Analysis of characteristics affecting instrumental activities of daily living in Parkinson’s disease patients without dementia

  • Seong-Min Choi
  • Geum-Jin Yoon
  • Hyun-Jung Jung
  • Byeong C. KimEmail author
Original Article


Patients with Parkinson’s disease (PD) are liable to experience impairment in their activities of daily living (ADL), which include ambulating, eating, dressing, bathing, and personal hygiene. The aim of this study is to assess which clinical characteristics contribute significantly to instrumental ADL (IADL) in PD patients without dementia. We included 106 PD patients in our study, and each patient’s motor and non-motor status and basic and instrumental ADL were assessed using the appropriate scales. Of the 106 PD patients, 31 (29.2%) had abnormal Korean IADL (K-IADL) scores. These patients were older and had higher scores in terms of the modified Hoehn and Yahr (mHY) staging scale, Unified Parkinson’s Disease Rating Scale (UPDRS) parts II and III, UPDRS part IV motor fluctuation, Beck Depression Inventory (BDI), and total Non-Motor Symptoms assessment scale for PD (NMSS), as well as lower scores in the Mini-Mental State Examination (MMSE). Pearson’s correlation analysis showed significant associations between the scores of K-IADL and each of the following characteristics of the patients: age, mHY stage, UPDRS parts II and III, UPDRS part IV motor fluctuation, BDI, total NMSS, and MMSE. Multivariate linear regression analysis showed that the significant clinical characteristics associated with the K-IADL scores were determined to be the UPDRS part II, MMSE, and BDI scores. The results of our study revealed that the cognitive, depression, and motor symptoms were the significant predictors of IADL in PD patients without dementia.


Parkinson’s disease Activities of daily living Cognition Depression 


Funding information

This work was supported by a grant from the Brain Research Program through the National Research Foundation of Korea, funded by the Ministry of Science, ICT, and Future Planning NRF-2016M3C7A1905469 (to BC Kim).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of the hospital, and informed consent was obtained from the study participants.


  1. 1.
    Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184CrossRefGoogle Scholar
  2. 2.
    Fahn S, Elton R, Marsden C (1987) Unified Parkinson’s Disease Rating Scale. In: Fahn S, Marsden C, Goldstein M, Calne D. (Eds.), Recent developments in Parkinson’s disease. McMillan Healthcare Information, Florham Park, NJ. 153–163Google Scholar
  3. 3.
    Bugalho P, Lampreia T, Miguel R, Mendonça MD, Caetano A, Barbosa R (2016) Non-motor symptoms in Portuguese Parkinson’s disease patients: correlation and impact on quality of life and activities of daily living. Sci Rep 6:32267CrossRefGoogle Scholar
  4. 4.
    Rasovska H, Rektorova I (2011) Instrumental activities of daily living in Parkinson’s disease dementia as compared with Alzheimer’s disease: relationship to motor disability and cognitive deficits: a pilot study. J Neurol Sci 301:279–282CrossRefGoogle Scholar
  5. 5.
    Desai AK, Grossberg GT, Sheth DN (2004) Activities of daily living in patients with dementia: clinical relevance, methods of assessment and effects of treatment. CNS Drugs 18:853–875CrossRefGoogle Scholar
  6. 6.
    Aarsland D, Kurz MW (2010) The epidemiology of dementia associated with Parkinson disease. J Neurol Sci 289:18–22CrossRefGoogle Scholar
  7. 7.
    Emre M, Aarsland D, Brown R, Burn DJ, Duyckaerts C, Mizuno Y, Broe GA, Cummings J, Dickson DW, Gauthier S, Goldman J, Goetz C, Korczyn A, Lees A, Levy R, Litvan I, McKeith I, Olanow W, Poewe W, Quinn N, Sampaio C, Tolosa E, Dubois B (2007) Clinical diagnostic criteria for dementia associated with Parkinson’s disease. Mov Disord 22:1689–1707CrossRefGoogle Scholar
  8. 8.
    Cheon SM, Park KW, Kim JW (2015) Identification of daily activity impairments in the diagnosis of Parkinson disease dementia. Cogn Behav Neurol 28:220–228CrossRefGoogle Scholar
  9. 9.
    Harrison MB, Wylie SA, Frysinger RC, Patrie JT, Huss DS, Currie LJ, Wooten GF (2009) UPDRS activity of daily living score as a marker of Parkinson’s disease progression. Mov Disord 24:224–230CrossRefGoogle Scholar
  10. 10.
    Lee SY, Kim SK, Cheon SM, Seo JW, Kim MA, Kim JW (2016) Activities of daily living questionnaire from patients’ perspectives in Parkinson’s disease: a cross-sectional study. BMC Neurol 16:73CrossRefGoogle Scholar
  11. 11.
    Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 25:2649–2653CrossRefGoogle Scholar
  12. 12.
    Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442CrossRefGoogle Scholar
  13. 13.
    Kang Y, Na DL, Hahn S (1997) A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. J Korean Neurol Assoc 15:300–308Google Scholar
  14. 14.
    Beck AT, Beamesderfer A (1974) Assessment of depression; the depression inventory. Mod Probl Pharmacopsychiatry 7:151–169CrossRefGoogle Scholar
  15. 15.
    Chaudhuri KR, Martinez-Martin P, Brown RG, Sethi K, Stocchi F, Odin P, Ondo W, Abe K, Macphee G, Macmahon D, Barone P, Rabey M, Forbes A, Breen K, Tluk S, Naidu Y, Olanow W, Williams AJ, Thomas S, Rye D, Tsuboi Y, Hand A, Schapira AH (2007) The metric properties of a novel non-motor symptoms scale for Parkinson’s disease: results from an international pilot study. Mov Disord 22:1901–1911CrossRefGoogle Scholar
  16. 16.
    Kang SJ, Choi SH, Lee BH, Kwon JC, Na DL, Han SH (2002) Korean Dementia Research Group, The reliability and validity of the Korean Instrumental Activities of Daily Living (K-IADL). J Korean Neurol Assoc 20:8–14Google Scholar
  17. 17.
    Mahoney FI, Bathel DW (1965) Function evaluation: the Bathel Index. Md State Med J 14:61–65Google Scholar
  18. 18.
    van Uem JMT, Cerff B, Kampmeyer M, Prinzen J, Zuidema M, Hobert MA, Gräber S, Berg D, Maetzler W, Liepelt-Scarfone I (2018) The association between objectively measured physical activity, depression, cognition, and health-related quality of life in Parkinson’s disease. Parkinsonism Relat Disord 48:74–81CrossRefGoogle Scholar
  19. 19.
    Visser M, van Rooden SM, Verbaan D, Marinus J, Stiggelbout AM, van Hilten JJ (2008) A comprehensive model of health-related quality of life in Parkinson’s disease. J Neurol 255:1580–1587CrossRefGoogle Scholar
  20. 20.
    Kim BJ, Liu L, Nakaoka S, Jang S, Browne C (2018) Depression among older Japanese Americans: the impact of functional (ADL & IADL) and cognitive status. Soc Work Health Care 57:109–125CrossRefGoogle Scholar
  21. 21.
    Hajek A, König HH (2016) Longitudinal predictors of functional impairment in older adults in Europe--evidence from the survey of health, ageing and retirement in Europe. PLoS One 11:e0146967CrossRefGoogle Scholar

Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Department of Neurology, Chonnam National University HospitalChonnam National University Medical SchoolGwangjuSouth Korea
  2. 2.National Research Center for DementiaGwangjuSouth Korea

Personalised recommendations