Objective: To compare patient and informant ratings of impairments in activities of daily living (ADL) of Parkinson’s Disease (PD) patients.

Background: Valid ratings of ADL function have a huge impact on therapeutic interventions. In the clinical routine, ADL function is typically assessed using interviews or questionnaires. PD patients offer insight into how ADL impairments directly impact them, however they tend to underestimate their abilities with increasing cognitive decline. While informants may be more sensitive to early cognitive decline, yet factors such as depression and caregiver burden may negatively influence ratings. To date, the concordance between self- or informant-reports is only sparsely investigated. Moreover, interactions of variables affecting ratings of ADL function are only partly understood.

Method: Data of 150 PD patients was analyzed; all patients underwent comprehensive neuropsychological and motor assessments. The 10-item Functional Activities Questionnaire was completed by both the patient (FAQ-S) and an informant (FAQ-I), independent of one another. Cohen’s κ statistics were used to summarize the level of agreement between patient and informants for each FAQ item. Correlations between FAQ ratings, patient and caregiver demographics, neuropsychological test scores, and the Bayer-ADL scale were conducted.

Results: Of all patients, 87 (58%) were cognitively normal, 50 (33.3%) had mild cognitive impairment, and 13 (8.7%) had PD dementia. Only two items showed a moderate agreement between both the patient and the informant: “finances” κ=0.41, p<0.001, and “traveling out of house” κ=0.47, p<0.001). All other items showed only fair or slight agreement (κ<0.40 p<0.001). Both the FAQ-I and FAQ-S total scores were positively correlated with patient’s age, motor severity, and depressive symptoms (0.27≤r≤0.50, all p<0.002). Negative correlations were found between the FAQ-I and FAQ-S and all cognitive domains (–0.47≤r≤–0.21, all p<0.001) except language, which was only correlated with the FAQ-I. The FAQ-I showed a stronger relationship to the Bayer-ADL (r=–0.85, p<0.001) than did the FAQ-S (r=–0.55, p<0.001).

Conclusion: There was poor agreement between patients’ and informants’ rating of ADL function using the individual items of the FAQ, with both ratings influenced only by patient characteristics.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/informant-vs-self-ratings-of-activities-of-daily-living-in-parkinsons-disease-patients/