This page contains a Flash digital edition of a book.
Activities of Daily Living Subscale for Early Parkinson’s Disease


Table 2: Activities of Daily Living Subscale in the Unified Parkinson’s Disease Rating Scale 01 2


3 Speech Salivation Swallowing Handwriting


Cutting food and handling utensils


Dressing Hygiene


Normal Mildly affected. No difficulty Moderately affected. being understood


Sometimes asked to repeat statements


Normal Slight but definite excess of saliva in mouth, may have night-time drooling


Normal Rare choking Normal Slightly slow or small


Normal Somewhat slow, but no help needed


Normal Somewhat slow, but no help needed


Normal Somewhat slow but no help required


Turning in bed and adjusting bed clothes


Falling Freezing when walking Walking Tremor Sensory complaints related to parkinsonism


Severely affected. Frequently asked to repeat statements


Moderately excessive saliva, Marked excess of saliva may have minimal drooling with some drooling


Occasional choking Requires soft food


Moderately slow or small, Severely affected, not all all words are legible Can cut most foods,


words are legible Food must be cut by


although clumsy and slow. someone else, can only May need some help


feed slowly Occasional assistance with Considerable help required, Helpless


buttoning and getting arms can only do a into sleeves


Help required to bath or shower. Very slow in hygienic care


Normal Somewhat slow and clumsy, Can turn alone or adjust but no help required


sheets, but with great difficulty


None None Rare falling Occasionally falls (less than once a day)


Rare freezing when walking, Occasional freezing may have start hesitation when walking


Normal Mild difficulty. May not swing arms, or may drag a leg


Absent Slight and infrequently present


None


Moderate difficulty, but requires no or little assistance


Moderate, bothersome to patient


tingling, or aching. Not distressing


few things alone


Requires assistance for washing, brushing teeth,


combing hair, and going to the bathroom


Can initiate, but not turn or adjust sheets alone


Helpless


Falls on average once daily Falls more often than once daily


Frequent freezing when walking. Occasionally falls from freezing


Frequent falls from freezing when walking


Severe disturbance of walking, Cannot walk at all, requires assistance


Severe, interferes with many activities


even with assistance


Marked, interferes with most activities


Occasionally has numbness, Frequently has numbness, Frequent painful sensations Excruciating pain tingling, or mild aching


Source: Movement Disorder Virtual University, 2008.72


Foley catheter or other mechanical aids


4


Unintelligible most of the time


Marked drooling, requires constant tissue or handkerchief


Requires nasogastric tube or gastrostomy feeding The majority of words are not legible Needs to be fed


than the UPDRS motor subscale.29


Furthermore, it has been suggested


that the UPDRS-ADL subscale is a better marker of disease progression and non-motor symptoms, less influenced by variability in drug cycle and motor fluctuations than subsections of other tests used in PD. Also, ADL subscales might be more sensitive to subtle functional changes affecting the patient (e.g., in hygiene, dressing, or eating) than motor subscales, which do not necessarily capture these changes.30,31


The UPDRS-ADL


subscale does not appear to be susceptible to placebo response, whereas a placebo response was observed with the UPDRS motor subscale.32


Indeed, the UPDRS-ADL subscale appears to be insensitive to the transient but objectively demonstrable motor changes that often occur in older subjects with higher motor impairment at baseline. Furthermore, the UPDRS-ADL subscale does not identify placebo-treated patients showing objectively defined improvement.32


In early PD, in the absence of overt motor symptoms, the analysis of non-motor symptoms is an important approach to detecting disease. There is, however, a lack of information available to help us understand


US NEUROLOGY


the relationship between different non-motor symptoms with a view to initiate earlier treatment for PD patients. The UPDRS-ADL subscale assesses motor and non-motor symptoms and, as such, may be more sensitive in detecting early disease, thus aiding diagnosis.


ADL questionnaires have also been used to assess pramipexole treatment: they showed that improvements were significantly greater with pramipexole treatment than with placebo, regardless of whether post-L-dopa rescue scores were included or not.36


In addition to the UPDRS-ADL subscale, there are various other ADL scales, which are less commonly used in clinical trials, including the Alzheimer’s Disease Cooperative Study-ADL scale (which includes 23 parameters), the Short Parkinson’s Evaluation Scale/Scales for Outcomes in Parkinson’s Disease, the Parkinson’s Disease Quality of Life Questionnaire, and the Parkinson’s Disease Activities of Daily Living Scale.33–35


In this article, the merits of the UPDRS and UPDRS-ADL subscale are discussed in the context of the beneficial effects of rasagiline (Azilect®,


93


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108