Objective: To define cognitive-driven impairments in activities of daily living (ADL) with high priority for rehabilitation ranked by Parkinson’s disease (PD) patients.

Background: Impairments in ADL primarily caused by cognitive dysfunction are crucial for the diagnosis of dementia in PD. Non-pharmacological interventions have been reported to be effective in slowing down worsening of cognitive function. However, there is a lack of ADL-specific trainings in PD focusing on the improvement of patients’ cognitive-driven ADL in order to delay the manifestation of dementia.

Method: 182 PD patients (62% males) anonymously completed the 58-item “PD-ADL priority for personal life rating survey” asking their priorities for rehabilitative training. For each of the nine domains of the International Classification of Functioning, Disability and Health (ICF) category “activities & participation,” at least one item was defined for each of the following cognitive domains: attention, executive function, memory, language, visual-spatial abilities (n=45 items). For nine combinations of ICF and cognitive domain categories, more than one item was defined. Percentages of a single item rated with highest priority (SIHP) out of all raters were calculated. To identify predictors of patients’ intraindividual cumulative number of items specified to have the highest personal importance (CHP) a stepwise regression was conducted including demographic and clinical data as predictors.

Results: Items of the patients’ ADL Top10 list represent functions out of all five cognitive domains. The two items rated as most important were assigned to the cognitive domain “attention”, focusing on driving ability. The next most important rated items were assigned to “executive functions” and deal with handling finances and health self-care. Considering the ICF domains, the two most important rated items were assigned to the ICF domain “mobility”. Four items of the patients’ ADL priority list were assigned to the ICF domain “self-care”. Regression models (F(1.177)=5.27, p=0.023) selected patients’ age (β=-0.41, p=0.023, R²=0.029) as the only predictor for CHP. Older patients gave fewer items the highest priority rating as impacting individual everyday life and important for treatment.

Conclusion: These cognitive-driven ADL tasks with a high relevance for PD patients’ everyday life should be considered in future innovative rehabilitation programs.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/priorities-of-pd-patients-for-treatment-of-cognitive-driven-adl-impairment/