2nd World Parkinson Congress Abstracts

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studies. Acknowledgements: Funding for this project was provided by the. Davis Phinney Foundation, the Parkinson Disease Foundation and. NIH K12 Building ...

WPC 2010 ABSTRACTS friendly technologies with precise measurements that can be implemented in clinical and research context by clinicians and rehabilitation professionals, allowing them to understand human motion during daily living activities. Methods: Our research group is working on a project focused on the development of different devices oriented to the identification and characterization of motor patterns concerning balance control and gait as well as upper limb dysfunction. Hence, developing new forms of analysis (non linear analysis) that might capture, in a better way, the dynamic of Parkinson Disease patient movements. Expected Results and Conclusion: Implementation of a new evaluation tool that allows us to assess human motor control in an improved, easy and precise structure. P21.05 Reliability and Validity of the Ambulatory Self Confidence Questionnaire in People with Parkinson’s Disease S.G. Brauer,1 R.M. Lamont,1 M.E. Morris,2 M.H. Woollacott3 (1The University of Queensland, Australia; 2The University of Melbourne, Australia; 3The University of Oregon, United States) Background: People with Parkinson Disease (PD) often demonstrate a deterioration in walking, such as reduced step length, speed and difficulty dual tasking. It is known that people with PD have low balance confidence and are often fearful of falling. A new measure of self-confidence when walking has been developed [1], which may be more applicable than balance confidence in people with PD. Aim: This study aimed to investigate whether ambulatory self confidence was related to personal characteristics, and whether this tool demonstrated test-retest reliability, concurrent and construct validity in people with PD. Methods: Twenty-eight people with PD attended two sessions one week apart where they rated their confidence (0, not at all confident; 10, extremely confident) when undertaking 22 walking tasks such as walking on a ramp, uneven sidewalk, or in the dark. Personal factors including age, disease duration, severity and falls history were recorded. Walking performance (speed and step length) was recorded using a 6m GAITrite system when walking at a comfortable pace, and when concurrently dual tasking with word finding or calculation tasks. Results: This cohort of people with PD reported quite high confidence when walking (mean 8.161.5 / 10), ranging from 4.5-10. Despite this, the ambulatory self confidence questionnaire was significantly (p0.499) and gait speed (r >0.411) under both single and dual task conditions. Conclusion: People with PD can demonstrate reduced confidence when walking under challenging conditions. This is more apparent in people who are older and have some indicators of greater severity, including walking at a slower speed with shorter steps. The ambulatory self-confidence questionnaire shows test-retest reliability and validity and could be used in people with PD. [1] Asano et al 2007. Gerontology. 53:373-81. P21.06 Use of Proxies to Measure Disability in Persons with Parkinson’s Disease M.A. Van der Marck, B. Post, L. Laverman, B.R. Bloem, M. Munneke (Radboud University Nijmegen Medical Centre, The Netherlands) Background Problems with self-report may arise when patients are unable to complete questionnaires, e.g. due to cognitive impairment or disability. Significant others may serve as alternative sources to obtain information. The reliance on the input of these others


depends on the quality of the information they provide. Hence, the agreement between answers of patients and proxies need to be determined. Objective: To explore the reliability of proxy evaluation of patients’ disability, using the AMC-Linear Disability Scale (ALDS) in patients with Parkinson’s disease (PD) and their caregivers. Methods: We used a generic disability rating scale with 30 activities of daily living. For each activity, three answers were analyzed: (1) not able to perform activity, (2) able to perform the activity, but with effort or (3) able to complete the activity. Patients self-evaluated the questionnaire and caregivers completed the proxy form. Answers were compared to determine agreement. Results: In total, 146 patient-proxy pairs participated. The patient group consisted of 95 men and 51 women, mean age 67.7 yrs (4280). Proxies (52 man, 94 women; mean age 66.7 yrs (42-83)) were living with the patient and were all spouses, except for one daughter. Overall, there was a mean agreement of 80,3% (range 64.8 – 93.8% on separate activities). Of the remaining answers (19,7%), half of the proxies rated disability lower than patients did, whereas the other half of the proxies rated patients disability higher. Pairs mainly disagreed on the following activities: ‘carry a tray’, ‘fill in an official form’ and ‘write a letter’. The highest agreement was seen for the activities ‘make coffee or tea’ and ‘answer the telephone’. Conclusion: Caregiver reports of PD patients disability showed a substantial agreement to patients own reports. Hence, proxy responses may be a reasonable source to obtain information when patients are not able to provide these data.

P21.07 Relation Between Hoehn and Yahr Staging Scale and Postural Behavior in Parkinson’s Disease: A Dynamic Post-Urography Study C. Godinho,1 F. Melo,2 V. Ferret-Sena,1 M. Dias,2 A. Calado,2 C. Semedo,2 J.M.M. Domingos,2 O. Fernandes2 (1Cooperativa de Ensino Superior Egas Moniz, Portugal; 2Portugal) Background: The Hoehn and Yahr staging scale (HY) has been primary used in research settings for defining inclusion/exclusion criteria in Parkinson’s disease (PD). The HY scale is highly correlated to some standardized scales of motor impairment, disability, and quality of life. Nevertheless its association with posturographic studies is not well known. Objective: The main objective of the present study was to identify if there is a correlation between the HY scale and postural behavior in PD, that would allow us to better distinguish between stage 2 and stage 3 (the more controverse). Methods: The present study outlines a transversal study in 76 individuals with idiopathic PD, 33 women and 43 men, between 44 and 85 years old (mean-age of 70 years in both groups). The participants were recruited from a central hospital in Lisbon and classified by 3 neurologist specialists in two different groups: group one (37 individuals in stage 2 HY) and group two (39 individuals in stage 3 HY). The inclusion criteria to be met were: suitable medically stable candidates followed by the PD neurologists specialists, no significant cognitive or orthopaedic impairments and ability of undertaking motor function tests on a force platform. A written consent form was obtained from all participants before evaluations and the study was approved by the hospital’s Ethic Committee. Postural behaviour was quantitatively evaluated on a force platform using four functional tests: modified Clinical Test of Sensory Interaction on Balance; Limits of Stability test, Sit to Stand test, and Walk Across test. All patients were tested during the period of presumed best drug effects. Results: The statistical results based on a linear analysis evaluation showed no differences between groups in all the 4 four tests applied. These results do not permit to establish correlation between the HY staging and the postural behavior alterations observed in these patients. Conclusions: This study looked to provide preliminary information in support of a future innovating evaluation of disease progres-

Movement Disorders, Vol. 25, Suppl. 3, 2010



sion in PD. However, future evaluation of nonlinear dynamics is needed in order to allow us to obtain information that may orientate multidisciplinary approaches with objective measures for functional training of balance and motor control. April 2010 Keywords: Parkinson’s Disease, Hoehn and Yahr scale; postural instability, posturography, balance. P21.08 Expression of Psychotic Symptoms in Parkinson’s Disease as Assessed by the Scale for the Assessment of Positive Symptoms (SAPS) H. Williams, D. Bahr, P. Peters, R. Mills (United States) Background: The SAPS is a recommended scale for the assessment of psychosis in Parkinson’s disease as reported by an MDS Task Force. The SAPS was originally developed and validated for schizophrenia and comprises 5 domains (hallucinations, delusions, bizarre behavior, positive formal thought disorder, and inappropriate affect). The scale has been used in clinical studies of clozapine and pimavanserin in PDP. Previous validation analyses have been reported (Ravina et al., 2008 and Mills et al., 2008) which show the SAPS scale to be a responsive measure of treatment effect in PDP, a condition characterized predominantly by hallucinations and delusions. In addition, a previous factor analysis of the H1D domains in a 60-patient sample (Bahr et al, 2009), suggested that only part of the scale (8 of 20 items measured) were relevant in this population. The current analysis was conducted using baseline pre-treatment SAPS H1D data from a Phase III international study of pimavanserin in 298 patients with PDP. Objective: This analysis examined the clinical expression of psychotic symptoms in 298 patients with Parkinson’s disease psychosis (PDP) using the Hallucinations and Delusions (H1D) domains of the SAPS. Methods: Principle components and factor analyses with orthogonal (varimax) rotation were performed to evaluate the factor structure of the SAPS H1D domains (20 items) in the PDP population. Items with a low incidence of moderate to severe ratings (