Objective: To assess the psychometric properties of the Neuropsychiatric Fluctuations Scale (NFS) [1] in patients with Parkinson’s disease (PD)

Background: PD presents with non-motor symptoms (NMS) that greatly affect patients’ quality of life. During the course of the disease, some NMS may fluctuate with dopaminergic intake, in parallel or not, with motor fluctuations. Investigation of these non-motor fluctuations is key to further understanding the pathophyisiology of PD and developing effective treatments.

Method: This is multi-center, cross-sectional study on a sample of patients with PD recruited from movement disorders clinics in several European countries. Data on socio-demographic characteristics and PD treatment was gathered. The NFS, composed of 20 items grouped in two subscales (for Off- and On-states, score range 0-30), was administered together with other PD-specific rating scales: Hoehn & Yahr stage, MDS-UPDRS, PDQ-8, QUICK/WOQ-19 and Shame in Parkinson’s Disease (SPARK) Scale. Data quality and acceptability (skewness, floor and ceiling effects), reliability (internal consistency and test-retest in 40 patients) and construct validity were calculated.

Results: The sample was composed by 127 patients (61% men, mean age: 63.2; mean PD duration: 9.1; median HY stage: 2), 79 patients with motor fluctuations (PwF, score>1 in QUICK/WOQ-19 scale) and 48 non-fluctuating patients (PnF). For the NFS-Off subscale, mean scores were: 16.5 (standard deviation, SD: 7.0) for PwF in Off; 6.21 (SD: 7.2) for PwF in On; and 3.4 (SD: 4.3) for PnF (p<0.001). For the NFS-On subscale, mean scores were: 6.0 (SD: 4.8) for PwF in Off; 18.0 (SD: 8.5) for PwF in On; and 19.6 (SD: 6.5) for PnF (p<0.001). Skewness was acceptable for both NFS subscales, and only floor effect was detected for NFS-Off in PwF in On (22.4%). Regarding internal consistency, Cronbach’s alpha was >0.70 in both subscales. For test-retest reliability, the intra-class correlation coefficient was 0.61 for NFS-Off and 0.65 for NFS-On. The NFS-Off subscale correlated 0.04 to 0.27 with MDS-UPDRS; 0.23 with PDQ-8; and 0.46 with SPARK. The NFS-On subscale correlated -0.02 to -0.20 with MDS-UPDRS, -0.16 with PDQ-8 and -0.32 with SPARK.

Conclusion: The preliminary data suggest that the NFS has acceptable psychometric properties and could be a useful tool for assessing neuropsychiatric fluctuations in patients with PD in clinical practice.

References: 1. Schmitt E, Krack P, Castrioto A, Klinger H, Bichon A, Lhommée E, Pelissier P, Fraix V, Thobois S, Moro E, Martinez-Martin P. The Neuropsychiatric Fluctuations Scale for Parkinson’s Disease: A Pilot Study. Mov Disord Clin Pract. 2018 Mar 23;5(3):265-272. doi: 10.1002/mdc3.12607.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/psychometric-properties-of-the-neuropsychiatric-fluctuations-scale-preliminary-results-in-patients-with-parkinsons-disease/