title: Development and psychometric evaluation of a scale to measure impaired self-awareness of hyper- and hypokinetic movements in Parkinson's disease.
abstract: OBJECTIVE
  Patients with Parkinson's disease (PD) can show impaired self-awareness of motor deficits (ISAm). We developed a new scale that measures ISAm severity of hyper- and hypokinetic movements in PD during medication on state and defined its psychometric criteria.
  
  
  METHODS
  Included were 104 right-handed, non-depressed, non-demented patients. Concerning ISAm, 38 motor symptoms were assessed using seven tasks, which were performed and self-rated concerning presence of deficit (yes/no) by all patients. The whole procedure was videotaped. Motor symptoms were then evaluated by two independent experts, blinded for patient's ratings, concerning presence, awareness of deficit, and severity. Exploratory principal component analysis (promax rotation) was applied to reduce items. Principal axis factoring was conducted to extract factors. Reliability was examined regarding internal consistency, split-half reliability, and interrater reliability. Validity was verified by applying two additional measures of ISAm.
  
  
  RESULTS
  Of the initial 38 symptoms, 15 remained, assessed in five motor tasks and merged to a total severity score. Factor analysis resulted in a four factor solution (dyskinesia, resting tremor right hand, resting tremor left hand, bradykinesia). For all subscales and the total score, measures of reliability (values 0.64-0.89) and validity (effect sizes>0.3) were satisfactory. Descriptive results showed that 66% of patients had signs of ISAm (median 2, range 0-15), with ISAm being most distinct for dyskinesia.
  
  
  CONCLUSIONS
  We provide the first validation of a test for ISAm in PD. Using this instrument, future studies can further analyze the pathophysiology of ISAm, the psychosocial sequelae, therapeutic strategies and compliance with therapy.
authors: 1Department of Neurology,University of Cologne,Cologne,Germany.
authors: Franziska
authors: F
authors: Maier
authors: 1Department of Neurology,University of Cologne,Cologne,Germany.
authors: Anna L
authors: AL
authors: Ellereit
authors: 1Department of Neurology,University of Cologne,Cologne,Germany.
authors: Carsten
authors: C
authors: Eggers
authors: 1Department of Neurology,University of Cologne,Cologne,Germany.
authors: Catharine J
authors: CJ
authors: Lewis
authors: 1Department of Neurology,University of Cologne,Cologne,Germany.
authors: Esther A
authors: EA
authors: Pelzer
authors: 1Department of Neurology,University of Cologne,Cologne,Germany.
authors: Elke
authors: E
authors: Kalbe
authors: 3Centre for Health Services Research Cologne (ZVFK),Medical Department of the University of Cologne,Germany.
authors: Nicole
authors: N
authors: Ernstmann
authors: 5Department of Clinical Neuropsychology,Barrow Neurological Institute,St. Joseph's Hospital & Medical Center,Phoenix,Arizona,USA.
authors: George P
authors: GP
authors: Prigatano
authors: 1Department of Neurology,University of Cologne,Cologne,Germany.
authors: Gereon R
authors: GR
authors: Fink
authors: 1Department of Neurology,University of Cologne,Cologne,Germany.
authors: Lars
authors: L
authors: Timmermann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness / Q000502:physiology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D006948:Hyperkinesis / Q000209:etiology*; D018476:Hypokinesia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications* / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric
keywords: motor skills