Ucb S.a. · EURONEXT:UCB
Ucb — Technical Presentation (2009)
24 slides from Ucb's technical presentation, 2009
Slide 1: Assessment of patients with PD in clinical practice and research
Assessment of patients with PD in clinical practice and research Richard Brown London, UK 1
Slide 2: Reasons for assessment
Reasons for assessment • Screening S i • Aid to diagnosis • Quantifying symptom severity • Measuring change • Describing symptom profile Key features of measures will differ depending on the purpose of the assessment 2
Slide 3: How to choose a measure
How to choose a measure • Was the test designed to measure what you want to assess? • Does it have acceptable reliability and validity? – based on published evidence • Has it been validated in Parkinson’s disease and/or Parkinson’s disease with dementia (PD/PD-D)? • Are there appropriate norms and c
Slide 4: Cognitive assessment: recommendations
Cognitive assessment: recommendations • Brief screening g ((alternative to Mini Mental State Exam,, MMSE)) – Montreal Cognitive Assessment (MoCA) • Screening g and diagnosis, g , assessment of severity y and profile, p , assessing change, comparison between disorders – Addenbrooke’s Cognitive Exam (
Slide 5: Montreal Cognitive Assessment (MoCA)
Montreal Cognitive Assessment (MoCA) • Administration Time 10 minutes • Maximum Score 30 • Cognitive Domains 1 – Includes items of executive function (trail making, abstraction and phonemic fluency) • Screening cut-off ≤25 (NB: based on Alzheimer’s disease/mild cognitive impairment) • Alternate form
Slide 6: Addenbrooke's Cognitive Examination (ACE-R)
Addenbrooke’s Cognitive Examination (ACE-R) • Administration Time 15–20 15 20 minutes • Maximum Score 100 • Cognitive Domains 6 – Attention/Orientation / ((18)) – Memory (26) – Verbal fluency (14) – Language (26) – Visuospatial (16) • Screening cut-off ≤831 • Alternate forms No • Validated in PD/PD-
Slide 7: Dementia Rating Scale (DRS)
Dementia Rating Scale (DRS) • Administration Time 15 30 minutes 15–30 • Maximum Score 144 • Cognitive Domains 5 – Attention (37) ( ) – Initiation and Perseveration (37) – Construction (6) – Conceptualization (39) – Memory (25) • Population norms Yes • Screening cut-off ≤123 (screening)1 • Alternate
Slide 8: Parkinson's Disease Cognitive Rating Scale (PD-CRS)
Parkinson’s Disease Cognitive Rating Scale (PD-CRS) • Administration Time 15 30 minutes 15–30 • Maximum Score 134 • Cognitive Domains 2 – ‘Cortical’ ((20)) ((naming, g, clock drawing g copy) py) – ‘Subcortical’ (114) (free recall imm. & del., sustained attention, clock drawing, working memory, fluen
Slide 9: Scale for Outcomes of Parkinson's disease – Cognitive (SCOPA-COG)
Scale for Outcomes of Parkinson’s disease – Cognitive (SCOPA-COG) • Administration Time 10–20 10 20 minutes • Maximum Score 43 • Cognitive Domains 4 – Memoryy (22) ( ) – Attention (4) – Executive (12) – Visuospatial (5) • Population norms No • Screening/diagnosis cut-offs N/A • Alternate forms No •
Slide 10: Neuropsychiatry/general screening
Neuropsychiatry/general screening • Wide range of psychiatric and behavioural symptoms in PD/PD-D yet no comprehensive measurement tool exists • We can assess psychiatric and behavioural problems as part of b oade sc broader screening eening fo for non-motor non moto symptoms s mptoms in PD • Advant
Slide 11: MDS-UPDRS (Part 1) (non-Motor Aspects of Experiences of Daily Living)
MDS-UPDRS (Part 1) (non-Motor Aspects of Experiences of Daily Living Living, nM-EDL) • New Part 1 to MDS MDS-UPDRS UPDRS • Screening, single item • ‘Non-Motor Aspects of Experiences of Daily Living’ • Both clinician rated and self self-completed completed questions • Standard UPDRS 0–4 severity rati
Slide 12: Non-Motor Symptom Questionnaire
Non-Motor Symptom Questionnaire • Self/carer completed • Simple ‘yes/no’ answers • Can be completed while waiting for consultation • Can form focus for discussion • Can guide follow-up assessment www.pdnmg.com/tools/nms-quest.pdf 12
Slide 13: Non-Motor Symptoms Scale (NMSS)
Non-Motor Symptoms Scale (NMSS) • Quantitative instrument • Assesses global NMSS severity • Clinician rated • Assesses frequency and severity of symptoms • 9 domains including – Sleep/fatigue – Mood/cognition – Perception/ hallucinations – Attention/memory – Sexual function www.pdnmg.com/tools/nms-s
Slide 14: Neuropsychiatric Inventory (NPI)
Neuropsychiatric Inventory (NPI) • Widely used clinically and in research including PD/PD-D PD/PD D • Clinician rated – based on interview with informant (typically carer; also version for formal care settings) • Screening S i questions i + follow-up f ll • Assesses presence/absence, frequency and s
Slide 15: NPI-Questionnaire (NPI-Q)
NPI-Questionnaire (NPI-Q) • Brief questionnaire version of full NPI • Completed by informant • Same domains as NPI • Assesses presence/absence, frequency and severity of symptoms + carer distress • Published validation studies in English, English Dutch, Dutch Spanish, Spanish Russian, Japanese • Onl
Slide 16: Scale for Outcomes of Parkinson's disease – Psychiatric Complications (SCOPA-PC)
Scale for Outcomes of Parkinson’s disease – Psychiatric Complications (SCOPA-PC) • Brief clinical interview • Simple 0–3 ratings severity rating • 7 problem areas – Hallucinations – Illusions and misidentifications – Paranoid ideation – Altered dream phenomena/REM sleep behaviour disorder (RBD) – Co
Slide 17: Individual symptoms
Individual symptoms • Multiple M lti l symptom-specific t ifi measures • Most developed for non-PD and non-neurological populations • Most involve self self-report report • Validity and reliability should not be assumed for PD, especially for patients with dementia • Conventional cut-offs for non-PD
Slide 18: Depression, anxiety, sleep and arousal
Depression, anxiety, sleep and arousal • Depression D i 1 – Beck Depression Inventory (BDI/BDI-II) – Geriatric Depression Scale (GDS) – Hospital Anxiety and Depression Scale (HADS) • Anxiety2 – Hospital Anxiety and Depression Scale (HADS) • Sleep and arousal – Parkinson’s Disease Sleepp Scale (PDSS)
Slide 19: Psychosis, neurocognitive and Impulse Control Disorder (ICD)
Psychosis, neurocognitive and Impulse Control Disorder (ICD) • Delusions and hallucinations1 – Neuropsychiatric Inventory (NPI) – Parkinson Psychosis Questionnaire (PPQ) • Neurocognitive2 – Apathy Scale (AS) – Frontal Systems Behaviour Scale (FrSBe) • ICD – South Oaks Gambling Screen (SOGS) – Compul
Slide 20: References: Cognitive assessment
References: Cognitive assessment MMSE/sMMSE: Folstein MF, Folstein SE, McHugh. ‘Mini-mental state’. A practical method for grading of cognitive state of patients for the clinician. J Psychiat Res 1975;12:189–198 M ll Malloy DW DW, StStandish di h TI TI. A guide id to t the th standardized t d di d M
Slide 21: Question 1. For an INITIAL assessment of a patient's cognitive function
Question 1. For an INITIAL assessment of a patient’s cognitive function, which, if any, of the tools listed b l below would ld you use? A) MoCA IIncorrect. t Whil While thithis assessment tool can B) MMSE be used,This Incorrect. Correct. it isbrief not is tool Incorrect. This tool is sensitive scree
Slide 22: Question 2. To assess a patient's psychiatric function
Question 2. To assess a patient's psychiatric function, which if any, which, any of the tools listed below would you use? A) NPI Correct. This tool can B) SCOPA-PC be used toThis Correct. assess tool the is Correct. This tool is non-motor widely usedsymptoms Incorrect. to assess This brief widely In
Slide 23: References: Psychiatric assessment
References: Psychiatric assessment nM-EDL: Link: www.movementdisorders.org/UserFiles/New%20UPDRS%207%203%2008%20final.pdf NMSQuest: Chaudhuri KR, Martinez-Martin P, Schapira AHV and the PDNMG. International multicentre pilot study of the first comprehensive h i self-completed lf l t d Non N Motor M
Slide 24: References: Psychiatric assessment
References: Psychiatric assessment PDSS: Chaudhuri KR,Pal S,Dimarco A, et al. The Parkinson's disease sleep scale: a new instrument for assessing sleep and nocturnal disability in Parkinson's disease. J Neurol Neurosurg Psychiatry 2002; 73: 629–635 Martinez-Martin P, Visser M, Rodriguez-Blazquez C,