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Determinants of disability and quality of life in mild to moderate Parkinson disease

D. Muslimovi, MSc, B. Post, MD, J. D. Speelman, MD, PhD, B. Schmand, PhD, R. J. de Haan, PhD For the CARPA Study Group

From the Departments of Neurology (D.M., B.P., J.D.S., B.S.) and Clinical Epidemiology and Biostatistics (R.J.d.H.), Academic Medical Centre, and Department of Psychonomics (B.S.), University of Amsterdam, The Netherlands.

Address correspondence and reprint requests to Dr. D. Muslimovic or Dr. B. Post, AMC Neurology, H2-222, PO Box 22660, 1100 DD Amsterdam, The Netherlands d.muslimovic{at}amc.uva.nl or b.post{at}amc.uva.nl

Objective: To identify factors that independently contribute to disability and quality of life (QoL) in patients with mild to moderate Parkinson disease (PD).

Methods: A group of 190 patients with PD recruited from outpatient clinics and the Dutch Parkinson’s Disease Association participated in this cross-sectional study. Data on demographic and clinical factors, motor symptoms, cognitive functions, affective symptoms, comorbidity, and social support were collected during neurologic and neuropsychological examinations. Disability was rated using the Schwab and England Activities of Daily Living Scale (SE-ADL), the AMC Linear Disability Score (ALDS), and the Functional Independence Measure (FIM). QoL was assessed with the Parkinson’s Disease Quality of Life questionnaire (PDQL) and the Medical Outcome Study Short Form (SF-36). Multiple linear regression analyses were conducted to identify determinants of disability and poor QoL.

Results: Axial impairment (postural instability and gait difficulty) explained the largest proportion of variance in disability. Bradykinesia and comorbidity contributed to disability, but to a lesser extent. Self-reported mood symptoms and axial impairment were the two factors most closely associated with poorer QoL, but comorbidity and bradykinesia additionally contributed to the explanatory power. Semantic fluency and psychomotor skills were the only cognitive variables related to some aspects of functional outcome.

Conclusion: Axial impairment is strongly associated with disability in patients with mild to moderate Parkinson disease (PD). Self-report indices of mood status and axial impairment are identified as the main determinants of poor quality of life (QoL). The results of this study may help to identify patients with PD at risk for functional dependence and reduced QoL.

Abbreviations: ALDS = AMC Linear Disability Score; CIRS = Cumulative Illness Rating Scale; COWAT = Controlled Oral Word Association Test; DART = National Adult Reading Test, Dutch version; FIM = Functional Independence Measure; GIT = Groningen Intelligence Test; HADS = Hospital Anxiety and Depression Scale; IADL = instrumental activities of daily living; JOLO = Judgment of Line Orientation; LED = levodopa equivalent dose; MMSE = Mini-Mental State Examination; PD = Parkinson disease; PDQL = Parkinson’s Disease Quality of Life questionnaire; PIGD = postural instability and gait difficulty; QoL = quality of life; RAVLT = Rey Auditory Verbal Learning Test; RBMT = Rivermead Behavioural Memory Test; SE-ADL = Schwab and England Activities of Daily Living Scale; SF-36 = Medical Outcome Study Short Form; UPDRS = Unified Parkinson’s Disease Rating Scale; WAIS = Wechsler Adult Intelligence Scale; WCST = Wisconsin Card Sorting Test; WMS = Wechsler Memory Scale.

Supplemental data at www.neurology.org

*These authors contributed equally.

Funded by the Prinses Beatrix Fonds (Grant PGO 01-0138 to B. Schmand). B. Post, J.D. Speelman, and R.J. de Haan are members of the Co-morbidity and Ageing in Rehabilitation Patients; The influence on Activities (CARPA) study group. The CARPA study group is supported by a grant from ZonMw, The Hague, The Netherlands.

Disclosure: The authors report no disclosures.

Received December 17, 2007. Accepted in final form February 29, 2008.

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