[Guidelines for the Neuropsychological Assessment of Patients with Parkinson's Disease]. / Empfehlungen zur neuropsychologischen Diagnostik beim Morbus Parkinson.

BACKGROUND: Presence of mild cognitive impairment is currently the best predictor for the development of Parkinson's disease dementia. Diagnostic criteria for both Parkinson's with mild cognitive impairment and Parkinson's disease dementia have been suggested by the Movement Disorder Society. However, not all cognitive tests recommended are available in the German language with proper standard values. OBJECTIVES: To define evidence-based guidelines for neuropsychological assessment of patients with Parkinson's disease in German. METHODS: Two systematic literature searches were conducted. First, articles that presented international guidelines (consensus papers or reviews) for the application of standardized neuropsychological assessments for the diagnosis of cognitive impairment in Parkinson's disease were selected. Of those, only neuropsychological assessments in German language with normative values referring either to a German, Austrian, or Swiss population were considered. Second, articles comparing test performances of healthy controls vs. Parkinson's disease and/or different cognitive Parkinson's disease subtypes (e.g. no cognitive impairment, Parkinson's with mild cognitive impairment, Parkinson's disease dementia) were selected. Effect sizes for group differentiation were calculated. RESULTS: Out of 127 full-text articles reviewed, 48 tests were identified during the first literature search. In the second search, 1716 articles were reviewed and 23 papers selected. The strongest effect sizes for group discrimination were revealed for tests assessing executive function, attention, and visuo-cognitive abilities. Based on the results of the two literature searches, consensus guidelines were defined by the authors, allowing for Level-II diagnosis for Parkinson's with mild cognitive impairment and Parkinson's disease dementia. CONCLUSIONS: The presented guidelines may have the potential to standardize and improve the neuropsychological assessment of Parkinson's disease patients in German speaking countries.

Reliability, validity and responsiveness of the German Manchester-Oxford Foot Questionnaire (MOXFQ) in patients with foot or ankle surgery.

BACKGROUND: Patient-reported outcome measures are a critical tool in evaluating the efficacy of orthopaedic procedures. The intention of this study was to develop and culturally adapt a German version of the Manchester-Oxford Foot Questionnaire (MOXFQ) and to evaluate reliability, validity and responsiveness. METHODS: According to guidelines forward and backward translation has been performed. The German MOXFQ was investigated in 177 consecutive patients before and 6 months after foot or ankle surgery. All patients completed MOXFQ, Foot and Ankle Outcome Score (FAOS), Short form 36 and numeric scales for pain and disability (NRS). Test-Retest reliability, internal consistency, floor and ceiling effects, construct validity and minimal important change were analyzed. RESULTS: The German MOXFQ demonstrated excellent test-retest reliability with ICC values >0.9 Cronbach's alpha (α) values demonstrated strong internal consistency. No floor or ceiling effects were observed. As hypothesized MOXFQ subscales correlated strongly with corresponding FAOS and SF-36 domains. All subscales showed excellent (ES/SRM >0.8) responsiveness between preoperative assessment and postoperative follow-up. CONCLUSIONS: The German version of the MOXFQ demonstrated good psychometric properties. It proofed to be a valid and reliable instrument for use in foot and ankle patients.

Factor structure, normative data and retest-reliability of a test of fine motor functions in patients with idiopathic Parkinson's disease.

The purpose of this study was to measure the stability of motor functions in patients with idiopathic Parkinson's disease (IPD). A test of fine motor skills was developed that allow objective repeated measures of momentary capability among this group of patients. The study included 114 right-handed IPD-patients (mean age: 67.0+/-9.4 years, mean duration of the disease: 6.1+/-4.9 years). Patients with dementia, pharmacogenic psychiatric side-effects, other neurological diseases and tremor-type IPD were excluded. All patients were tested with an apparative motor performance test ('Motorische Leistungsserie nach Schoppe') and 24 hr later, again with the identical test. The patients (all properly adjusted to medication) were receiving different drug combinations; there was no change in the medication between tests for patients included in the analysis. Seven factors were extracted: 'finger-tapping speed,' 'speeded manual dexterity,' 'speeded finger dexterity,' 'movement planning,' 'complex movement: right,' 'complex movement: left,' and 'steadiness.' The subtests proved to have acceptable test-retest reliability. It is thus possible to produce objective, statistically sound data which enable a confirmation of improvement via medication or of the illness' progression. The presentation of normative data permits intra- and inter-individual interpretations of a single patient's performance. In addition, the patients' performance can also be compared with that of healthy controls in similar age groups (cf. data in the literature).