Objective: To evaluate hand dexterity and daily hand task performance in individuals with PD and investigate the predictive validity of dexterity testing for functional impairment in daily activities.

Background: Impaired dexterity is a key component of bradykinesia in Parkinson’s disease (PD) from early stages. The alternating finger-tapping test is commonly used to assess hand dexterity. However, its relationship with real-world daily activity performance remains insufficiently established.

Method: 30 patients with mild to moderate stage PD (median Hoen Yahr stage of 2.0) and 30 age- and sex-matched controls were recruited. Dexterity Questionnaire, clinical rating scales (MDS-UPDRS parts II and III), the alternate finger-tapping test (AFTT), and the nine-hole pegboard test (9-HPT) were collected. Performance times for daily hand activities (ADL), including buttoning, unbuttoning, wearing, and removing a face mask, were recorded. Differences between PD patients and healthy controls were analyzed, followed by correlation analysis, receiver operating characteristic (ROC) analysis to determine the predictive validity of objective dexterity measures for functional hand impairment.

Results: Patients with PD demonstrated significantly higher Dexterity Questionnaires scores (p<0.001), greater AFTT scores (p=0.003), prolonged 9-HPT completion times (p<0.001) and longer performance times across all ADL tasks compared with controls (all p<0.001) (Table 1). Buttoning required the longest completion time among all ADL tasks. Daily activity performance correlated most strongly with 9-HPT completion time, but not dexterity questionnaires, clinical rating scales or AFTT (Table 2). ROC analysis showed excellent discriminating ability of the 9-HPT for impaired buttoning (AUC 0.93, p<0.001) and unbuttoning (AUC 0.96, p<0.001), outperforming clinical motor severity scale and AFTT (Figure 1). Cut-off 9-HPT values of 31.5 and 33.5 seconds optimally predicted buttoning and unbuttoning impairment in PD, respectively.

Conclusion: Our preliminary findings demonstrated that AFTT failed to predict daily hand function in patients with PD. 9-HPT provided a clinically meaningful objective measure of daily hand performance, particularly for dressing. These suggested that the 9-HPT may detect subtle functional decline beyond clinical scales and conventional AFTT, implying its potential utility as future functional biomarkers in PD.

Baseline and Daily Hand Performance

Dexterity–ADL Correlations in Parkinsons PD group

ROC: 9-HPT/AFTT/MDS-III for button tasks

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-alternating-finger-tapping-test-poorly-predicts-real-world-daily-activity-performance-in-parkinsons-disease/