Objective: Validate the University of California San Diego Performance-Based Skills Assessment (UPSA) in Parkinson’s disease (PD)

Background: Diagnostic criteria for PD dementia (PDD) require significant impairment in activities of daily living not ascribable to motor or autonomic symptoms, yet there are currently no standards for assessing such cognitive functional impairment. Questionnaire-based functional scales exist, but are open to bias by limited insight, mood or caregiver burden. A performance-based functional assessment avoids such biases, provides objective data and can be used in the validation other scales.

Methods: 52 PD participants completed the UPSA [table1], questionnaire-based cognitive functional scales (Penn Daily Assessment Questionnaire (PDAQ), PD-Cognitive Functional Rating Scale (PD-CFRS)); scales of global cognition (Montreal Cognitive Assessment (MoCA)), Dementia Rating Scale (DRS)), health-related quality of life (PDQ-39), and mood (Hospital Anxiety and Depression Scale (HADS)), Apathy Evaluation Scale (AES)); neuropsychological battery (10 tests, 2 in each of 5 domains); and motor exam (UPDRS Part III). For retest reliability, 18 participants repeated the UPSA after a mean interval of 6 weeks. Cognitive classification (PD-normal cognition (PD-NC), PD-mild cognitive impairment (PD-MCI) or PDD) was determined by consensus conference, blinded to UPSA scores.

Results: Participants included 30 PD-NC, 6 PD-MCI and 16 PDD [table2]. The UPSA demonstrated strong internal consistency (Cronbach’s α=0.83) and retest reliability (r=0.9). Moderate correlations exist between UPSA and DRS (r=0.67, p<0.001), PDAQ (r=0.65, p<0.001), PD-CFRS (r=-0.55, p<0.001) and PDQ-39 (r=-0.51, p=<0.001). UPSA was strongly correlated with UPDRS Part III (r=-0.77, p<0.001); this was attenuated by adjusting for age, education and PD duration (r=-0.51, p<0.001). Correlation was weak between UPSA and HADS (Anxiety r=-0.15, p=0.28; Depression r=-0.24, p=0.09), but moderate for apathy (AES r=-0.39 p=0.004). The UPSA discriminated PDD from non-demented (PD-NC and PD-MCI) participants (AUC=0.92) [figure1]. An UPSA cut-off score of 70 detected PDD with a sensitivity of 75% and specificity of 94%. 

Conclusions: The UPSA provides valid information on cognitive functional abilities in PD and reliably distinguishes demented from non-demented PD patients, though performance may be affected by motor severity and apathy.

References: 1. Emre M, Aarsland D, Brown R, Burn DJ, et al. Clinical diagnostic criteria for dementia associated with Parkinson’s disease. Movement Disorders. 2007 Sep 15;22(12):1689-707.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/validation-of-a-performance-based-assessment-of-functional-ability-related-to-cognition-in-parkinsons-disease/