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Application of the p9NORM correction method to timed neuropsychological tests in Parkinson’s disease and multiple system atrophy

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Abstract

Objective

Timed neuropsychological tests do not take into account physical impairment during scoring procedures. Dysarthria and upper limb impairment can be easily measured with the PATA rate test (PRT) and the nine-hole pegboard test (9HPT). We recently validated a normalization method for timed neuropsychological tests using the PRT and 9HPT (p9NORM). We now validate the p9NORM in Parkinson’s disease (Yarnall et al. Neurology 82(4):308–316; 2014) and multiple system atrophy (MSA).

Methods

We enrolled twenty-six patients with PD, eighteen patients with MSA, and fifteen healthy controls (HC). p9NORM was applied to patients with abnormal PRT and/or 9HPT. All subjects were tested with a comprehensive neuropsychological battery.

Results

No differences emerged in demographics across groups: (PD: mean age ± SD 66 ± 8; education 9 ± 4 years; MSA: age 60 ± 8; education 10 ± 4 years; HC: age 61 ± 12; education 9 ± 4 years). In MSA patients, the scores on the trail making test (TMT-A p = 0.003; TMT-B p = 0.018), attentional matrices (AM; p = 0.042), and symbol digit modalities test (SDMT p = 0.027) significantly differed following application of p9NORM. In PD patients, the TMT-A (p < 0.001), TMT-B (p = 0.001), and AM (p = 0.001) differed after correction. PD and MSA showed cognitive impairment relative to HC performance. When comparing MSA with PD, the SDMT, AM, and fluencies were similar. TMT-A and -B raw scores were different between groups (p = 0.006; p = 0.034), but these differences lost significance after p9NORM corrections (p = 0.100; p = 0.186).

Conclusions

We confirm that the p9NORM can be successfully used in both PD and MSA patients, as it mitigates the impact of disability on timed tests, resulting in a more accurate analysis of cognitive domains.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

We thank the patients and their families for taking part to this study.

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Author notes

  1. Teresa Costabile and Chiara Pane contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosciences and Reproductive and Odontostomatological Sciences, University “Federico II”, Via Pansini, 5, 80131, Napoli, NA, Italy

    Teresa Costabile, Chiara Pane, Luisa Aurisicchio, Adriana Salvati, Maria Lieto, Silvio Peluso, Antonio Reia, Natascia De Lucia, Anna De Rosa, Alessandro Filla, Giuseppe De Michele & Francesco Saccà

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  1. Teresa Costabile
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  2. Chiara Pane
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Contributions

Design and conceptualization of the study: Teresa Costabile and Francesco Saccà; data acquisition: Teresa Costabile, Chiara Pane, Luisa Aurisicchio, Adriana Salvati, Maria Lieto, Antonio Reia, and Natascia De Lucia; analysis or interpretation of the data: Teresa Costabile and Francesco Saccà; drafting or revising the manuscript for intellectual content: Teresa Costabile, Chiara Pane, Anna De Rosa, Alessandro Filla, Giuseppe De Michele, and Francesco Saccà.

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Correspondence to Chiara Pane.

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The study was approved by the local ethics committee (n. 47/15), and was performed in accordance with the Declaration of Helsinki, European guidelines CPMP/ICH/135/95.

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All healthy controls (HC) and patients gave written informed consent before any activity linked to the study.

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Costabile, T., Pane, C., Aurisicchio, L. et al. Application of the p9NORM correction method to timed neuropsychological tests in Parkinson’s disease and multiple system atrophy. Neurol Sci 41, 3633–3641 (2020). https://doi.org/10.1007/s10072-020-04478-3

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