Identification of Daily Activity Impairments in the Diagnosis of Parkinson Disease Dementia.

OBJECTIVE: We studied activities of daily living (ADL) in Parkinson disease (PD) to identify the cognitive ADL impairments that could differentiate patients with PD dementia from those without dementia.

BACKGROUND: Most people with PD have impairments in their ADL, making it difficult to distinguish between those caused by cognitive or motor dysfunction.

METHODS: We evaluated 24 patients with PD dementia and 48 with PD without dementia. For comparison, we evaluated 24 patients with Alzheimer disease and 25 healthy control participants. Caregivers completed the instrumental ADL scale, allowing us to examine participants' actual activity (actual score) and cognitive ability to perform certain ADL (cognitive score).

RESULTS: The nondemented patients with PD had better actual scores than those with dementia. The patients with PD dementia had significantly worse cognitive scores for keeping appointments and for talking about recent events, followed by managing money, using a telephone, and cooking. A comparison of the actual and cognitive scores revealed significant differences between the two PD groups, suggesting the physical impact of PD on certain ADL. Factor analysis confirmed that ADL items could be separated into cognitive and physical components.

CONCLUSIONS: Although most patients with PD had difficulties in ADL, we identified specific cognitive ADL items that could help in differentiating patients with and without dementia.