Validation of a UPDRS-/MDS-UPDRS-based definition of functional dependency for Parkinson's disease. (July 2020)

• Record Type: Journal Article
• Authors: Ramsay, Neil; Macleod, Angus D.; Alves, Guido; Camacho, Marta; Forsgren, Lars; Lawson, Rachael A.; Maple-Grødem, Jodi; Tysnes, Ole-Bjørn; Williams-Gray, Caroline H.; Yarnall, Alison J.; Counsell, Carl E.; Macleod, Angus D.; Counsell, Carl E.; Tysnes, Ole-Bjørn; Camacho, Marta; Williams-Gray, Caroline; Rachael A Lawson, ; Maple-Grødem, Jodi; Guido Alves, S.; Forgren, Lars; Counsell, Carl E.; Macleod, Angus D.; Caslake, Robert; Taylor, Kate S.M.; McGhee, David J.M.; Gordon, Joanna; Harris, Clare; Forbes, Hazel; Barker, Roger A.; Foltynie, Thomas; Mason, Sarah L.; Williams-Gray, Caroline H.; Barker, Roger A.; Camacho, Marta; Cummins, Gemma; Evans, Jonathan R.; Breen, David P.; Wijeyekoon, Ruwani S.; Williams-Gray, Caroline H.; Forsgren, Lars; Linder, Jan; Edström, Mona; Andersson, Jörgen; Eriksson, Linda; Bäckström, David; Hariz, Gun-Marie; Domellöf, Magdalena; Alves, Guido; Tysnes, Ole-Bjørn; Gjerstad, Michaela Dreetz; Pedersen, Kenn Freddy; Forsaa, Elin Bjelland; Frantzen, Veslemøy Hamre; Laugaland, Anita; Maple-Grødem, Jodi; Lange, Johannes; Simonsen, Karen; Fiske, Eldbjørg; Dalen, Ingvild; Müller, Bernd; Skeie, Geir Olve; Renså, Marit; Telstad, Wenche; Labusau, Aliaksei; Kastet, Jane; HogenEsch, Ineke; Kjerandsen, Marianne; Håland, Liv Kari; Herlofson, Karen; Ongre, Solgunn; Bruun, Siri; Burn, David; Rochester, Lynn; Yarnall, Alison J.; Lawson, Rachael A.; Duncan, Gordon W.; Khoo, Tien K.;
• Is Part Of: Parkinsonism & related disorders. Volume 76(2020)
• Page Start: 49
• Page End: 53
• Publication Date: 2020-07
• Subjects: Parkinson's disease -- Dependency -- Measurement scales -- Validation; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2020.05.034
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Introduction: Functional dependency in basic activities of daily living (ADLs) is a key outcome in Parkinson's disease (PD). We aimed to define dependency in PD, using the original and MDS versions of the Unified Parkinson's Disease Rating Scale (UPDRS). Methods: We developed two algorithms to define dependency from items of UPDRS Part 2 and MDS-UPDRS Part 2 relating to basic ADLs (feeding, dressing, hygiene and walking, and getting out of a chair). We validated both algorithms using data from 1110 patients from six community-based PD incidence cohorts, testing concurrent validity, convergent validity, and predictive validity. Results: Our optimal algorithm showed high specificity and moderate to high sensitivity versus Schwab & England <80% (specificity 95% [95% confidence interval (CI) 93–97] and sensitivity 65% [95% CI 55–73] at baseline; 88% [95% CI 85–91] and 85% [95% CI 79–97] respectively at five-years follow-up). Convergent validity was demonstrated by strong associations between dependency defined by the algorithm and cognition (MMSE), quality of life (PDQ39), and impairment (UPDRS part 3) (all p < 0.001). Algorithm-defined dependency status also predicted mortality: HR for mortality in those dependent vs independent at baseline was 1.6 (95%CI 1.2–2.1) and in those dependent vs independent at five-years' follow-up was 2.2 (1.6–3.0). Discussion: We have demonstrated the concurrent validity, convergent validity, and predictive validity of a UPDRS-/MDS-UPDRS-based algorithm to define functional dependency in PD. This can be used for studying dependency in any study where UPDRS or MDS-UPDRS part 2 data have been collected. Highlights: Functional dependency is an important outcome in Parkinson's disease. We have defined dependency based on the UPDRS/MDS-UPDRS scale. We have demonstrated its concurrent, convergent, and predictive validity.