Objective: To evaluate the psychometric properties of the Neuropsychiatric fluctuation scale (NFS) for Parkinson’s disease (PD).

Background: Neuropsychiatric fluctuations (NpsyF) in PD are frequent and have a negative impact on patients’ autonomy[1,2]. In OFF medication, NpsyF entail “minus” neuropsychiatric symptoms (NPS) like sadness, lack of motivation, anxiety, fatigue, and slowness of thinking, while  in ON medication, they consist in high mood, even mania, hyperactivity, and a general feeling of well-being, called “plus” NPS[3]. The identification and management of these NpsyF are important to optimize treatment of PD. The Neuropsychiatric Fluctuation Scale (NFS) has been recently (2018) designed to assess patients’ NpsyF in real time[4]. NFS comprises 20 items, ten assessing “plus” neuropsychological symptoms, and ten assessing “minus” neuropsychological symptoms, administered in a mixed order. It yields two subscores with a maximal score of 30 points each for the plus and minus signs, as well as a total score ranging from -30 to + 30.

Method: One hundred and one fluctuating PD patients were included. The NFS was administrated twice during a levodopa challenge (in both ON- and OFF-medication conditions). Motor, non-motor states and motor complications (MDS-UPDRS I-IV), depression (Beck depression scale, BDI-II), and non-motor fluctuations items of the Ardouin Scale for Behavioral Assessment in Parkinson’s Disease (ECMP) were also evaluated. Internal consistency was assessed using Cronbach’s alpha coefficient, sensitivity with the Student test, and convergent validity through correlations with BDI-II and ECMP.

Results: In the ON- and OFF- medication conditions respectively, the Cronbach’s alpha coefficient was 0.72 and 0.76 for NFS-minus items, and 0.88 and 0.77 for NFS-plus items. NFS-minus, NFS-plus and NFS total scores all significantly differed between the OFF- and ON-medication conditions (all p<0.001). In addition, OFF medication, the NFS total score was significantly correlated with the EMCP OFF (p=0.004) and the BDI-II (p=0.04). In contrast, the correlations were not significant in ON medication (ECMP ON, p=0.7; BDI-II, p= 0.3).

Conclusion: These results show a good internal consistency of the NFS-plus and NFS-minus items in both medication conditions. In addition, the NFS has a good sensitivity to the medication condition. The NFS can be used to assess acute neuropsychiatric fluctuations, adding to available tools.

References: 1. Witjas T, Kaphan E, Azulay JP, Blin O, Ceccaldi M, Pouget J, et al. Nonmotor fluctuations in Parkinson’s disease: frequent and disabling. Neurology. 2002;59:408–13.
2. Storch A, Schneider CB, Wolz M, Stürwald Y, Nebe A, Odin P, et al. Nonmotor fluctuations in Parkinson disease: severity and correlation with motor complications. Neurology. 2013;80:800–9.
3. Franke C, Storch A. Chapter Thirty-Three – Nonmotor Fluctuations in Parkinson’s Disease. In: Chaudhuri KR, Titova N, editors. Int Rev Neurol [Internet]. Academic Press; 2017 [cited 2020 Mar 23]. p. 947–71. Available from: http://www.sciencedirect.com/science/article/pii/S0074774217300661
4. Schmitt E, Krack P, Castrioto A, Klinger H, Bichon A, Lhommée E, et al. The Neuropsychiatric Fluctuations Scale for Parkinson’s disease: A pilot study. Mov Disord Clin Paractice. 2018 Feb 2;

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MDS Abstracts - https://www.mdsabstracts.org/abstract/psychometric-characteristics-of-the-neuropsychiatric-fluctuation-scale/