Category: Parkinson's Disease: Cognitive functions
Objective: This pilot explored the feasibility and culture-fairness of a psychophysical visuoperceptual test for Parkinson’s disease (PD) in a multicultural population in East London.
Background: PD affects people from a wide variety of ethnic backgrounds and cognitive impairment is a common non-motor symptom. However, diagnostic tests lack sensitivity in identifying cognitive impairment in patients with PD (PwP) originating outside of English-speaking countries . Perception of distorted visual stimuli on the Cats-and-Dogs (CnD) tool is observably reduced in PD . This pilot explored the feasibility, practicalities, and potential efficacy of this test in identifying PD in a diverse population, to inform a larger study.
Method: 18 PwP and 16 healthy controls were recruited into the East London Parkinson’s Disease project. Participants received a battery of tests, including ethnicity, years of education, assessment of global cognition and visual acuity, before the validated CnD visual processing distortion task. After the task, practical information was gathered on test anxiety, tolerability, willingness to repeat and experience of duration.
Results: Logistic regression after adjusting for age, sex and ethnicity showed that accuracy on the CnD task was significantly lower in PwP than controls (p = 0.038), whilst there was no difference for ethnicity (White and South Asian participants performed similarly; p>0.05). Group-level psychophysical curves showed that PwP had worse visuoperception than controls. In contrast, curves were highly overlapping for White and South Asian ethnic groups, supporting similar performance for these groups. The test was generally tolerable, with 69.7% of subjects reporting that they were willing to repeat the tests and 75.7% of subjects reporting that their attitude towards the test was ‘good’ or ‘neutral’. Only 3 patients could not complete the CnD task due to difficulty with the keyboard or following instructions and hence were excluded.
Conclusion: Pilot evidence supports the feasibility of the CnD task as a visuoperceptual test that can differentiate PwP from individuals without PD in this diverse population. Our data suggest that performance on this task is not influenced by ethnicity. Further exploration of the efficacy of the CnD task in a larger sample size of differing ethnicities is warranted.
References:  Statucka M, Cherian K, Fasano A, Munhoz RP, Cohn M. Multiculturalism: A Challenge for Cognitive Screeners in Parkinson’s Disease. Mov Disord Clin Pract. 2021;8(5):733-42.
 Weil RS, Schwarzkopf DS, Bahrami B, Fleming SM, Jackson BM, Goch TJC, et al. Assessing cognitive dysfunction in Parkinson’s disease: An online tool to detect visuoperceptual deficits. Mov Disord. 2018;33(4):544-53.
To cite this abstract in AMA style:D. Mair, K. Dey, E. Camboe, A. Zirra, R. Weil, D. Gallagher, C. Budu, T. Haque, A. Noyce, C. Marshall, S. Waters. Piloting the Cats-and-Dogs tool as a culture-fair test for sensory processing impairment in Parkinson’s disease [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/piloting-the-cats-and-dogs-tool-as-a-culture-fair-test-for-sensory-processing-impairment-in-parkinsons-disease/. Accessed September 21, 2023.
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