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Validation of a Performance-based Assessment of Functional Ability Related to Cognition in Parkinson’s Disease

Study Rationale:                   
There is a pressing need for new treatments to address cognitive impairment in Parkinson’s disease, yet there is no consensus on how to best evaluate their effectiveness. Treatment trials to date mainly use cognitive testing but improvement on such tests has questionable clinical or practical benefits. Functional assessments, which evaluate the ability to perform activities of daily living, may prove more useful for this purpose to ensure that treatments lead to meaningful day-to-day improvements for patients. A performance-based assessment, where patients are observed performing activities of daily living through role playing, may provide objective data that could assist in the validation of other scales.

Through this study, we seek to validate the UCSD Performance-Based Skills Assessment (UPSA), which objectively assesses cognitively-demanding activities of daily living in Parkinson’s disease by assessing its psychometric properties, its correlation with other validated measures of function and its ability to detect degrees of cognitive impairment. 

Study Design:
We will enroll 90 participants with Parkinson’s disease with a range of cognitive abilities, including normal cognition, mild cognitive impairment and dementia. Participants will perform the UPSA, as well as a battery of neuropsychological testing, questionnaire-based functional assessments, mood scales and motor examinations. We will evaluate how performance on the UPSA correlates with alternative methods of assessing cognition and functionality, as well as determine if motor symptoms contribute to impaired performance on these assessments. We will also determine if the UPSA may be useful for diagnosis of Parkinson’s disease dementia, as impairment in activities of daily living due to cognitive difficulties is required for this diagnosis. 

Impact on Diagnosis/Treatment of Parkinson’s Disease:             
By validating the USPA, we hope to provide a new tool to evaluate functional ability related to cognition in Parkinson’s disease, with a focus on the patient’s abilities and day-to-day activities, so that any future treatments could ensure meaningful changes for people living with this disease.    

Next Steps for Development:
Future projects would involve using the UPSA as an outcome measure for a treatment trial evaluating functional task simulation exercises. Functional task simulation exercises, or “enriched exercise,” simultaneously provide mental stimulation and physical exercise, and may also lead to improvements in cognitive functional abilities, as well as slow or prevent cognitive decline. 

Final Outcome

We evaluated the University of California, San Diego Performance-Based Skills Assessment (UPSA), which involves performing day-to-day activities, such as interpreting a utility bill or making a shopping list, in front of a trained observer through role-playing tasks. 100 people with Parkinson's disease (PD) completed the UPSA, as well as several other cognitive tests, mood and quality-of-life questionnaires and a motor examination with a neurologist. Of these 100 people, 56 had no cognitive impairment, 19 had mild cognitive impairment and 25 had dementia. People at different stages of PD were able to complete the UPSA. People with dementia performed significantly worse on the UPSA than those without dementia. The accuracy of UPSA in detecting dementia in people with Parkinson's was 91%. A relationship between thinking and memory tests and the UPSA score was stronger than that between motor tests and the UPSA score. We also found a strong relationship between individual performance on the UPSA and self-reported abilities measured by two questionnaires specific to Parkinson's disease: the Penn Daily Assessment Questionnaire and the Parkinson' Disease-Cognitive Functional Rating Scale. This means that we will be able to use the more easily administered questionnaires in a clinical setting -- a doctor's office -- and be able to trust the results. The next steps in this research will be to evaluate whether performance on the UPSA can predict future diagnosis of dementia, as this type of test might detect subtle cognitive and memory changes better than traditional paper-and-pencil testing.

Presentations & Publications
An abstract presenting initial analysis of this data was presented at the International Congress of Parkinson's Disease and Movement Disorders in Vancouver, British Columbia in June 2017. It was also presented to the University of Colorado Movement Disorders Center at the Annual Research Retreat in August 2017. A paper describing final analysis is being prepared for submission in the next several months, and secondary analysis on the types of errors that were made by people with Parkinson's disease on the UPSA will be performed as well.


  • Benzi Michael Kluger, MD and MS

    Aurora, CO United States

  • Samantha K. Holden, MD

    Aurora, CO United States

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