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Value and appropriate use of rating scales and apparative measurements in quantification of disability in Parkinson's disease

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Journal of Neural Transmission - Parkinson's Disease and Dementia Section

Summary

Despite widespread use in pharmacotherapeutical trials, in the majority of rating scales used in Parkinson's disease (PD) validity, reliability and appropriate use have never been confirmed by statistical data. For this reason 350 unselected PD-pats. were investigated by an extensive standardized test-battery including registration of basis data, Columbia University Rating Scale (CURS), scale for assessment of functional disability (ADL), SCAG-scale, Hoehn & Jahr-scale (HY), mod. Webster step second-test (WSST), Purduepegboard, questionnaire for subjective complaints (SC), WDG, LPS1/2, 3/4, 6, 7, 10, clinical assessment of dementia, v. Zerssen-scale and orthostatic hypotension (60° tilt up). For CURS, SCAG and ADL instrumental reliability was calculated by Cronbach's alpha. For CURS, SCAG, ADL and the total data of complete test battery (CTB) principal component analysis (PCA) was performed for data reduction. CURS, SCAG and ADL showed high internal consistency (alpha ∼≥0.9). For CURS 5 factors accounting for 66% total variance could be extracted by PCA. They represent gait, rigidity, tremor, right/left dexterity (eigenvalues >1). For SCAG 3 factors (61% of total variance) representing dementia, depression and change of personality were extracted. For ADL 3 factors (67% of total variance) could be extracted, representing overall functional disability, handwriting and disablity by pain. PCA of the CTB identified 8 interpretable factors (66% of total variance) characterizing at least partially the clinical profile of PD: 1. motor disability (assessment by rating-scales) 2. dementia, 3. motor-disability (assessment by apparative measurements), 4. depression, 5. orthostatic hypotension, 6. WDG, 7. tremor and 8. pain. Our data confirm the suitability of the investigated scales and give a rational base for their appropriate use in a sense of data reduction and economical evaluation.

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References

  • Alba A, Trainor FS, Ritter W, Dacso MM (1968) A clinical disability rating for Parkinson patients. J Chron Dis 21: 507–522

    Article  PubMed  Google Scholar 

  • Baas H, Fischer PA (1984) Salbengesicht. Zentrale Dyregulation der Talgsekretion beim Parkinson-Syndrom. In: Fischer PA (Hrsg) Vegetativstörungen beim Parkinson-Syndrom. Editiones Roche, Basel/Grenzbach, S 221–234

    Google Scholar 

  • Baas H, Fischer PA (1986) Fluktuationen der Beweglichkeit beim Parkinson-Syndrom. In: Fischer PA (Hrsg) Spätsyndrome der Parkinson-Krankheit. Editiones Roche, Basel/Grenzach, S 213–233

    Google Scholar 

  • Birkmayer W, Neumayer E (1972) Die moderne medikamentöse Behandlung des Parkinsonismus. Z Neurol 202: 257–280

    Article  PubMed  Google Scholar 

  • Briebach T, Baa H, Fischer PA (1990) Orthostatische Regulationsstörung beim Parkinson-Syndrom. Nervenarzt 61: 491–494

    PubMed  Google Scholar 

  • Brown RG, McCarthy B, Jahanshahi M, Marsden CD (1989) Accuracy of self reported disability in patients with parkinsonism. Arch Neurol 46: 955–959

    PubMed  Google Scholar 

  • Canter GJ, de la Torre R, Mier M (1961) A method for evaluating disability in patients with Parkinson's disease. Nerv Ment Dis 133: 143–147

    Google Scholar 

  • Cassell K, Shaw K, Stern G (1973) A computerized tracking technique for the assessment of parkinsonian motor disabilities. Brain 96: 815–826

    PubMed  Google Scholar 

  • Cleeves L, Findley LJ, Gresty M (1986) Assessment of rest tremor in Parkinson's disease. Adv Neurol 45: 349–352

    Google Scholar 

  • Diamond SG, Markham CH (1983) Evaluating the evaluations: or how to weight the scale of parkinsonian disability. Neurology 33: 1098–1099

    PubMed  Google Scholar 

  • Duvoisin RC (1970) The evaluation of extrapyramidal disease. In: Ajuriaguerra J (ed) Monoamines, noyeaux gris centraux et syndrome de Parkinson. Masson, Paris, pp 313–325

    Google Scholar 

  • Fahn S, Elton RL, UPDRS Development Committee (1987) Unified Parkinson's disease rating scale. In: Fahn S, Marsden CD, Calne DB, Goldstein M (eds) Recent developments in Parkinson's disease. Macmillian Health Care Information, New York, pp 153–164

    Google Scholar 

  • Fischer PA (1986) Longterm course in Parkinson's syndrome and cerebral polypathy(Parkinson plus). Adv Neurol 45: 235–238

    Google Scholar 

  • Forrest M, Andersen B (1986) Ordinal scale and statistics in medical research. Br Med J 292: 537–538

    Google Scholar 

  • Gaitz CM, Varner RV, Overall JE (1977) Pharmacotherapy for organic brain syndrome in late life. Arch Gen Psychiatry 34: 839–845

    PubMed  Google Scholar 

  • Gerstenbrand F, Klingler D, Poewe W, Schnaberth G (1986) Präsentation des Dokumentationsbogens für Parkinsonkranke der Österreichischen Parkinsongesellschaft. In: Schnaberth G, Auff E (Hrsg) Das Parkinson-Syndrom. Editiones Roche, Wien

    Google Scholar 

  • Godwin-Austen RB, Tomlinson EB, Frears CC, Kok HWL (1969) Effects of L-Dopa in Parkinson's disease. Lancet ii: 165–168

    Article  Google Scholar 

  • Gotham AM, Brown RG, Marsden CD (1986) Depression in Parkinson's disease: a quantitative and qualitative analysis. J Neurol Neurosurg Psychiatry 49: 381–389

    PubMed  Google Scholar 

  • Hamot HB, Patin RJ, Singer MJ (1984) Factur structure of the Sandoz Clinical Assessment Geriatric Scale (SCAG). Psychopharmacol Bull 20: 142–150

    PubMed  Google Scholar 

  • Hely M, Morris JGL, Wilson A, Fahey P, O'Sullivan DJ, Williamson PM (1990) An evaluation of the Columbia Scale. In: Agnoli A (ed) European Conference on Parkinson's Disease and Extrapyramidal Disorders. John Libbey, Rome London Paris New York, p 136 (Abstract)

    Google Scholar 

  • Hoehn MM, Yahr MD (1967) Parkinsonism: onset progression and mortality. Neurology 17: 427–442

    PubMed  Google Scholar 

  • Horn W (1983) Leistungsprüfsystem (LPS) Handanweisung, 2. Aufl. Hogrefe, Göttingen

    Google Scholar 

  • Jankovic J, Frost JD (1980) Quantitative assessment of parkinsonism and essential tremor: clinical application of triaxial accelerometry. Neurology 30: 393

    Google Scholar 

  • Kartzinel R, Calne DB (1976) Studies with bromocriptine. Part 1. On-off phenomena. Neurology 26: 508–510

    PubMed  Google Scholar 

  • Kennard C, Munro AJ, Park DM (1984) The reliability of clinical assessment of Parkinson's disease. J Neurol Neurosurg Psychiatry 47: 322–323

    PubMed  Google Scholar 

  • Korten JJ (1977) Correlations in 80 patients with Parkinson's disease. In: Lakke JPWF, Korf J, Wesseling H (eds) Parkinson's disease. Concepts and prospects. Excerpta Medica, Amsterdam, pp 101–110

    Google Scholar 

  • Lakke JPWF (1981) Classification of extrapyramidal disorders. J Neurol Sci 51: 311–327

    Article  PubMed  Google Scholar 

  • Lang AET, Fahn S (1989) Assessment of Parkinson's disease. In: Munsat T (ed) Quantification of neurological deficits. Butterworth, Boston, pp 285–309

    Google Scholar 

  • Larsen TA, LeWitt PA, Calne DB (1983) Theoretical and practical issues in assessment of deficits and therapy in parkinsonism. In: Calne DB, Horowski R, McDonald RJ, Wuttke W (eds) Lisuride and other dopamine agonists. Raven Press, New York, pp 363–373

    Google Scholar 

  • Larsen TA, Calne S, Calne DB (1984) Assessment of Parkinson's disease. Clin Neuropharmacol 7: 165–169

    PubMed  Google Scholar 

  • Liebermann A, Dziatolowski M, Gopinathan G, Kopersmith M, Neophytides A, Korein J (1980) Evaluation of Parkinson's disease. In: Goldstein M (ed) Ergot compounds and brain function. Neuroendocrine and neuropsychiatric aspects. Raven Press, New York, pp 277–286

    Google Scholar 

  • Markham CH, Diamond SG (1981) Evidence to support early levodopa therapy in Parkinson's disease. Neurology 31: 125–131

    PubMed  Google Scholar 

  • Marsden CD, Schachter M (1981) Assessment of extrapyramidal disorders. Br J Clin Pharmacol 11: 129–151

    PubMed  Google Scholar 

  • Martinez-Martin P, Bermejo-Parejy F (1988) Rating scales in Parkinson's disease. In: Jankovic J, Tolosa E (eds) Parkinson's disease and movement disorders. Urban & Schwarzenberg, Baltimore Munich

    Google Scholar 

  • Mc Dowell F, Lee JE, Swift T, Sweet RD, Ogsbury JS, Tessler JT (1970) Treatment of Parkinson's syndrome with dihydroxyphenylalanine (levodopa). Ann Intern Med 72: 29–35

    PubMed  Google Scholar 

  • Montgomery GK (1984) PD and Columbia Scale. Neurology 34: 557–558

    Google Scholar 

  • Montgomery GK, Reynolds NC, Warren RM (1985) Qualitative assessment of Parkinson's disease: study of reliability and data reduction with an abbreviated Columbia scale. Clin Neuropharmacol 8: 83–92

    PubMed  Google Scholar 

  • Parkes JD, Zilkha KJ, Calver DM, Knill-Jones RP (1970a) Controlled trial of amantadine hydrichloride in Parkinson's disease. Lancet i: 259–262

    Article  Google Scholar 

  • Parkes JD, Zilkha KJ, Marsden CD, Baxter RCH, Knill-Jones RP (1970b) Amantadine dosage in treatment of Parkinson's disease. Lancet i: 1130–1133

    Article  Google Scholar 

  • Petrinovich L, Hardyck C (1964) Behavioural changes in Parkinson patients. A factor analytical study. J Chron Dis 17: 225–233

    Article  Google Scholar 

  • Potvin AR, Tourtelotte WW (1975) The neurological examination: advancements in its quantification. Arch Phys Med Rehabil 56: 425–437

    PubMed  Google Scholar 

  • Schwab RS, England RC (1969) Projection technique for evaluating surgery in Parkinson's disease. In: Gillingham FJ, Donaldson MC (eds) 3rd Symposium on Parkinson's Disease. E. S. Livingstone, Edinburgh

    Google Scholar 

  • Shader RI, Harmatz JS, Salzman C (1974) A new scale for clinical assessment on geriatric populations: SANDOZ Clinical Assessment Geriatric (SCAG). J Am Geriatr Soc 22: 107–113

    PubMed  Google Scholar 

  • Taylor AE, Saint-Cyr JA, Lang AE (1986) Frontal lobe dysfunction in Parkinson's disease: the cortical focus of neostriatal outflow. Brain 109: 845–883

    PubMed  Google Scholar 

  • Teravainen H, Calne DB (1980) Quantitative assessment of Parkinsonian deficits. In: Rinne UK, Klinger M, Stamm G (eds) Parkinson's disease-current progress, problems and management. Elsevier, Amsterdam, pp 145–164

    Google Scholar 

  • Tiffin J (1979) Purdue pegboard. Examiner manual. Lafayette Instruments Company, Reorder Nr. 7-435. Lafayette 2

    Google Scholar 

  • Velasco F, Velasco M (1973) A quantitative evaluation of the effects of L-Dopa on Parkinson's disease. Neuropharmacology 12: 89–99

    Article  PubMed  Google Scholar 

  • Ward CD, Sane JN, Dambrosia JM (1983) Methods for evaluating treatment in Parkinson's disease. In Fahn S, Calne DB, Shoulson I (eds) Advances in neurology, vol 37. Raven Press, New York, pp 1–7

    Google Scholar 

  • Webster DD (1968) Critical analysis of the disability in Parkinson's disease. Mod Treat 5: 257–282

    PubMed  Google Scholar 

  • Wiener Determinationsgerät. Schuhfried Ltd, Mödling, Austria

  • Yahr MD, Duvoisin RC, Schear MJ, Barrett RE, Hoehn MM (1969) Treatment of parkinsonism with levodopa. Arch Neurol 21: 343–354

    PubMed  Google Scholar 

  • Zerssen v D, Koeller DM, Rey ER (1970) Die Befindlichkeits-Skala. Ein einfaches Instrument zur Objektivierung von Befindlichkeitsstörungen, insbesondere im Rahmen von Längsschnittuntersuchungen. Arzneimittelforschung/Drug Res 20: 915–918

    Google Scholar 

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  1. H. Baas

    Present address: Department of Neurology, University of Frankfurt/Main, Schleusenweg 2-16, D-W-6000, Frankfurt/Main, Federal Republic of Germany

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  1. Department of Neurology, University of Frankfurt/Main, Schleusenweg 2-16, D-W-6000, Frankfurt/Main, Federal Republic of Germany

    K. Stecker & P. A. Fischer

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Baas, H., Stecker, K. & Fischer, P.A. Value and appropriate use of rating scales and apparative measurements in quantification of disability in Parkinson's disease. J Neural Transm Gen Sect 5, 45–61 (1993). https://doi.org/10.1007/BF02260914

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