Comparison of activities of daily living impairments in Parkinson's disease patients as defined by the Pill Questionnaire and assessments by neurologists.
OBJECTIVE
To compare the clinical judgment of experienced neurologists after interviewing Parkinson's disease (PD) patients and their caregivers with the use of the Pill Questionnaire to determine the presence of impairments on activities of daily living (ADL).


BACKGROUND
ADL impairment is a criterion for the diagnosis of dementia associated with PD. The Pill Questionnaire has been recommended as a screening tool to assess ADL impairment in PD patients, but its usefulness and validity have not been fully investigated.


METHODS
We recruited idiopathic PD patients from 12 hospitals in Taiwan, and the patients underwent clinical assessments, a neuropsychological test battery and the Unified Parkinson Disease Rating Scale evaluation. The Pill Questionnaire was administered by study assistants. Patient and caregiver interviews were performed by experienced neurologists who were blinded to the Pill Questionnaire results.


RESULTS
In total, 284 PD patients (mean age 71.8±9 years, mean education 8.7±5.3 years, mean disease duration 5.4±5.3 years) were recruited. 63 patients showed ADL impairment by the Pill Questionnaire, and 108 patients showed ADL impairment by neurologists' clinical interviews. κ Statistics showed moderate agreement between the two methods (κ=0.521, p<0.001). Of the 108 patients who were diagnosed with ADL impairment by neurologists, only 56 patients (51.9%) showed impairment according to the Pill Questionnaire. Most of the missed patients had milder cognitive impairment and lower motor disability.


CONCLUSIONS
A comprehensive interview is essential to determine the presence of ADL impairment in PD patients, especially in patients with early PD.
Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan Institute of Clinical Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.
Wei-Ju
WJ
Lee
Department of Neurology and Center for Parkinson's Disease, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Yung-Yee
YY
Chang
Department of Neurology Chushang Show-Chwan Hospital, Nantou and Chung-Shan University Hospital, Taichung, Taiwan.
Juei-Jueng
JJ
Lin
Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Yueh-Feng
YF
Sung
Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan Division of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Jie-Yuan
JY
Li
Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Shuu-Jiun
SJ
Wang
Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan.
Rou-Shayn
RS
Chen
Department of and Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Taiwan Department of Neurology, Kaohsiung Municipal Ta Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Yuan-Han
YH
Yang
Department of Neurology, Shung Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
Chaur-Jong
CJ
Hu
Department of Neurology, China Medical University Hospital; School of Medicine, Medical College and Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, Taiwan.
Chon-Haw
CH
Tsai
Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, College of Medicine, Taipei Medical University, and College of Medicine, National Taiwan University, Taipei, Taiwan.
Han-Cheng
HC
Wang
Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.
Shey-Lin
SL
Wu
Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.
Ming-Hong
MH
Chang
Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Jong-Ling
JL
Fuh
D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D003704:Dementia / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology*; D011237:Predictive Value of Tests; D011795:Surveys and Questionnaires
COGNITION; DEMENTIA; PARKINSON'S DISEASE