Effect of Cognitive Disability and Ambulation Status on Functioning in Moderate-to-Advanced Parkinson Disease

Abstract

Background: As the disease progresses to moderate to advanced stages, people with Parkinson's disease (PwP) are likely to have various degrees of disability due to the motor and non-motor symptoms, such as ambulatory difficulty and cognitive impairment. The objective of this study was to investigate the impact of cognition and ambulation status on the functioning and disability of PwP using the World Health Orgnaization Disability Assessment Schedule 2.0 (WHODAS 2.0). Materials and Methods: A group of 10,581 PwP with Hoehn and Yahr Staging 3 and above were collected from a database of disability evaluation and functional assessment using the Taiwan Data Bank of Persons with Disability between July 2012 and October 2018. WHODAS 2.0 was administered and all PwP were grouped based on their ambulatory status, which was assessed by 3-m back and forth walk and cognitive ability, assessed by WHODAS 2.0 first domain with cutoff level at 58. Results: Non-ambulation and cognitive disability contributed independently to disability in all aspects of WHODAS 2.0 survey, including self-care, getting along with others, performing life activities and participation in society. Compared to ambulation status, cognitive disability had a greater negative impact on functioning in all aspects. Conclusion: Cognitive disability was associated with greater disability in moderate to advanced PwP than non-ambulatory status. The results of this study may indicate that cognition preservation is essential to ameliorate functional impairment and disability in moderate to advanced PwP.

Clinical Characterization of Parkinson's Disease Patients With Cognitive Impairment

“…As a matter of fact, these two conditions could share similar pathophysiological mechanisms, such as chronic inflammation, impaired hypothalamic-pituitary axis stress response, imbalanced energy metabolism, mitochondrial dysfunction, oxidative stress, and neuroendocrine dysfunction (68). A previous study has highlighted the important role of preserving cognitive functions to prevent disability and functional impairment (69).…”

Disability and cognitive impairment are interdependent in primary antiphospholipid syndrome

“…There are, to our knowledge, no previous reports that evaluate disability and CI in PAPS or systemic lupus erythematosus (SLE), and there are few studies that assess this correlation in other clinical contexts. In patients with Parkinson's disease, Wang et al 17 reported an association between CI and greater functional disability. Furthermore, Slavkovic et al , 18 in multiple sclerosis (MS), confirmed a significant inverse correlation between WHODAS 2.0 and neurological impairment.…”

Factor Structure of an ICF-Based Measure of Activity and Participations for Adults in Taiwan's Disability Eligibility Determination System

“…The WHODAS 2.0 has been translated into 47 languages and dialects and is suitable for assessing health status and disability in a variety of settings and populations ( 28 ). Psychometric properties of the WHODAS 2.0 and/or the FUNDES-Adult have been evaluated for a number of clinical conditions, including, but not limited to, the following health conditions: musculoskeletal diseases ( 29 – 32 ), chronic diseases ( 31 , 33 – 36 ), psychiatric conditions ( 29 , 31 , 33 , 37 – 47 ), cancer ( 33 , 48 , 49 ), hearing impairment ( 50 – 52 ), visual impairment ( 50 ), stroke ( 10 , 31 , 33 , 53 – 58 ), Parkinson's disease ( 59 – 62 ), spinal conditions ( 18 , 63 – 65 ), traumatic brain injury ( 63 , 66 , 67 ), multiple sclerosis ( 68 ), persons with disabilities ( 22 , 23 , 35 , 69 , 70 ), older patients discharged from emergency departments ( 71 ) and general population ( 8 , 72 ). Psychometric properties for WHODAS 2.0 36-item and/or FUNDES-Adult have generally been found adequate.…”

“…The WHODAS 2.0 has been translated into 47 languages and dialects and is suitable for assessing health status and disability in a variety of settings and populations (28). Psychometric properties of the WHODAS 2.0 and/or the FUNDES-Adult have been evaluated for a number of clinical conditions, including, but not limited to, the following health conditions: musculoskeletal diseases (29-32), chronic diseases (31,(33)(34)(35)(36), psychiatric conditions (29,31,33,(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47), cancer (33,48,49), hearing impairment (50-52), visual impairment (50), stroke (10,31,33,(53)(54)(55)(56)(57)(58)), Parkinson's disease (59)(60)(61)(62), spinal conditions (18,(63)(64)(65), traumatic brain injury (63,66,67), multiple sclerosis (68), persons with disabilities (22,23,…”