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

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...

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Published in:	Parkinsonism & related disorders Vol. 76; pp. 49 - 53
Main Authors:	Ramsay, Neil, Macleod, Angus D., Alves, Guido, Camacho, Marta, Forsgren, Lars, Lawson, Rachael A., Maple-Grødem, Jodi, Tysnes, Ole-Bjørn, Williams-Gray, Caroline H., Yarnall, Alison J., Counsell, Carl E., Williams-Gray, Caroline, Rachael A Lawson, Guido Alves, S., Forgren, Lars, Caslake, Robert, Taylor, Kate S.M., McGhee, David J.M., Gordon, Joanna, Harris, Clare, Forbes, Hazel, Barker, Roger A., Foltynie, Thomas, Mason, Sarah L., Cummins, Gemma, Evans, Jonathan R., Breen, David P., Wijeyekoon, Ruwani S., Linder, Jan, Edström, Mona, Andersson, Jörgen, Eriksson, Linda, Bäckström, David, Hariz, Gun-Marie, Domellöf, Magdalena, Gjerstad, Michaela Dreetz, Pedersen, Kenn Freddy, Forsaa, Elin Bjelland, Frantzen, Veslemøy Hamre, Laugaland, Anita, Lange, Johannes, Simonsen, Karen, Fiske, Eldbjørg, Dalen, Ingvild, Müller, Bernd, Skeie, Geir Olve, Renså, Marit, Telstad, Wenche, Labusau, Aliaksei, Kastet, Jane, HogenEsch, Ineke, Kjerandsen, Marianne, Håland, Liv Kari, Herlofson, Karen, Ongre, Solgunn, Bruun, Siri, Burn, David, Rochester, Lynn, Duncan, Gordon W., Khoo, Tien K.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-07-2020
Subjects:	Aged Algorithms Cohort Studies Dependency Female Functional Status Humans Male Measurement scales Mental Status and Dementia Tests - standards Middle Aged Parkinson Disease - diagnosis Parkinson Disease - mortality Parkinson Disease - physiopathology Parkinson's disease Reproducibility of Results Sensitivity and Specificity Validation Validation Parkinson's disease Dependency Measurement scales
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Summary:	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. •Functional dependency is an important outcome in Parkinson's disease.•We have defined dependency based on the UPDRS/MDS-UPDRS scale.•We have demonstrated its concurrent, convergent, and predictive validity.
ISSN:	1353-8020 1873-5126 1873-5126
DOI:	10.1016/j.parkreldis.2020.05.034