Objective: To determine the convergent validity of the screening questions included in instructions to patients for Part 1A of the International Parkinson and Movement Disorder Society revision of the UPDRS (MDS-UPDRS).

Background: Neuropsychiatric symptoms are associated with significant morbidity in Parkinson’s disease (PD). It is important to develop screening measures that are both valid and quickly administered in a clinical setting.

Methods: We recruited 95 PD subjects into a prospective study to investigate neuropsychiatric symptoms in PD. Subjects were administered the MDS-UPDRS Part 1A screening questions, Montreal Cognitive Assessment (MoCA), Scale for the Assessment of Positive Symptoms (SAPS), Beck Depression Inventory – II (BDI), Beck Anxiety Inventory (BAI), Apathy Scale (AS), and Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s disease – Short (QUIP). Visual illusions and sense of presence were queried separately. Correlation was calculated using Spearman’s rank correlation coefficient.

Results: PD subjects were 41% female and had a mean age of 68.8 years (SD=±8.4) and mean duration of disease of 6.6 years (SD=±4.0). The mean MoCA raw score was 24.3 (SD=±2.9). MDS-UPDRS item 1.2 (hallucinations and psychosis) was highly correlated with the SAPS hallucinations and delusions score (r=0.62, p<0.0001); item 1.3 (depressed mood), 1.4 (anxious mood), and 1.6 (features of dopamine dysregulation syndrome) were moderately correlated with the BDI-II (r=0.46, p<0.0001), BAI (r=0.45, p<0.0001), and QUIP (r=0.40, p=0.0001), respectively; and item 1.5 (apathy) had low correlation with the AS (r=0.24, p=0.02). Using criteria for psychosis in PD, MDS-UPDRS item 1.2 (≥1) was 35% sensitive and 95% specific for identifying psychosis. Using a cutoff of 13/14 on the BDI, MDS-UPDRS item 1.3 (≥1) was 68% sensitive and 72% specific for identifying depression. Using a cutoff of 13/14 on AS, MDS-UPDRS item 1.5 (≥1) was 34% sensitive and 81.5% specific for identifying apathy.

Conclusions: These data demonstrate that the instructions to patients for Part 1A of the MDS-UPDRS Part1A alone are not sensitive enough to screen PD patients for neuropsychiatric symptoms. Modifications or additions to the screening questions in instructions to patients may improve individual item sensitivity.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/screening-for-neuropsychiatric-symptoms-in-parkinsons-disease/