Validation of a simple screening tool for early diagnosis of advanced Parkinson's disease in daily practice: the CDEPA questionnaire
Martinez-Martin P (1,2), Kulisevsky J (1,3), Mir P (1,4), Tolosa E (1,5), García-Delgado P (6), Luquin MR (7).
(1) Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
(2) National Center of Epidemiology, Carlos III Institute of Health, Madrid, Spain.
(3) Department of Neurology, Movement Disorders Unit, Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Universitat Oberta de Catalunya (UOC), Barcelona, Spain.
(4) Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
(5) Movement Disorders Unit, Department of Neurology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
(6) Grupo de Investigación en Atención Farmacéutica, Facultad de Farmacia, Universidad de Granada, Granada, Spain.
(7) Department of Neurology, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain.
Early clinical diagnosis of advanced Parkinson's disease (APD) may be difficult. This study aimed to validate a simple screening tool, the CDEPA questionnaire ("Cuestionario De Enfermedad de Parkinson Avanzada" [Questionnaire for Advanced Parkinson's Disease]), for the identification of APD in daily practice.
The study included 173 consecutively selected patients with PD (40% were women, mean age was 68.4 ± 10.5 years), stratified according to the Hoehn and Yahr (HY) scale.
The CDEPA questionnaire defined APD as the presence of severe disability requiring help for activities of daily living (ADL), motor fluctuations with limitation or inability to perform ADL, severe dysphagia, recurrent falls, or dementia.
The diagnostic performance of the questionnaire was assessed against the gold standard criterion based on clinical judgment. PD was categorized as advanced in 65 (38%) patients when using the gold standard and in 109 (63%) patients when the CDEPA questionnaire was used.
The CDEPA questionnaire and the gold standard agreed moderately (kappa statistic of 0.48, P < 0.001). The CDEPA classified APD with a sensitivity of 97%; specificity of 57%; total accuracy of 72.3%; and area under the curve (for a binary classifier) of 77.2%. Significant differences were found between the groups created by the CDEPA in several usual PD evaluations (HY Scale, SCOPA Motor Scale, Non-motor Symptoms Scale for PD, Clinical Impression of Severity Index for PD, Clinical Global Impression-Severity Scale, and Patient Global Impression-Severity Scale). CDEPA showed satisfactory inter-rater agreement (kappa = 0.88) and test-retest concordance (kappa 0.83).
In conclusion, the CDEPA questionnaire is a valid, reliable, and useful instrument for easily screening APD.
CITATION NPJ Parkinsons Dis. 2018 Jul 2;4:20. doi: 10.1038/s41531-018-0056-2. eCollection 2018.