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

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 E Counsell; Parkinson's Incidence Cohorts Collaboration; PINE Study; CamPaIGN study; PICNICS study; NYPUM Study; ParkWest Study: ParkWest Principal investigators; Study personnel; ICICLE-PD Study

doi:10.1016/j.parkreldis.2020.05.034

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

Parkinsonism Relat Disord. 2020 Jul:76:49-53. doi: 10.1016/j.parkreldis.2020.05.034. Epub 2020 May 30.

Authors

Collaborators

Angus D Macleod¹², Carl E Counsell¹², Ole-Bjørn Tysnes¹³, Marta Camacho¹⁴, Caroline Williams-Gray¹⁴, Rachael A Lawson¹⁵, Jodi Maple-Grødem¹⁶, S Guido Alves¹⁶, Lars Forgren¹⁷, Carl E Counsell, Angus D Macleod, Robert Caslake, Kate S M Taylor, David J M McGhee, Joanna Gordon, Clare Harris, Hazel Forbes, Roger A Barker, Thomas Foltynie, Sarah L Mason, Caroline H Williams-Gray, Roger A Barker, Marta Camacho, Gemma Cummins, Jonathan R Evans, David P Breen, Ruwani S Wijeyekoon, Caroline H Williams-Gray, Lars Forsgren, Jan Linder, Mona Edström, Jörgen Andersson, Linda Eriksson, David Bäckström, Gun-Marie Hariz, Magdalena Domellöf, Guido Alves¹⁸, Ole-Bjørn Tysnes¹⁹, Michaela Dreetz Gjerstad¹⁶, Kenn Freddy Pedersen¹⁶, Elin Bjelland Forsaa¹⁶, Veslemøy Hamre Frantzen¹⁶, Anita Laugaland¹⁶, Jodi Maple-Grødem¹⁶, Johannes Lange¹⁶, Karen Simonsen¹⁶, Eldbjørg Fiske¹⁶, Ingvild Dalen¹⁶, Bernd Müller¹⁹, Geir Olve Skeie¹⁹, Marit Renså¹⁹, Wenche Telstad²⁰, Aliaksei Labusau²⁰, Jane Kastet²⁰, Ineke HogenEsch²¹, Marianne Kjerandsen²¹, Liv Kari Håland²¹, Karen Herlofson²², Solgunn Ongre²², Siri Bruun²², David Burn, Lynn Rochester, Alison J Yarnall, Rachael A Lawson, Gordon W Duncan, Tien K Khoo

Affiliations

¹ Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK. Electronic address: [email protected].
² Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK. Electronic address: [email protected].
³ The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway; Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Norway. Electronic address: [email protected].
⁴ Department of Clinical Neurosciences, University of Cambridge, UK. Electronic address: [email protected].
⁵ Department of Clinical Science, Neurosciences, Umeå University, Sweden. Electronic address: [email protected].
⁶ Translational and Clinical Research Institute, Newcastle University, UK. Electronic address: [email protected].
⁷ The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway; Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Norway. Electronic address: [email protected].
⁸ Department of Neurology, Haukeland University Hospital, University of Bergen, Norway. Electronic address: [email protected].
⁹ Department of Clinical Neurosciences, University of Cambridge, UK. Electronic address: [email protected].
¹⁰ Translational and Clinical Research Institute, Newcastle University, UK. Electronic address: [email protected].
¹¹ Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK. Electronic address: [email protected].
¹² University of Aberdeen, UK.
¹³ University of Bergen, Norway.
¹⁴ University of Cambridge, UK.
¹⁵ Newcastle University, UK.
¹⁶ Stavanger University Hospital, Norway.
¹⁷ Umeå University, Sweden.
¹⁸ Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway.
¹⁹ Haukeland University Hospital, Norway.
²⁰ Førde Hospital, Norway.
²¹ Haugesund Hospital, Norway.
²² Sørlandet Hospital Arendal, Norway.

PMID: 32645619
DOI: 10.1016/j.parkreldis.2020.05.034

Abstract

Introduction: 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).

Methods: 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.

Results: 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).

Discussion: 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.

Keywords: Dependency; Measurement scales; Parkinson's disease; Validation.

Publication types

Research Support, Non-U.S. Gov't
Validation Study

MeSH terms

Aged
Algorithms
Cohort Studies
Female
Functional Status*
Humans
Male
Mental Status and Dementia Tests / standards*
Middle Aged
Parkinson Disease / diagnosis*
Parkinson Disease / mortality
Parkinson Disease / physiopathology*
Reproducibility of Results
Sensitivity and Specificity

Abstract

Publication types

MeSH terms

Grants and funding