Objective: The Seoul-instrumental activity of daily living (S-iADL) scale is well known to the tool for instrumental activities of Korean elders. However, the cutoff point of S-iADL was also determined from patients, who were constituted from most of Alzheimer disease and other dementia patients. Although S-iADL has never been validated in Parkinson disease dementia (PDD), this scale has been used for diagnosis of PDD in Korea. The aim of this study is to identify cutoff score of S-iADL for differentiation of PDD from PD with normal cognition (PD-NC) and PD with mild cognitive impairment (PD-MCI).

Background: In diagnosis of PDD, dementia symptoms with insidious onset and slow progression ought to reveal in at least two of the four core cognitive domains and it has to be severe enough to impair daily life, which must be independent from motor or autonomic dysfunctions. However, there is no exact recommendation how to evaluate ADL in PDD patients.

Method: Newly diagnosed PD patients was divided into two subgroups as follows: PD-NC and PD-MCI (n=114) versus PDD (n=13). Clinical diagnosis of PDD was defined by suggestions of the MDS-Task Force team. We obtained age at registration, age at onset, education, gender, disease duration, S-iADL, Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), CDR-sum of box (CDR-SOB), initial motor Unified Parkinson’s Disease Rating Scale (mUPDRS) and Hoehn-Yahr (HY) stage.

Results: mUPDRS (p=0.036), HY stage (p=0.025), MMSE z-score (p=0.002), MoCA (p=0.002) and CDR (p=0.018) shows significant differences between PD-NC plus PD-MCI and PDD. Cutoff point of S-iADL was over 1.0. For diagnosing PDD, S-iADL showed that 80% of sensitivity, 82.93 % of specificity, 36.4% of positive predictive value (PPV), and 97.1% of negative predictive value (NPV). PDD was not correlated with S-iADL, but MMSE z-score, CDR and CDR-SOB are associated with PDD.

Conclusion: S-iADL shows an limitation to diagnose PDD from PD-NC and PD-MCI. Interesting point in this study, PDD is more correlated with CDR and CDR-SOB than S-iADL. In addition, MMSE z-score and MoCA are also well associated with PDD. Therefore, it needs to have another good ADL scale, not S-iADL, in the future.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/validation-of-the-seoul-instrumental-activity-daily-living-in-the-detection-of-dementia-in-parkinson-disease/