Cognitive Functional Abilities in Parkinson's Disease: Agreement Between Patients and Informants

Deck, Benjamin L.; Xie, Sharon X.; Choi, Gyujae; Rick, Jacqueline; Siderowf, Andrew; Rudovsky, Samuel; Duda, John E.; Morley, James F.; Dahodwala, Nabila; Trojanowski, John Q.; Weintraub, Daniel

doi:10.1002/mdc3.12781

Cited by 17 publications

(21 citation statements)

References 37 publications

(76 reference statements)

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“…Although we found overall moderate agreement between participant and study partner reports in general, it was notably lower for participants diagnosed with PD‐MCI. A recent study aimed at assessing the degree of difference between participants and study partners on the PDAQ‐15 found discrepancies among the 2 groups that grew with increasing cognitive impairment . Conversely, we found the weakest correlation between the 2 sources to be within the PD‐MCI group, again potentially because of the overall higher global cognitive abilities in our cognitively impaired groups.…”

Section: Discussioncontrasting

confidence: 50%

“…A recent study aimed at assessing the degree of difference between participants and study partners on the PDAQ-15 found discrepancies among the 2 groups that grew with increasing cognitive impairment. 26 Conversely, we found the weakest correlation between the 2 sources to be within the PD-MCI group, again potentially because of the overall higher global cognitive abilities in our cognitively impaired groups. Our results suggest that participants with PD-MCI may be more acutely aware of cognitive changes and how they may subtly impact IADLs.…”

Section: Discussionmentioning

confidence: 62%

“…12 Interestingly, our results do not support the presence of anosognosia reported by others among participants with more advanced cognitive impairment. 26 However, our sample size in the PDD group was small (n = 24), and global cognitive scores overlapped with the PD-MCI group (and was thus more likely to include participants with relatively preserved insight); as a result, this group may not adequately represent patients with more severe cognitive decline.…”

Section: Discussionmentioning

confidence: 98%

“…However, the authors state that the majority of participants included in this sample had significant cognitive impairment. 26 Additional validation of the PDAQ-15 with performance-based functional measures across all levels of cognitive function in PD will be an important future step. Additional limitations include that a larger sample size is needed to more adequately assess specific relationships between cognitive tests and IADL changes within cognitive groups.…”

Section: Discussionmentioning

confidence: 99%

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Participant and Study Partner Reported Impact of Cognition on Functional Activities in Parkinson's Disease

Cholerton

Poston

Tian

et al. 2019

Movement Disord Clin Pract

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Introduction Introduction: Cognitive dysfunction is common in Parkinson's disease (PD) and associated with reduced functional abilities and increased dependence. To date, however, little is known about the relationship between performance of instrumental activities of daily living (IADLs) and cognitive stages in PD, and there are conflicting reports as to whether declines in specific cognitive domains predict IADL impairment. Methods Methods: Participants with PD were drawn from the Pacific Udall Center and included in the study if both participant and study partner IADL ratings and cognitive tests were completed (n = 192). Logistic regression analyses were performed to determine whether participant and/or study partner rating predicted mild cognitive impairment or dementia. Correlations are reported for the relationship between participant/study partner IADL reports as well as for specific cognitive tests. ResultsResults: Although both participant and study partner ratings of IADL performance were associated with a diagnosis of PD with dementia, only participant self-rating of functional ability was significantly associated with a diagnosis of PD with mild cognitive impairment. Functional ability correlated most strongly with measures of processing speed, auditory working memory, and immediate verbal recall for both the participant and study partner ratings. Conclusion Conclusion: For participants with PD in the early stages of cognitive decline, self-rating may be more sensitive to the impact of cognitive changes on IADL function than ratings made by a knowledgeable study partner. Changes in executive function, processing speed, and learning may indicate a higher likelihood of IADL impairment. Careful assessment of cognition and IADL performance is recommended to permit individualized interventions prior to significant disability.Cognitive impairment is pervasive in Parkinson's disease (PD), often resulting in devastating impacts on quality of life, functional performance, and independence. 1 A decline in the ability to perform instrumental activities of daily living (IADL) related to cognitive impairment, although often initially subtle, can negatively impact disease outcome if not identified and adequately compensated. 2 Although significant functional impairment may be more apparent in PD-related dementia (PDD), subtle deficits in complex IADLs occur frequently among those with PDrelated mild cognitive impairment (PD-MCI), and the presence of such deficits may help to reveal the presence of early cognitive decline. 3 The assessment of functional change in PD presents challenges, however. Performance-based measures are not often

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Participant and Study Partner Reported Impact of Cognition on Functional Activities in Parkinson's Disease

Cholerton

Poston

Tian

et al. 2019

Movement Disord Clin Pract

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“…A range of performance-based tests already exist and some of them have been used in PD cohorts. However, they are either timeconsuming in either assessment and/or scoring [Direct Assessment of Functional Status (Brennan et al, 2016;Deck et al, 2019); Older Americans Resources and Services scale (Shulman et al, 2006); Naturalistic Action Test (Roll, Giovannetti, Libon, & Eppig, 2019); Financial capacity instrument (FCI) (Martin et al, 2013); Medication Management Ability Assessment (Pirogovsky et al, 2013); Multiple Object Test (MOT) (Beyle et al, 2018;Glonnegger et al, 2016)], need extraordinary materials [Six activities task (Fellows & Schmitter-Edgecombe, 2019)], are assessed in a domestic environment [Performance Assessment of Self-Care Skills, (Foster, 2014)], correlate with PD-related motor symptoms [University of California San Diego Performance-Based Skills Assessment, UPSA (Holden et al, 2018)], or motor influences on the performance-based test have not been examined in PD studies yet [Timed Instrumental Activities of Daily Living scale (Higginson, Lanni, Sigvardt, & Disbrow, 2013)]. In Alzheimer's disease research, a performance-based test for mild cognitive impairment (MCI) and early dementia was recently developed: the Erlangen Test of Activities of Daily Living in Persons with Mild Dementia and Mild Cognitive Impairment (ETAM).…”

Section: Introductionmentioning

confidence: 99%

Assessment of Cognitive-Driven Performance-Based Activities of Daily Living Dysfunction in Parkinson’s Disease

Sulzer

Bäumer

Hoang

et al. 2019

J Int Neuropsychol Soc

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Objectives:Parkinson’s disease (PD) patients with mild cognitive impairment (PD-MCI) have an increased risk of developing dementia (PDD). As activities of daily living (ADL) impairment is mandatory for the diagnosis of PDD, assessing early signs of instrumental ADL (iADL) dysfunction, especially in PD-MCI, is essential. In PD, self- and caregiver-reported iADL performance is often confounded by motor dysfunction and mood. Objective and time-efficient performance-based measurements are needed to screen for cognitive-related iADL dysfunction. We evaluated the Erlangen Test of Activities of Daily Living in Mild Dementia and Mild Cognitive Impairment (ETAM) in PD and determined its value for characterizing a subgroup of PD-MCI patients with mild performance-based iADL impairment.Methods:Twenty-one cognitively normal PD patients (PD-NC), 24 PD-MCI patients, and 18 healthy controls (HC) were analyzed. Assessments included the ETAM, a comprehensive neuropsychological test battery, iADL, mood, and motor measurements.Results:PD-MCI patients scored significantly lower on the ETAM total score compared to PD-NC patients (p = .002), whereas HC and PD-NC patients did not statistically differ. No HC scored lower than 27 points (diagnostic cutoff for mild iADL impairment); only PD-MCI patients scored below this cutoff (29.2%) suggesting the ETAM is able to characterize a PD-MCI subgroup with early iADL impairment. PD-MCI patients below the cutoff were more impaired in the attention domain (p = .04).Conclusions:The ETAM is a potentially valuable clinical assessment, able to detect first signs of iADL dysfunction in PD-MCI. Further studies in larger cohorts are needed to evaluate the prognostic ability for predicting PDD.

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Association between Subjective Cognitive Complaints and Incident Functional Impairment in Parkinson's Disease

Weintraub,

Marras,

Amara

et al. 2024

Movement Disorders

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BackgroundEarly identification of subjective cognitive complaints (SCC) in Parkinson's disease (PD) may improve patient care if it predicts cognition‐related functional impairment (CFI).ObjectivesThe aim was to determine the cross‐sectional and longitudinal association between SCC and CFI in PD.MethodsData were obtained from Fox Insight, an online longitudinal study that collects PD patient‐reported outcomes. Participants completed a PD Patient Report of Problems that asked participants for their five most bothersome disease problems. SCCs were placed into eight categories through human‐in‐the‐loop curation and classification. CFI had a Penn Parkinson's Daily Activities Questionnaire (PDAQ‐15) score ≤49. Cox proportional hazards models and Kaplan–Meier survival analyses determined if baseline SCC was associated with incident CFI.ResultsThe PD‐PROP cohort (N = 21,160) was 55.8% male, mean age was 65.9 years, and PD duration was 4.8 years. At baseline, 31.9% (N = 6750) of participants reported one or more SCCs among their five most bothersome problems, including memory (13.2%), language/word finding (12.5%), and concentration/attention (9.6%). CFI occurred in 34.7% (N = 7332) of participants. At baseline, SCC was associated with CFI (P‐value <0.001). SCC at baseline was associated with incident CFI (hazard ratio [HR] = 1.58 [95% confidence interval: 1.45, 1.72], P‐value <0.001), as did cognitive impairment not otherwise specified (HR = 2.31), executive abilities (HR = 1.97), memory (HR = 1.85), and cognitive slowing (HR = 1.77) (P‐values <0.001). Kaplan–Meier curves showed that by year 3 an estimated 45% of participants with any SCC at baseline developed new‐onset CFI.ConclusionsSelf‐reported bothersome cognitive complaints are associated with new‐onset CFI in PD. Remote electronic assessment can facilitate widespread use of patient self‐report at population scale. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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Cognitive Functional Abilities in Parkinson's Disease: Agreement Between Patients and Informants

Cited by 17 publications

References 37 publications

Participant and Study Partner Reported Impact of Cognition on Functional Activities in Parkinson's Disease

Participant and Study Partner Reported Impact of Cognition on Functional Activities in Parkinson's Disease

Assessment of Cognitive-Driven Performance-Based Activities of Daily Living Dysfunction in Parkinson’s Disease

Association between Subjective Cognitive Complaints and Incident Functional Impairment in Parkinson's Disease

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