Article Text

other Versions

Download PDFPDF
Research paper
Comparison of activities of daily living impairments in Parkinson's disease patients as defined by the Pill Questionnaire and assessments by neurologists
  1. Wei-Ju Lee1,2,3,
  2. Yung-Yee Chang4,
  3. Juei-Jueng Lin5,
  4. Yueh-Feng Sung6,
  5. Jie-Yuan Li2,7,
  6. Shuu-Jiun Wang2,8,
  7. Rou-Shayn Chen9,
  8. Yuan-Han Yang10,11,
  9. Chaur-Jong Hu12,
  10. Chon-Haw Tsai13,
  11. Han-Cheng Wang14,
  12. Shey-Lin Wu15,
  13. Ming-Hong Chang1,2,
  14. Jong-Ling Fuh2,8
  1. 1Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
  2. 2Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
  3. 3Institute of Clinical Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan
  4. 4Department of Neurology and Center for Parkinson's Disease, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
  5. 5Department of Neurology Chushang Show-Chwan Hospital, Nantou and Chung-Shan University Hospital, Taichung, Taiwan
  6. 6Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  7. 7Division of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
  8. 8Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
  9. 9Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan
  10. 10Department of and Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Taiwan
  11. 11Department of Neurology, Kaohsiung Municipal Ta Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  12. 12Department of Neurology, Shung Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
  13. 13Department of Neurology, China Medical University Hospital; School of Medicine, Medical College and Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, Taiwan
  14. 14Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, College of Medicine, Taipei Medical University, and College of Medicine, National Taiwan University, Taipei, Taiwan
  15. 15Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
  1. Correspondence to Dr Jong-Ling Fuh, The Neurological Institute, Taipei Veterans General Hospital, Taipei 11217, Taiwan; jlfuh{at}


Objectives To compare the clinical judgment of experienced neurologists after interviewing Parkinson's disease (PD) patients and their caregivers with the use of the Pill Questionnaire to determine the presence of impairments on activities of daily living (ADL).

Background ADL impairment is a criterion for the diagnosis of dementia associated with PD. The Pill Questionnaire has been recommended as a screening tool to assess ADL impairment in PD patients, but its usefulness and validity have not been fully investigated.

Methods We recruited idiopathic PD patients from 12 hospitals in Taiwan, and the patients underwent clinical assessments, a neuropsychological test battery and the Unified Parkinson Disease Rating Scale evaluation. The Pill Questionnaire was administered by study assistants. Patient and caregiver interviews were performed by experienced neurologists who were blinded to the Pill Questionnaire results.

Results In total, 284 PD patients (mean age 71.8±9 years, mean education 8.7±5.3 years, mean disease duration 5.4±5.3 years) were recruited. 63 patients showed ADL impairment by the Pill Questionnaire, and 108 patients showed ADL impairment by neurologists’ clinical interviews. κ Statistics showed moderate agreement between the two methods (κ=0.521, p<0.001). Of the 108 patients who were diagnosed with ADL impairment by neurologists, only 56 patients (51.9%) showed impairment according to the Pill Questionnaire. Most of the missed patients had milder cognitive impairment and lower motor disability.

Conclusions A comprehensive interview is essential to determine the presence of ADL impairment in PD patients, especially in patients with early PD.


Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles