The clinical impression of severity index for Parkinson's disease: International validation study

Abstract

This study sought to provide further information about the psychometric properties of the Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD), in a large, international, cross-culturally diverse sample. Six hundred and fourteen patients with PD participated in the study. Apart from the CISI-PD, assessments were based on Hoehn & Yahr (HY) staging, the Scales for Outcomes in PD-Motor (SCOPA-M), -Cognition (SCOPA-COG) and -Psychosocial (SCOPA-PS), the Cumulative Illness Rating Scale-Geriatrics, and the Hospital Anxiety and Depression Scale. The total CISI-PD score displayed no floor or ceiling effects. Internal consistency was 0.81, the test-retest intraclass correlation coefficient was 0.84, and item homogeneity was 0.52. Exploratory and confirmatory factor analysis (CFI = 0.99, RMSEA = 0.07) confirmed CISI-PD's unifactorial structure. The CISI-PD showed adequate convergent validity with SCOPA-COG and SCOPA-M (r(S) = 0.46-0.85, respectively) and discriminative validity for HY stages and disease duration (P < 0.0001). In a multiple regression model, main CISI-PD predictors were SCOPA-M, disease duration, and depression. The results obtained were not only comparable to but also extended those yielded by the preliminary validation study, thus showing that the CISI-PD is a valid instrument to measure clinical impression of severity in PD. Its simplicity and easy application make it an attractive and useful tool for clinical practice and research.

Analysis of four scales for global severity evaluation in Parkinson’s disease

“…It is designed to be scored after the interview and examination have been carried out, in order to capture information enough and decrease the judgment based on the mere patient’s appearance. 9,10 In addition, CISI-PD has a higher precision (range, 0 to 24 points) than the other scales (1 to 7 with the CGIS or 1 to 5 with the HY and PGIS). In spite of the CISI-PD is composed of four items, it may be considered a global evaluation because gathers the overall clinical impression on the corresponding domains and takes seconds to be completed.…”

“…Previous studies found that CISI-PD explains 92% of the CGIS variance and as a whole, correlated at higher level than other global measures with a diversity of scales assessing a diversity of PD-related manifestations and consequences. 9,10,17,18 …”

“…These four scales were the Hoehn and Yahr staging (HY), 7 the Clinical Global Impression-Severity (CGIS), 1 the Patient Global Impression-Severity (PGIS), 2,8 and the Clinical Impression of Severity Index for Parkinson’s disease (CISI-PD). 9,10 Two of these instruments are generic (CGIS and PGIS) and the other two are specific for PD (HY and CISI-PD). On the other hand, three are single-item scales (HY, CGIS, and PGIS) and one is multi-item scale (CISI-PD).…”

Living with chronic illness scale: international validation of a new self-report measure in Parkinson’s disease

“…The Clinical Impression of Severity Index-PD (CISI-PD) 18,19 evaluates the global impression of PD severity in four areas: Motor signs; Disability; Motor complications; and Cognitive status. Items are rated from 0 (normal) to 6 (very severe) and the total score runs from 0 to 24.…”

Imaging, Cognition, and Parkinson’s Disease—An Overview

“…However, cognitive and behavioral problems in PD are common 1 and can have a significant effect on quality of life. 2,3 The prevalence of dementia in patients with PD has conservatively been estimated to range between 24 and 31%. 4 The cognitive profile observed in PD patients with dementia (PDD) is substantially different from that of the primarily cortical dementia of Alzheimer's disease (AD).…”