Objective: Evaluate concordance between self-reported and performance-based measures of cognitive functional abilities in PD by cognitive class.

Background: PD-specific cognitive functional questionnaires, the Penn Daily Assessment Questionnaire (PDAQ) [1] and PD-Cognitive Functional Rating Scale (PD-CFRS) [2], have been developed and rely on a knowledgeable informant. These scales are brief and easy to administer, but may be limited by lack of a caregiver or caregiver burden or mood. Self-report on these scales could potentially supplement informant-based responses, especially in earlier stages of cognitive decline.

Method: 110 PD participants completed the PDAQ and PD-CFRS independently, as well as a performance-based assessment of cognitive functional abilities (UCSD Performance-Based Skills Assessment (UPSA)). Complete neuropsychological battery and functional interview were administered; cognitive classification (PD-normal cognition (PD-NC), PD-MCI or PDD) was determined by consensus conference, utilizing MDS Level II criteria [table1].

Results: Self-report PDAQ and PD-CFRS scores correlated with UPSA overall (r=0.57, p<0.001; r=-0.61, p<0.001, respectively) and in PD-NC (r=0.35, p=0.006; r=-0.4, p=0.001, respectively), but not in PD-MCI (r=0.37, p=0.1; r=-0.3, p=0.18, respectively) or PDD (r=0.19, p=0.35; r=-0.39, p=0.051, respectively) [figure1 & 2]. Self-report scores on both scales significantly differed between PD-NC and any cognitive impairment (PD-MCI or PDD) (PDAQ: mean diff=9.7, p<0.001; PD-CFRS: mean diff=3.0, p<0.001). Self-report PDAQ scores significantly differed between PD-NC and PD-MCI specifically (mean diff=4.5, p=0.03), but not for PD-CFRS (mean diff=0.4, p=0.5). Self-report PDAQ and PD-CFRS correlated strongly with one another (r=-0.75, p<0.001), a correlation that held in all cognitive groups (PD-NC: r=-0.82, p<0.001; PD-MCI: r=-0.67, P<0.001; PDD: r=-0.51, p=0.009) [figure3]. Multivariately, no demographic or clinical variables significantly affected this relationship.

Conclusion: Self-report of cognitive functional abilities is accurate in PD-NC, but inaccurate in PD-MCI and PDD using the PDAQ and PD-CFRS. Self-report scores on PDAQ could distinguish PD-NC from PD-MCI, but not those on PD-CFRS. Self-report PDAQ and PD-CFRS scores correlated strongly with one another in all cognitive groups. Self-report measures of cognitive functional ability should be avoided in PD with cognitive impairment of any severity.

References: 1. Brennan L, Siderowf A, Rubright JD, Rick J, Dahodwala N, Duda JE, Hurtig H, Stern M, Xie SX, Rennert L, Karlawish J, Shea JA, Trojanowski JQ, Weintraub D. The Penn Parkinson’s Daily Activities Questionnaire-15: Psychometric properties of a brief assessment of cognitive instrumental activities of daily living in Parkinson’s disease. Parkinsonism Relat Disord 2016;25:21-6. 2. Kulisevsky J, Fernandez de Bobadilla R, Pagonabarraga J, Martinez-Horta S, Campolongo A, Garcia-Sanchez C, Pascual-Sedano B, Ribosa-Nogue R, Villa-Bonomo C. Measuring functional impact of cognitive impairment: validation of the Parkinson’s disease cognitive functional rating scale. Parkinsonism Relat Disord 2013;19:812-7.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/self-report-of-cognitive-functional-abilities-is-inaccurate-in-pd-mci-and-pdd/