Measuring quality of life with the Parkinson's Disease Questionnaire-39 in people with cognitive impairment

Abstract

Introduction Quality of life (QoL) is a key outcome in healthcare. However, whether cognitively impaired people with Parkinson's disease (PD) can reliably self-report QoL is unclear, and patients are often excluded from studies based on cognition test scores. The aim of this analysis was to assess the validity of the Parkinson's Disease Questionnaire-39 (PDQ-39) in PD patients with and without cognitive impairment. Methods In this study, 221 individuals with PD completed the PDQ-39, Montreal Cognitive Assessment (MOCA), and Beck's Depression Inventory (BDI-II). The PDQ-39's internal consistency, convergent validity with BDI-II, and floor and ceiling effects were analyzed for patients with and without cognitive impairment. Results Ninety-four patients showed cognitive impairment (MOCA <21), whereas 127 patients had mild/no impairment. Both MOCA groups differed significantly with regards to PD severity. The PDQ-39's internal consistency was adequate for most subdomains in both MOCA groups, but floor effects were present for the subdomains Stigmatization, Social Support and Communication, regardless of impairment. For some subdomains, the PDQ-39's convergent validity with the BDI receded in the low MOCA group but remained significant for most PDQ-39 domains, especially for the PDQ total score (r = .386, p < .001) and for the subdomain emotional well-being (r = .446, p < .001). Conclusion The PDQ-39 can be used to measure QoL in cognitively impaired PD patients, thus test scores indicating cognitive impairment alone should not lead to exclusion of PD patients from clinical studies. Although the correlation between BDI-II and PDQ-39 shrinks for some subdomains in cognitively impairment patients, this finding may be explained by the difference in PD severity, as factors influencing QoL may shift with increasing age and PD symptoms.