Neurology, Parkinson’s Disease

Clinical Impression of Severity Index for Parkinson’s Disease (CISI-PD): A Full Guide for Researchers and Clinicians

Introduction

The Clinical Impression of Severity Index for Parkinson’s Disease (CISI-PD) is a foundational instrument for assessing the global severity of Parkinson’s Disease (PD). Developed in 2006 by a team including Pablo Martínez-Martín et al, it has since garnered over 90 citations on Google Scholar, underscoring its significant impact in both clinical and research environments. This concise, 4-item questionnaire offers a clear picture of a patient’s functional independence across critical domains. Consequently, it has become an indispensable tool for guiding rehabilitation, monitoring disease progression, and supporting research in PD.

This article will delve into the CISI-PD’s key features, applications, and clinical value, offering actionable insights for researchers and clinicians to enhance patient assessment in Parkinson’s disease management.

Key Features of the Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD)

Purpose and Use

The primary purpose of the CISI-PD is to assess global PD severity based on a clinician’s judgment following direct clinical examination and patient interview. Clinicians use it extensively to monitor patient progress over time and for research purposes. Its focus on tangible clinical aspects makes it a vital tool for understanding disease severity and informing care plans.

Target Population

The CISI-PD is validated for adult populations aged 18 and above, encompassing

Young adults (18-24 years)
Middle-aged adults (25-44 years)
Older adults (45-64 years)
Seniors (65+ years)

Specifically, it is widely utilized in the assessment of individuals with Parkinson’s Disease.

Structure

The CISI-PD is a concise, 4-item scale designed to evaluate functional independence in PD. The main domain is neurology with questions cover four core sub-domains:

Motor Signs: This assesses motor symptoms such as tremor, rigidity, and bradykinesia.
Disability: This evaluates the extent to which PD affects a patient’s functional ability in daily activities.
Motor Complications: This assesses the presence and severity of motor complications like dyskinesia and motor fluctuations.
Cognitive Status: This assesses the patient’s cognitive abilities, including memory and concentration.

Scoring Method

The CISI-PD employs a rated numerical scale (0-6) for each domain, based on comprehensive clinical examination and interview, with each item scored by the clinician from 0 (normal) to 6 (very severe). The total score, therefore, ranges from 0 to 24. Interpretation is guided by the total score that classify the level of severity:

Mild: 1–7
Moderate: 8–14
Severe: ≥15

The scoring reflects the clinician’s global impression of PD severity after interview and examination.

Administration Format

Administering the CISI-PD is efficient as it can be administered via in-person interview.
It typically takes 5 to 10 minutes to complete the questionnaire. However, the time can vary based on clinician experience and patient complexity.

Although straightforward, basic training is recommended to ensure consistent and accurate scoring.

Applications of the Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD)

The CISI-PD is a versatile tool with several key applications in both clinical practice and research:

Monitoring: Clinicians track a patient’s progress or decline over time, particularly during treatment.
Research: It serves as a reliable endpoint for studies evaluating interventions for Parkinson’s Disease.

Languages and availability

To support its global application, the CISI-PD has been translated and validated in numerous languages, including

English
Spanish
French
Russian
German
Japanese and others.

Therefore, its multilingual accessibility enhances its value in diverse clinical and research contexts.

The CISI-PD is an open-access tool, free for clinical and academic use. It is published by the Movement Disorder Society and the Movement Disorders journal.

Reliability and Validity

The CISI-PD is recognized as a highly reliable and valid instrument. Its psychometric soundness is supported by a strong Cronbach’s alpha, typically ranging from 0.81 to 0.90, which reflects excellent internal consistency.
Numerous validation studies have confirmed its robustness across various patient populations and settings, cementing its status as a valuable measure.

The Original Validation Study link
The international validation study link

Limitations and Considerations

Despite its strengths, the CISI-PD has a few limitations:

Lack of Patient Self-Assessment: Its clinician-rated nature introduces potential assessment bias, as it does not capture subjective patient experiences.
Narrow Focus: It primarily focuses on motor aspects, potentially overlooking crucial non-motor symptoms such as mood or sleep disorders.
Severity Index, Not Diagnostic: The tool serves as a severity index rather than a diagnostic instrument for Parkinson’s Disease.

Additional Resources

The full set of CISI-PD items is available in the original study published in 2006 at the following link
For inquiries, contact Dr. Pablo Martinez-MartinCarlos III Institute of Health,Madrid, Spain: pmartinez@isciii.es
For additional resources, consult the Movement Disorder Society link

Frequently Asked Questions (FAQ)

Who can use the CISI-PD?
Clinicians, researchers, and other healthcare providers use the CISI-PD for adults aged 18 and over, specifically in the context of Parkinson’s Disease assessment.
How long does it take to complete the CISI-PD?
Clinicians can typically complete the assessment in 5 to 10 minutes, making it highly practical for busy settings.
How is the CISI-PD administered?
Healthcare teams administer the questionnaire via an in-person interview format.
Is there any cost to using the CISI-PD?
The CISI-PD is free for clinical and academic use.

A Word from ResRef about the Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD)

The Clinical Impression of Severity Index for Parkinson’s Disease (CISI-PD) is a concise, reliable, and clinically valuable tool designed to assess the global severity of Parkinson’s Disease through four critical domains: motor signs, disability, motor complications, and cognitive status. Its ease of administration and strong psychometric properties make it widely adopted in both clinical practice and research settings. While it relies on clinician evaluation rather than patient self-report, which may limit capturing subjective patient experiences, its structured approach provides a standardized method for monitoring disease progression and informing treatment decisions.

References

Martínez‐Martín, P., Forjaz, M. J., Cubo, E., Frades, B., de Pedro Cuesta, J., & ELEP Project Members. (2006). Global versus factor‐related impression of severity in Parkinson’s disease: a new clinimetric index (CISI‐PD). Movement Disorders, 21(2), 208-214. link
Martínez‐Martín, P., Rodríguez‐Blázquez, C., Forjaz, M. J., & de Pedro, J. (2009). The clinical impression of severity index for Parkinson’s disease: international validation study. Movement disorders: official journal of the Movement Disorder Society, 24(2), 211-217.‏link