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Validation of a UPDRS-/MDS-UPDRS-based definition of functional dependency for Parkinson's disease

2020; Elsevier BV; Volume: 76; Linguagem: Inglês

10.1016/j.parkreldis.2020.05.034

1873-5126

Neil Ramsay, Angus D. Macleod, Guido Alves, Marta Camacho, Lars Forsgren, Rachael A. Lawson, Jodi Maple‐Grødem, Ole‐Bjørn Tysnes, Caroline H. Williams‐Gray, Alison J. Yarnall, Carl Counsell, Angus D. Macleod, Carl Counsell, Ole‐Bjørn Tysnes, Marta Camacho, Caroline H. Williams‐Gray, Rachael A. Lawson, Jodi Maple‐Grødem, Guido Alves, Lars Forgren, Carl Counsell, Angus D. Macleod, Robert Caslake, Kate Taylor, David McGhee, Joanna Gordon, Clare Harris, H. A. W. Forbes, Roger A. Barker, Thomas Foltynie, Sarah Mason, Caroline H. Williams‐Gray, Roger A. Barker, Marta Camacho, Gemma Cummins, Jonathan Evans, David P. Breen, Ruwani Wijeyekoon, Caroline H. Williams‐Gray, Lars Forsgren, Jan Linder, Mona Edström, Jörgen Andersson, Linda Eriksson, David Bäckström, Gun‐Marie Hariz, Magnus Domellöf, Guido Alves, Ole‐Bjørn Tysnes, Michaela D. Gjerstad, Kenn Freddy Pedersen, Elin Bjelland Forsaa, Veslemøy Hamre Frantzen, Anita Laugaland, Jodi Maple‐Grødem, Johannes Lange, Karen Simonsen, Eldbjørg Fiske, Ingvild Dalen, Bernd Müller, Geir Skeie, Marit Arnevik Renså, Wenche Telstad, Aliaksei Labusau, Jane Kastet, Ineke Hogenesch, Marianne Kjerandsen, Liv Kari Håland, Karen Herlofson, S. O. Ongre, Siri Bruun, David J. Burn, Lynn Rochester, Alison J. Yarnall, Rachael A. Lawson, Gordon W. Duncan, Tien K. Khoo,

Autism Spectrum Disorder Research

Functional dependency in basic activities of daily living (ADLs) is a key outcome in Parkinson's disease (PD). We aimed to define dependency in PD, using the original and MDS versions of the Unified Parkinson's Disease Rating Scale (UPDRS).We developed two algorithms to define dependency from items of UPDRS Part 2 and MDS-UPDRS Part 2 relating to basic ADLs (feeding, dressing, hygiene and walking, and getting out of a chair). We validated both algorithms using data from 1110 patients from six community-based PD incidence cohorts, testing concurrent validity, convergent validity, and predictive validity.Our optimal algorithm showed high specificity and moderate to high sensitivity versus Schwab & England <80% (specificity 95% [95% confidence interval (CI) 93-97] and sensitivity 65% [95% CI 55-73] at baseline; 88% [95% CI 85-91] and 85% [95% CI 79-97] respectively at five-years follow-up). Convergent validity was demonstrated by strong associations between dependency defined by the algorithm and cognition (MMSE), quality of life (PDQ39), and impairment (UPDRS part 3) (all p < 0.001). Algorithm-defined dependency status also predicted mortality: HR for mortality in those dependent vs independent at baseline was 1.6 (95%CI 1.2-2.1) and in those dependent vs independent at five-years' follow-up was 2.2 (1.6-3.0).We have demonstrated the concurrent validity, convergent validity, and predictive validity of a UPDRS-/MDS-UPDRS-based algorithm to define functional dependency in PD. This can be used for studying dependency in any study where UPDRS or MDS-UPDRS part 2 data have been collected.