Extended "Timed Up and Go" assessment as a clinical indicator of cognitive state in Parkinson's disease.
OBJECTIVE
To evaluate a modified extended Timed Up and Go (extended-TUG) assessment against a panel of validated clinical assessments, as an indicator of Parkinson's disease (PD) severity and cognitive impairment.


METHODS
Eighty-seven participants with idiopathic PD were sequentially recruited from a Movement Disorders Clinic. An extended-TUG assessment was employed which required participants to stand from a seated position, walk in a straight line for 7m, turn 180° and then return to the start, in a seated position. The extended-TUG assessment duration was correlated to a panel of clinical assessments, including the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Quality of Life (PDQ-39), Scales for Outcomes in Parkinson's Disease (SCOPA-Cog), revised Addenbrooke's Cognitive Index (ACE-R) and Barratt's Impulsivity Scale 11 (BIS-11).


RESULTS
Extended-TUG time was significantly correlated to MDS-UPDRS III score and to SCOPA-Cog, ACE-R (p<0.001) and PDQ-39 scores (p<0.01). Generalized linear models determined the extended-TUG to be a sole variable in predicting ACE-R or SCOPA-Cog scores. Patients in the fastest extended-TUG tertile were predicted to perform 8.3 and 13.4 points better in the SCOPA-Cog and ACE-R assessments, respectively, than the slowest group. Patients who exceeded the dementia cut-off scores with these instruments exhibited significantly longer extended-TUG times.


CONCLUSIONS
Extended-TUG performance appears to be a useful indicator of cognition as well as motor function and quality of life in PD, and warrants further evaluation as a first line assessment tool to monitor disease severity and response to treatment. Poor extended-TUG performance may identify patients without overt cognitive impairment form whom cognitive assessment is needed.
School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia.
Tess
T
Evans
Western Australian Neuroscience Research Institute, A Block, QEII Medical Centre, Nedlands, WA, Australia.
Alexa
A
Jefferson
Western Australian Neuroscience Research Institute, A Block, QEII Medical Centre, Nedlands, WA, Australia; Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA, Australia.
Michelle
M
Byrnes
Western Australian Neuroscience Research Institute, A Block, QEII Medical Centre, Nedlands, WA, Australia; Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA, Australia.
Sue
S
Walters
Western Australian Neuroscience Research Institute, A Block, QEII Medical Centre, Nedlands, WA, Australia; Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA, Australia.
Soumya
S
Ghosh
Western Australian Neuroscience Research Institute, A Block, QEII Medical Centre, Nedlands, WA, Australia; Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA, Australia; Institute of Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia.
Frank L
FL
Mastaglia
School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia.
Brian
B
Power
Western Australian Neuroscience Research Institute, A Block, QEII Medical Centre, Nedlands, WA, Australia; Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA, Australia; School of Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia. Electronic address: ryan.anderton@nd.edu.au.
Ryan S
RS
Anderton
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications*; D013997:Time Factors
Cognitive state; Parkinson's disease; SCOPA; Timed Up and Go