Objective: To evaluate an extended Timed Up and Go (extended-TUG) as a potential holistic indicator of Parkinson’s disease; hypothesised to correlate closely with disease severity and cognitive impairment by a panel of clinical assessments. 

Background:

The disability of Parkinson’s Disease (PD) is determined by variable motor and non-motor functional decline, the latter being more significant for quality of life yet under-recognised in the clinical setting. A modification to the traditional TUG, whereby total distance is increased from 6 to 14 metres, was found to be a valid treatment outcome measure, irrespective of location (home or clinic) or practitioner discipline [1]. Ostensibly a motor assessment, the extended-TUG assessment correlates closely with patient quality of life, a patient outcome derived from cognitive, motor and other aspects of the disease [2]. The value of extended-TUG in appraising cognitive status has not been probed by dedicated assessments. 

Methods:

87 participants with diagnosed idiopathic PD were sequentially recruited from the Movement Disorders Clinic, Sir Charles Gairdner Hospital, Perth Australia. An Extended-TUG test was performed, and required participants to stand from a seated position, walk for 7 metres, turn 180 degrees and return. Test duration was correlated to validated assessments including the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), PD Quality of Life (PDQ-39), Scales for Outcomes in Parkinson’s Disease (SCOPA-Cog), and the revised Addenbrooke’s Cognitive Index (ACE-R).

Results:

Time to complete extended-TUG was significantly correlated to UPDRS domains, SCOPA-Cog, ACE-R (p<0.001) and PDQ-39 score (p <0.01). Generalized linear models found the extended-TUG to be a sole variable in predicting ACE-R or SCOPA-Cog scores; where patients in the fastest extended-TUG tertile were predicted to perform 8.3 points and 13.4 points than the slowest group respectively. When stratified by known dementia cut-off scores, the dementia group exhibited significantly longer extended-TUG duration (p <0.05).   

Conclusions: Extended-TUG appears to be a significant indicator of patient cognition, motor function, and quality of life in PD. Poor performance could demarcate patients for whom in-depth cognitive assessment is indicated but not self-evident; larger studies of extended-TUG as a first line tool are suggested.

References: [1] C. Zampieri, A. Salarian, P. Carlson-Kuhta, J.G. Nutt, F.B. Horak, Assessing mobility at home in people with early Parkinson’s disease using an instrumented Timed Up and Go test, Parkinsonism Relat Disord 17(4) (2011) 277-80 [2] Van Uem, S. Walgaard, E. Ainsworth, S.E. Hasmann, T. Heger, S. Nussbaum, M.A. Hobert, E.M. Micó-Amigo, R.C. Van Lummel, D. Berg, W. Maetzler, Quantitative Timed-Up-and-Go Parameters in Relation to Cognitive Parameters and Health-Related Quality of Life in Mild-to-Moderate Parkinson’s Disease, PloS one 11(4) (2016) e0151997.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/extended-timed-up-and-go-a-clinical-indicator-of-cognitive-state-in-parkinsons-disease/