Objective: To determine which commonly used cognitive screening tests were the best predictors of ADL performance in PD and to determine if additional functional and cognitive testing offered predictive value.

Background: Persons with PD often experience cognitive deficits that impact activities of daily living (ADL).  Although PD is primarily a movement disorder, clinicians often utilize cognitive screens to predict ADL performance and guide intervention.

Method: A cross-sectional secondary analysis of 39 participants with PD (mean age=69.39±6.63; 27 males, 12 females) were included in this two-step regression analysis in predicting ADLs using the ADL Questionnaire (ADL-Q). The cognitive screening tests in the first step were the Mini-Mental Status Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Clinical Dementia Rating Scale (CDR). In the second step, the best screening test with demographic data (age, sex, and education) were entered into block 1 of a hierarchical regression with block 2 containing the following: Trail Making Test parts A and B (TMT A/B), Clock Drawing Test, Timed Up and Go (TUG), Dual-Task TUG, State Trait Anxiety Inventory, and Geriatric Depression Scale.

Results: The CDR was the best predictor of ADL-Q (β = .286) compared to the MoCA (β = -.216) and the MMSE (β = -.141). In the hierarchical regression block 1 accounted for a significant amount of the variance in ADL-Q (R²=.322, p<0.01). In block 2, TMT B and TUG were the only functional measures that were statistically significant and explained a significant amount of additional variability in ADL-Q, above and beyond block 1 (R² change=.199, p<0.04). Overall, the model explained 46.9% of the variance in ADL-Q scores (R²=.469, p<0.001).

Conclusion: Our results suggest that the CDR is better than the two most commonly used cognitive screening tests in PD (MMSE and MoCA) at predicting ADL performance in persons with PD. Moreover, the TMT B and TUG added additional value in predicting ADL function. This suggests that while the cognitive screening test is important in PD, a comprehensive assessment including additional cognitive and functional tests is helpful in gaining a more complete picture of ADL function which can be helpful for decision-making about level of care, patient/family education, and discharge planning.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cognitive-and-functional-predictors-of-adl-performance-in-persons-with-parkinsons-disease/