.Conclusions: These results suggest that motor features in the early stages of PD can serve as important indicators of non‐motor symptoms, potentially guiding more personalized therapeutic approaches. Geriatr Gerontol Int 2025; 25: 392–397.