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scores between MoCA-deﬁned groups based on recommended
cutpoints for PD-related cognitive impairment (8). Because
of the small sample sizes and nonnormal distribution of some
variables, we utilized the nonparametric Kruskal-Wallis equality of populations rank test with Dunn's pairwise comparisons
for this analysis.
We also explored whether measured cognitive abilities predicted ECog scores over and above age, education, and disease
duration. Disease duration, which is associated with increasing
disability in PD, was utilized as a proxy of the accumulative
motor dysfunction of PD. The Hoehn and Yahr score conﬂates
independence and motor dysfunction in its ratings and thus
would have confounded the interpretation of functional impairment and motor dysfunction (10).
RESULTS
The sample consisted of 49 community-dwelling individuals
(33 male) with PD. Participants were an average age of 72 years
(SD = 8.0), had 14 years of education (SD = 1.4), and were
primarily Caucasian (n = 47). Most individuals had moderateseverity disease as measured by the Hoehn and Yahr scale (I,
25%; II, 27%; III, 41%; IV, 6%; and V, 2%). Informants primarily resided with and saw the patient daily (96%) and were
predominantly spouses (86%) and lived with the patient (96%).
Of the sample, 12 individuals had normal MoCA scores, 24
were probable MCI (MoCA ≥21, <26), and 13 had probable
dementia (MoCA <21).
Descriptive statistics for the ECog and the constituent subscales can be found in the Table. Only one caregiver in our
sample rated an individual as having no diﬃculties on any of
the items, while none of the respondents was rated at the ceiling for the items.
Individuals with probable dementia, as deﬁned by the
MoCA, demonstrated lower scores (P < 0.05) on the ECog total score and all domain scores with the exception of visuospatial
skills, divided attention, and organization. The latter showed a
trend in the expected direction (P = 0.06). In our small sample,
MCI and normal control participants did not diﬀer signiﬁcantly on the ECog. Hierarchical multiple regression analysis
was used to test if MoCA predicted ECog abilities over and

above demographic factors (age and education) as well as total
disease duration (our proxy for motor-related debility in PD).
Results indicated that demographic factors and disease duration
were not predictive of ECog scores (R2 = 0.06, F(3, 45) = 0.97,
P > 0.05); the addition of the MoCA was (F(1, 44) = 4.51,
β = −0.06, P < 0.05), explaining an additional 9% of the variance.
DISCUSSION
The ECog is potentially an attractive daily functioning
measure for PD, as it was designed to capture mild diﬃculties
driven by a variety of cognitive deﬁcits, including the executive dysfunction that is common in PD. Because the ECog has
demonstrated utility in other neurodegenerative processes such
as Alzheimer's disease, frontotemporal dementia, and Huntington's disease, it may allow for a common language for evaluating
disability related to activities of daily living across populations
for research and clinical purposes.
In the current study, ECog scores varied in the expected
direction, with increasing levels of dysfunction associated with
lower scores on the MoCA. Because physical dysfunction in
PD may also impact daily activities, it was encouraging that
cognitive dysfunction as measured by the MoCA was a stronger
predictor of ECog scores than disease duration (a proxy for
motor dysfunction given the accumulation of motor disability
with increasing disease duration) or demographic factors. This
ﬁnding suggests that the ECog items may be sensitive markers
of cognitive dysfunction in PD, over and above the impact of
the motor dysfunction of the disease. It is important to note,
though, that the lack of a direct motor measure makes this
conclusion only tentative at this time.
Capturing day-to-day diﬃculties is critical for clinical and
research studies of PD MCI and dementia; also, caregivers of
individuals with PD seem to be able to parse the diﬀerence between the motor versus cognitive impact of the disease (11). The
ECog thus provides an attractive measure to capture this critical
information about functional diﬃculties while also avoiding
ﬂoor and ceiling eﬀects. This is an important consideration in
a measure if it is to capture change in functional abilities over
time or as a result of an intervention.

Table. Everyday Cognition scores in Parkinson's disease and comparison between cognitively defined subgroups
Everyday Cognition
score

Total
sample

Normal cognition
(N = 12)

Probable MCI
(N = 23)

Probable dementia
(N = 13)

Total score

2.01 (0.86)

1.75 (0.75)

1.87 (0.79)

2.52 (0.91)

Normal, MCI < dementia

Memory

2.31(0.97)

1.95 (0.92)

2.22 (0.96)

2.84 (0.87)

Normal, MCI < dementia

Language

1.92 (0.89)

1.61 (0.79)

1.82 (0.87)

2.41 (0.86)

Normal, MCI < dementia

Visuospatial

1.75 (0.86)

1.69 (0.94)

1.58 (0.67)

2.15 (1.05)

NS

Planning

1.96 (1.04)

1.72 (0.94)

1.77 (0.91)

2.54 (1.21)

Normal, MCI < dementia

Organization

1.91 (0.98)

1.61 (0.72)

1.73 (0.92)

2.54 (1.10)

Trend; normal, MCI < dementia

Divided attention

2.20 (1.00)

2.06 (1.02)

2.08 (0.97)

2.57 (1.03)

NS

Group comparison

Scores are presented as mean (standard deviation). MCI indicates mild cognitive impairment; NS, nonsignificant. Each score could range from 1 (no change) to 4 (performs these
tasks much worse than 10 years ago).

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