Objective: To validate novel scores assessing cognitive-driven activity of daily living (ADL) dysfunction in a large, international pooled non-demented Parkinson’s disease (PD) cohort.

Background: The core feature for differentiating dementia in PD (PDD) from mild cognitive impairment (PD-MCI) is the loss of the ability to perform activities necessary for independent living. To justify a diagnosis of PDD, ADL disabilities should be primarily caused by cognitive, not motor problems. Previous work in a cohort of non-demented PD patients differentiated cognitive-driven from motor-driven ADL impairments using a quotient derived from the Functional Activities Questionnaire (FAQQ). Aim was to validate this quotient in a larger sample.

Method: Demographic, motor, and cognitive data of 520 PD patients was analyzed within the frame of the CENTRE-PD project. Based on previous work[1], we computed the FAQQ reflecting patients’ global cognitive status compared to PD-related motor severity. For validation purposes, a second quotient was derived using linear regression models with age, sex, disease duration, depression and levodopa equivalence as cofounders. The quotients were used to split the PD-MCI group, with values >1 indicating more cognitive- compared to motor-driven ADL impairment.

Results: Using Level I criteria, 318 (61.2%) patients were classified as cognitively normal (PD-CN), and 202 (38.8%) were classified as PD-MCI. Except for three FAQ items (7, 8, 9), the previous association from each FAQ item to either the Montreal Cognitive Assessment (MoCA) or the Unified Parkinson’s Disease Rating Scale Part III could be replicated. Both the new (chi-square, p<0.001) and original (p=0.002) quotient significantly differentiated between PD-MCI groups. Total MoCA scores were significantly different between groups only for the original composition of the quotient (p=0.016), indicating that PD-MCI patients with more cognitive-driven ADL impairment had more severe cognitive dysfunction.

Conclusion: We replicated the differentiation of cognitive- from motor-driven ADL impairments in a large cohort of non-demented PD patients. The association of cognitive and motor components stays relatively stable in a harmonized population, significantly differentiating PD-MCI groups even when using Level I criteria. However, the original quotient seems favorable when identifying a potential risk group for PDD.

References: 1 Becker, S. , Bäumer, A. , Maetzler, W. , Nussbaum, S. , Timmers, M. , Van Nueten, L. , Salvadore, G. , Zaunbrecher, D. , Roeben, B. , Brockmann, K. , Streffer, J. , Berg, D. and Liepelt‐Scarfone, I. (2019). Assessment of cognitive‐driven activity of daily living impairment in non‐demented Parkinson’s patients. J Neuropsychol. doi:10.1111/jnp.12173

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MDS Abstracts - https://www.mdsabstracts.org/abstract/validation-of-a-novel-quotient-differentiating-cognitive-and-motor-driven-activity-of-daily-living-impairments-in-pd-patients/