Objective: To evaluate hand and arm function and its association with motor symptoms as well as activities of daily living (ADL) in de novo Parkinson’s disease (PD).

Background: Motor symptoms and disability in upper limb are common in PD and usually assessed using Unified PD Rating Scale (UPDRS). Activities, like reaching, grasping, manipulating objects, writing, dressing, and eating, may be more demanding as the disease progresses. However, hand and arm functions at very early stages of the disease are still poorly described.

Method: Forty-eight persons with de novo PD [mean (SD) age 67 (10.1) years, 18 (38%) female] were assessed with UPDRS motor, UPDRS ADL items 4-8 and 11 [1] (handwriting, cutting food and handling utensils, dressing, hygiene, turning in bed and adjusting bed clothes, walking) and finger dexterity with Nine Hole Peg test (NHPT). NHPT requires participants to repeatedly place and then remove nine pegs into nine holes one at a time, as quickly as possible. The tests were timed, with a stopwatch (in seconds), from the moment the participant touched the first peg until the last peg hit the dish. One practice trial was allowed by the PD affected hand/arm. The more affected hands/arms were defined according to higher UPDRS motor upper limb scores compared to contralateral hand/arm. Linear regression analyses were used for estimation of associations between results from NHPT (independent variable) and UPDRS motor as well as UPDRS ADL (dependent variables), respectively. Both models were adjusted for age and gender.

Results: The median (q1-q3, min-max) of UPDRS motor and UPDRS ADL was 21 (14-27; 8-53) and 4 (2-6; 0-10), respectively. The median (q1-q3; min-max) of NHPT performance was 32 (25-38; 20-56) seconds that is below normal values for older adults [2]. One second longer time to perform NHPT was significantly associated (p<0.001) with increased UPDRS motor and UPDRS ADL scores (B; 95%CI: 0.7; 0.3-1.1 and 0.2; 0.1-0.3, respectively).

Conclusion: According to NHPT, more than 75% of persons with de novo PD showed finger dexterity impairments. Performance on the NHPT reflected both motor and ADL aspects of PD specific disorders. Thus, hand and arm functions need more attention already in very early stages of PD. Also, longitudinal studies that preferably commences at the time of diagnosis are needed to evaluate any changes over time and any appropriate treatment.

References: 1. Hagell, P., Measuring activities of daily living in Parkinson’s disease: On a road to nowhere and back again? Measurement, 2019. 132: p. 109-124.
2. Oxford Grice, K., et al., Adult norms for a commercially available Nine Hole Peg Test for finger dexterity. Am J Occup Ther, 2003. 57(5): p. 570-3.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hand-and-arm-function-in-persons-with-de-novo-parkinsons-disease/