Objective: Seoul instrumental activity of daily living (S-iADL) scale is well known to the tool for instrumental activities of Korean elders. However, cutoff point of S-iADL was also determined from patients, who were constituted from most of AD and other dementia patients. Although S-iADL has never been validated in 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-NC and PD-MCI.

Background: The iADL is more complex and demanding in terms of cognitive control than physical ADL, and therefore more vulnerable to cognitive decline early in the course of Alzheimer’s disease (AD). One report suggests that iADL total score is particularly correlated with PD duration and the Hoehn and Yahr (H-Y) score in the Parkinson’s disease dementia (PDD). This results show that motor deficits remain the major contributor to iADL impairment in PDD. On the other hand, another study shows that cognition plays a unique role in iADLs in PDD and is consistent with what is found in AD.

Methods: PD patients was divided into two subgroups as follows: PD patients with normal cognition (PD-NC) and mild cognitive impairment (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.

Conclusions: S-iADL shows a 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-of-daily-living-in-the-detection-of-dementia-in-parkinsons-disease/