Objective: To evaluate the difference of chopsticks skill in early stage of Parkinson’s disease (PD) and atypical parkinsonism (AP) using a questionnaire and simple motor task.

Background: In East Asians, using chopsticks as eating utensils is learned since early childhood. Unlike using a fork and knife, chopstick skill highly requires finger dexterity of a dominant hand. Chopstick skill may be useful as a proxy for apraxia which is more common in atypical parkinsonism. We aimed to evaluate the difference of chopsticks skill in early stage of Parkinson’s disease (PD) and atypical parkinsonism (AP) using a questionnaire and simple motor task.

Method: Consecutively recruited 111 patients with PD and 74 with AP (Progressive supranuclear palsy [PSP], 40; Multiple system atrophy, 30; Cortical basal syndrome, 4). They were all drug naïve state. Current state of chopsticks use (Chopstick questionnaire, CQ) was interviewed by best response among the 5 scale answers (0, normal; 1, rather slow or clumsy than before but no difficulty in having meal; 2, slowness and clumsiness that make meal time prolong but can eat by chopstick; 3, I can’t pick some of the dishes; 4, I can’t use chopstick anymore). A motor task of chopsticks skill (CST) was tested by counting the number of tablets carried using chopsticks with dominant hand from one dish (10 cm diameter) to the other dish of 20 cm-distance for 20 seconds, which was repeated 3 times.

Results: The age and age-at-onset were not different between PD and AP. (P=.54). Poor chopsticks skill (CQ=3 or 4) presented in 23.0% (n=17) of patients with AP, especially 30% of PSP, but in only 5.6% (n=6) of PD (OR=5.070 in AP, OR=7.29 in PSP, P≤.001 in both). Only 1 patient (0.9%) of 111 PD patients complained infeasible chopsticks use (CQ=4), while 6 patients (8.1%) of 74 AP patients did (P<.05, OR=9.441, 95% CI 1.112-80.142). The mean numbers of pills transferred for 20 seconds (CST) were 10.1 ± 3.1 in PD and 7.8±3.3 in AP (P<.001). CST was well correlated with the motor UPDRS, especially with gait/postural instability score and bradykinesia score (R = -.500 and -.442, P<.001). With respect to cognitive function, visuospatial function and frontal executive function were associated with chopsticks skill (CST) (P<.05).

Conclusion: We found that loss of the ability of chopsticks skill in the early stage of parkinsonism might imply red flag for the presence of atypical parkinsonism, especially PSP.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/early-impairment-of-chopsticks-skill-predict-atypical-parkinsonism/