Deck Benjamin L, Xie Sharon X, Choi Gyujae, Rick Jacqueline, Siderowf Andrew, Rudovsky Samuel, Chen-Plotkin Alice, Duda John E, Morley James F, Dahodwala Nabila, Trojanowski John Q, Weintraub Daniel
Departments of Neurology, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA.
Department of Psychology Drexel University Philadelphia Pennsylvania USA.
Mov Disord Clin Pract. 2019 May 17;6(6):440-445. doi: 10.1002/mdc3.12781. eCollection 2019 Jul.
The Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15) assesses cognition-related instrumental activities of daily living (IADL) in Parkinson's disease (PD).
To assess the degree and predictors of disagreement between patients (PT) and knowledgeable informants (KI) on the PDAQ-15.
We recruited 254 PT and KI pairs (PT-KI), determined predictors of agreement, and compared scores to a performance-based functional measure (Direct Assessment of Functional Status [DAFS]; N = 61).
PT and KI total score (intraclass correlation = 0.57) and individual item (Cohen's kappa = 0.46-0.62) agreement were moderate. Patient depression, global cognition, and caregiver burden (all < 0.05), predicted PT-KI discrepancy. PT-KI discrepancy was highest in patients with a dementia diagnosis, followed by mild cognitive impairment and then normal cognition (all < 0.01), with PT rating themselves relatively more functionally intact as cognition worsened. DAFS performance was more highly correlated with KI (r = 0.82; < 0.001) than PT (r = 0.62; < 0.001) PDAQ-15 score.
Our results support using KI as proxies when assessing cognitive IADLs in PD PTs, particularly in cases of more advanced cognitive decline.
宾夕法尼亚帕金森病日常活动问卷 - 15（PDAQ - 15）评估帕金森病（PD）中与认知相关的工具性日常生活活动（IADL）。
评估患者（PT）和知情者（KI）在PDAQ - 15上的分歧程度及预测因素。
我们招募了254对PT和KI，确定一致性的预测因素，并将分数与基于表现的功能测量方法（功能状态直接评估[DAFS]；N = 61）进行比较。
PT和KI的总分一致性（组内相关系数 = 0.57）以及单个项目的一致性（科恩kappa系数 = 0.46 - 0.62）为中等程度。患者的抑郁、整体认知和照料者负担（均P < 0.05）可预测PT - KI的差异。在患有痴呆诊断的患者中，PT - KI差异最大，其次是轻度认知障碍患者，然后是认知正常的患者（均P < 0.01），随着认知功能恶化，PT对自身功能完整性的评分相对更高。与PT的PDAQ - 15评分（r = 0.62；P < 0.001）相比，DAFS表现与KI的相关性更高（r = 0.82；P < 0.001）。
我们的结果支持在评估PD患者的认知IADL时使用KI作为代理人，尤其是在认知衰退更严重的情况下。
