Parkinson Psychosis Rating Scale PPRS

♦ This is the first scale aimed only at measuring psychotic symptoms in PD, and it correlates with other, accepted scales for the measurement of psychosis.

♦ Patients are scored 1 (absent) to 4 (severe) on the following six items:

O Visual hallucinations. O Illusions and misidentification of persons. O Paranoid ideation. O Sleep disturbances. O Confusion. O Sexual preoccupation.

♦ In addition, a Global Functional Impairment score is measured from the carer report.

♦ Each severity term is described for each category of symptoms.

Strengths.

O It does not measure symptoms that may be confounded by the motor dysfunction in PD.

O It focuses on three symptoms that are the most common in PD drug-induced psychosis: visual hallucinations, paranoia, and sleep disturbances.

O A global scale for functional improvement is included which may be useful for measuring change over time.

O Agreement between neurology and psychiatry raters is high.

O There is no correlation between PPRS and MMSE scores, indicating that PPRS scores are not influenced by cognitive dysfunction.

Limitations.

O This test has been evaluated using only a small number of subjects.

O One item, sexual preoccupation, is extraneous and not of any value.

O Nonvisual hallucinations and nonparanoid delusions are not assessed.

O The test is administered to the patient and tire carer separately. No instructions are provided for scoring items where tire two sources are discrepant.

O The global assessment 'moderate' score means 'preoccupied/withdrawn/no motivation', which is frequently seen in nonpsychot-ic patients with PD, and is usually independent of psychosis.

O The category 'illusions and misidentification of persons' is usually seen in nonpsychotic patients with dementia, and is not a typical feature of psychosis in PD.

O The category 'sleep disturbances' does not capture the nature of the typical sleep problems of psychotic PD patients. They do not usually have nightmares, but rather have altered sleep cycles and tend to become paranoid at night.

Epworth Sleepiness Scale (ESS)

♦ This is a validated self-report measure of daytime sleepiness covering any designated time period (97). It can be used to assess an adult population and has been used in multiple disorders, including PD.

♦ It assesses the likelihood of falling asleep in eight situations common in developed countries (e.g. sitting and reading, watching TV, talking to another person, as a passenger in a car).

♦ Scoring on each item is 0 = would never doze; 1 = slight chance of dozing; 2 = moderate chance of dozing; 3 = high chance of dozing.

♦ Since sleepiness is highly variable and may be normal, the scale assesses sleepiness severity, not pathology. A score >6 is considered indicative of sleepiness; >10 is very sleepy; >16 is dangerously sleepy.

97 Epworth Sleepiness Scale. Different situations where drowsiness or falling asleep may occur are scored.

Epworth Sleepiness Scale (ESS)

Sitting and reading

0

2

3

Watching TV

0

2

3

Sitting inactive in a public place

0

2

3

Being a passenger in a motor vehicle for an hour or more

0

2

3

Lying down in the afternoon

0

2

3

Sitting and talking to someone

0

2

3

Sitting quietly after lunch (no alcohol)

0

2

3

Stopped for a few minutes in traffic while driving

0

2

3

Each is scored as:

0 = would never doze or sleep

1 = slight chance of dozing or sleeping

2 = moderate chance of dozing or sleeping

3 = high chance of dozing or sleeping

O The ESS is simple, easy to use and takes approximately 2 minutes to complete. O It can be self-administered, and questions can be answered by the patient or carer. O It is disease independent. O It discriminates sleepy from nonsleepy subjects.

O It is stable over time in healthy people. O It changes appropriately with treatment.

O One question is ambiguous concerning falling asleep at a red light (driver or not driver is not specified). O Duration of activities, such as reading and watching TV, is not specified and rapidity of sleep onset is not recorded (falling asleep within 2 minutes of sitting down is different to falling asleep after 30 minutes of reading). O The ESS score does not correlate with the multiple sleep latency test, an objective measure of sleepiness. O Sleepiness is a variable phenomenon (i.e. medication side-effects, time of day, night's rest), which is not captured by this measure.

Parkinson's Disease Sleep Scale (PDSS)

♦ This gives a visual analogue score for each of 15 features commonly associated with sleep disturbance in PD (98) (Chaudhuri et al., 2002). The patient is asked to rate each item based on their experience during the past week, by placing a cross at the appropriate point on the line.

O Overall quality of night's sleep (item 1). O Sleep onset and maintenance insomnia

(items 2 and 3). O Nocturnal restlessness (items 4 and 5). O Nocturnal psychosis (items 6 and 7). O Nocturia (items 8 and 9). O Nocturnal motor symptoms (items 10-13). O Sleep refreshment (item 14). O Daytime dozing (item 15).

O A simple tool for assessing sleep disturbance. O Sub-items can detect specific problems, e.g. bladder dysfunction.

O Zero represents the worse score (opposite to UPDRS scoring).

Parkinson's Disease Sleep Scale

1 The overall quality of your night's sleep is: AWFUL EXCELLENT

2 Do you have difficulty falling asleep at night? ALWAYS NEVER

3 Do you have difficulty staying asleep? ALWAYS NEVER

4 Do you have restlessness of legs or arms at night or in the evening, causing disruption of sleep?

ALWAYS

NEVER

5 Do you fidget in bed?

ALWAYS

NEVER

6 Do you suffer from distressing dreams at night? ALWAYS NEVER

7

Do you suffer from distressing hallucinations at night (seeing or hearing things that you are told do not exist)?

ALWAYS

NEVER

8

Do you get up at night to pass urine?

ALWAYS

NEVER

9

Do you have incontinence of urine because you are unable to move due to 'off' symptoms?

ALWAYS

NEVER

10

Do you experience numbness or tingling of your arms or legs which wakes you from sleep at night?

ALWAYS

NEVER

11

Do you have painful muscle cramps of your arms or legs whilst sleeping at night?

ALWAYS

NEVER

12

Do you wake early in the morning with painful posturing of arms or legs?

ALWAYS

NEVER

13

On waking, do you experience tremor?

ALWAYS

NEVER

14 Do you feel tired and sleepy after waking in the morning?

ALWAYS

NEVER

14 Do you feel tired and sleepy after waking in the morning?

ALWAYS

NEVER

15 Have you unexpectedly fallen asleep during the day?

FREQUENTLY

NEVER

98 Parkinson's Disease Sleep Scale.The patient places a cross on each line in response to the question:'How would you rate the following, based on your experience in the past week?'.The position on the visual analogue score is converted into a numerical score.

Parkinson's Disease Questionnaire (PDQ-39)

Due to having Parkinson's Disease, how often during the last month have you...

MOBILITY *

0

I

2

3

4

1 Had difficulty doing the leisure activities you would like to do?

2 Had difficulty looking after your home, for example, housework, cooking or gardening?

3 Had difficulty carrying shopping bags?

4 Had problems walking half a mile?

5 Had problems walking 100 yards (approximately one block)?

6 Had problems getting around the house as easily as you would like?

7 Had difficulty getting around in public places?

8 Needed someone else to accompany you when you went out?

9 Felt frightened or worried about falling in public?

10 Been confined to the house more than you would like?

ACTIVITIES OF DAILY LIVING *

0

I

2

3

4

11 Had difficulty washing yourself?

12 Had difficulty dressing yourself?

13 Had problems doing up buttons or shoe laces?

14 Had problems writing clearly?

15 Had difficulty cutting up your food?

16 Had difficulty holding a drink without spilling it?

EMOTIONAL WELL-BEING *

0

I

2

3

4

17 Felt depressed?

18 Felt isolated and lonely?

19 Felt weepy or tearful?

20 Felt angry or bitter?

21 Felt anxious?

22 Felt worried about the future?

STIGMA *

0

I

2

3

4

23 Felt you had to hide your Parkinson's from people?

24 Avoided situations that involved eating or drinking in public?

25 Felt embarrassed in public?

26 Felt worried about other people's reaction to you?

SOCIAL SUPPORT *

0

I

2

3

4

27 Had problems with close personal relationships?

28 Felt you lacked the support you needed from your spouse or partner?

29 Felt you lacked the support you needed from your family or close friends?

PDQ-39 continued

COGNITION *

0

1

2

3

4

30 Unexpectedly fallen asleep during the day?

31 Had problems with your concentration, for example, when reading or watching TV?

32 Felt your memory was failing?

33 Had distressing dreams or hallucinations?

COMMUNICATION *

0

1

2

3

4

34 Had difficulty speaking?

35 Felt unable to communicate effectively?

36 Felt ignored by people?

BODILY DISCOMFORT *

0

1

2

3

4

37 Had painful muscles cramps or spasms?

38 Had aches and pains in your joints or body?

39 Felt uncomfortably hot or cold?

0 = never; 1 = occasionally; 2 = sometimes; 3 = often; 4 = always / unable to do at all * These headings allow calculation of sub-domains but are not shown to patients

0 = never; 1 = occasionally; 2 = sometimes; 3 = often; 4 = always / unable to do at all * These headings allow calculation of sub-domains but are not shown to patients

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