Objective: To elucidate the relationship between these subjective and objective ratings of PDQ-39 and the changes in brain microstructure.

Background: PDQ-39 has been used to assess the reliability and validity of subjective measures in patients with PD. The scale is designed to ensure the reliability and validity of subjective measures in PD patients and consists of 39 questions that assess 8 sub-items and an overall index (Summary Index, SI). However, there is no evidence of whether the patient’s subjective assessment reflects the progression of neurodegeneration in PD.

Method: PDQ-39 and various objective indices (MDS-UPDRS, age, gender, H&Y severity, MMSE, FAB, MoCA-J, and LEDD) were evaluated in 71 PD patients without cognitive problems, and 3T-MRI was performed at the same time. Based on previous reports for the evaluation of quality of life (QOL) by using MDS-UPDRS part2, a cutoff value for QOL satisfaction on PDQ-39 summery index (SI) was set 20 points (over 20 points mean high-PDQ-39). MRI data were analyzed for differences in patient background between the high and low PDQ-39 group.

Results: MRI data were obtained from 27 healthy controls and 71 PD patients without cognitive problems. The high-PDQ-39 group showed significantly higher scores in MDS-UPDRS part1, part2, H&Y, and FAB (P<0.05). There were no significant differences in the other major parameters. MRI analysis showed significant differences in Axial diffusivity (AD), Mean diffusivity (MD), Radial diffusivity (RD), etc. in the low value group, but only significant differences in Isotropic volume fraction (ISOVF) in the high value group. H&Y was divided into two groups; 1 and 2 (mild n=40), and 3 or more (moderate/severe n=31). MDS-UPDRS part3(on) with a cut off value of 34 [1] , Mild/moderate group and severe group. Using MRI data, H&Y showed significant differences in AD, but not in other parameters.

Conclusion: There was no significant difference in white matter between the high-PDQ-39 group and normal subjects. Whereas, the low-PDQ-39 group showed a predominant difference in white matter. These findings suggest that PDQ-39 might be influenced by not only physical problems due to neurodegeneration but also the patient’s environment, such as social influences and relationships, and the stigma for PD etc.

References: [1] Pablo Martínez-Martín et al. Parkinsonism and Related Disorders, 2014.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/subjective-assessment-of-parkinsons-disease-in-relation-to-changes-in-brain-microstructure/