Assessment of Affective-Behavioral States in Parkinson’s Disease Patients: Towards a New Screening Tool

Article type: Research Article

Authors: Schedlich-Teufer, Charlotte^{a; *; 1} | Jost, Stefanie Theresa^{a; 1} | Krack, Paul^b | Witt, Karsten^{c; d} | Weintraub, Daniel^{e; f; g} | Baldermann, Juan Carlos^{a; h} | Sommerauer, Michael^a | Amstutz, Deborah^b | van Eimeren, Thilo^{a; i; j} | Dafsari, Haidar Salimi^a | Kalbe, Elke^k | Visser-Vandewalle, Veerle^l | Fink, Gereon Rudolf^{a; m} | Kessler, Josef^a | Barbe, Michael Thomas^a

Affiliations: [a] Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany | [b] Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland | [c] Department of Neurology, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany | [d] Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany | [e] Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA | [f] Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA | [g] Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA | [h] Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany | [i] Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany | [j] German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany | [k] Department of Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany | [l] Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany | [m] Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany

Correspondence: [*] Correspondence to: Charlotte Schedlich-Teufer, Department of Neurology, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany. Tel.: +49 221 478 7494; Fax: +49 221 478 89013; E-mail: charlotte.schedlich-teufer1@uk-koeln.de.

Note: [1] These authors contributed equally to this work.

Abstract: Background:Assessment of affective-behavioral states in patients with Parkinson’s disease (PD) undergoing deep brain stimulation (DBS) is essential. Objective:To analyze well-established questionnaires as a pilot-study with the long term aim to develop a screening tool evaluating affective-behavioral dysfunction, including depression, anxiety, apathy, mania, and impulse control disorders, in PD patients screened for DBS. Methods:Two hundred ninety-seven inpatients with PD underwent standardized neuropsychiatric testing including German versions of Beck Depression Inventory-II, Hospital Anxiety and Depression Scale, Apathy Evaluation Scale, Self-Report Manic Inventory, and Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale, to assess appropriateness for DBS. Statistical item reduction was based on exploratory factor analysis, Cronbach’s alpha, item-total correlations, item difficulty, and inter-item correlations. Confirmatory factor analysis was conducted to assess factorial validity. An expert rating was performed to identify clinically relevant items in the context of PD and DBS, to maintain content validity. We compared the shortened subscales with the original questionnaires using correlations. To determine cutoff points, receiver operating characteristics analysis was performed. Results:The items of the initial questionnaires were reduced from 129 to 38 items. Results of confirmatory factor analyses supported the validity of the shortened pool. It demonstrated high internal consistency (Cronbach’s alpha = 0.72–0.83 across subscales), and the individual subscales were correlated with the corresponding original scales (rs = 0.84–0.95). Sensitivities and specificities exceeded 0.7. Conclusion:The shortened item pool, including 38 items, provides a good basis for the development of a screening tool, capturing affective-behavioral symptoms in PD patients before DBS implantation. Confirmation of the validity of such a screening tool in an independent sample of PD patients is warranted.

Keywords: Parkinson’s disease, deep brain stimulation, screening tool, questionnaire, depression, anxiety, apathy, mania, impulse control disorders, hallucinations

DOI: 10.3233/JPD-202375

Journal: Journal of Parkinson's Disease, vol. 11, no. 3, pp. 1417-1430, 2021