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How cautious should we be when assessing apathy with the Unified Parkinson's Disease Rating Scale?
Author(s) -
KirschDarrow Lindsey,
Zahodne Laura B.,
Hass Chris,
Mikos Ania,
Okun Michael S.,
Fernandez Hubert H.,
Bowers Dawn
Publication year - 2009
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.22437
Subject(s) - apathy , receiver operating characteristic , parkinson's disease , rating scale , cut point , psychology , disease , psychiatry , physical therapy , medicine , statistics , developmental psychology , mathematics , cognition
Current practice often assesses apathy with a single item from the Unified Parkinson's Disease Rating Scale (UPDRS, item 4). Yet, the relationship between the UPDRS item 4 and the validated Apathy Scale (AS) is unknown. The purpose of this study was to evaluate the operating characteristics of UPDRS item 4 in relation to the AS. Three hundred and one patients with PD were administered the AS and the UPDRS. We compared the UPDRS item 4 to the standard AS classification of ≥14 as apathetic. A receiver operating characteristics (ROC) curve was obtained, and sensitivity, specificity, positive, and negative predictive power were calculated. The ROC curve showed area under the curve as 0.75. A cut‐off of 1 had good sensitivity (81%) but poor specificity (53%; high false positive rate). A cut‐off point of 2 had acceptable specificity (87%) but poor sensitivity (52%, high false negative rate). Continuing to increasing the cut‐off point (e.g., 3, 4) continues to increase specificity at the expense of dramatically reducing sensitivity. These findings suggest the use of caution when screening for apathy with item 4 due to its poor sensitivity in relation to the AS. © 2009 Movement Disorder Society