A method for measuring time spent in bradykinesia and dyskinesia in people with Parkinson’s disease using an ambulatory monitor

Abstract Background Fluctuations in motor function in Parkinson’s Disease (PD) are frequent and cause significant disability. Frequently device assisted therapies are required to treat them. Currently, fluctuations are self-reported through diaries and history yet frequently people with PD do not accurately identify and report fluctuations. As the management of fluctuations and the outcomes of many clinical trials depend on accurately measuring fluctuations a means of objectively measuring time spent with bradykinesia or dyskinesia would be important. The aim of this study was to present a system that uses wearable sensors to measure the percentage of time that bradykinesia or dyskinesia scores are above a target as a means for assessing levels of treatment and fluctuations in PD. Methods Data in a database of 228 people with Parkinson’s Disease and 157 control subjects, who had worn the Parkinson’s Kinetigraph ((PKG, Global Kinetics Corporation™, Australia) and scores from the Unified Parkinson’s Disease Rating Scale (UPDRS) and other clinic scales were used. The PKG’s provided score for bradykinesia and dyskinesia every two minutes and these were compared to a previously established target range representing a UPDRS III score of 35. The proportion of these scores above target over the 6 days that the PKG was worn were used to derive the percent time in bradykinesia (PTB) and percent time in dyskinesia (PTD). As well, a previously describe algorithm for estimating the amplitude of the levodopa response was used to determine whether a subject was a fluctuator or non-fluctuator. Results Using this approach, a normal range of PTB and PTD based on Control subject was developed. The level of PTB and PTD experienced by people with PD was compared with their levels of fluctuation. There was a correlation (Pearson’s ρ = 0.4) between UPDRS II scores and PTB: the correlation between Parkinson Disease Questionnaire scores and UPDRS Total scores and PTB and slightly lower. PTB and PTD fell in response to treatment for bradykinesia or dyskinesia (respectively) with greater sensitivity than clinical scales. Conclusions This approach provides an objective assessment of the severity of fluctuations in Parkinson’s Disease that could be used in in clinical trials and routine care.

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A Method for Measuring Time Spent in Bradykinesia and Dyskinesia in People With Parkinson’s Disease Using an Ambulatory Monitor

10.21203/rs.3.rs-174850/v1 ◽

2021 ◽

Author(s):

Hamid Khodakarami ◽

Navid Shokouhi ◽

Malcolm Horne

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Clinical Trials ◽

Rating Scale ◽

Objective Assessment ◽

Response To Treatment ◽

Target Range ◽

Measuring Time ◽

Parkinsons Disease ◽

Percent Time

Abstract BackgroundFluctuations in motor function in Parkinson’s Disease (PD) are frequent and cause significant disability. Frequently device assisted therapies are required to treat them. Currently, fluctuations are self-reported through diaries and history yet frequently people with PD do not accurately identify and report fluctuations. As the management of fluctuations and the outcomes of many clinical trials depend on accurately measuring fluctuations a means of objectively measuring time spent with bradykinesia or dyskinesia would be important. The aim of this study was to present a system that uses wearable sensors to measure the percentage of time that bradykinesia or dyskinesia scores are above a target as a means for assessing levels of treatment and fluctuations in PD.MethodsData in a database of 228 people with Parkinson’s Disease and 157 control subjects, who had worn the Parkinsons Kinetigraph ((PKG, Global Kinetics CorporationTM, Australia) and scores from the Unified Parkinsons Disease Rating Scale (UPDRS) and other clinic scales were used. The PKG’s provided score for bradykinesia and dyskinesia every two minutes and these were compared to a previously established target range representing a UPDRS III score of 35. The proportion of these scores above target over the 6days that the PKG was worn were used to derive the percent time in bradykinesia (PTB) and percent time in dyskinesia (PTD). As well, a previously describe algorithm for estimating the amplitude of the levodopa response was used to determine whether a subject was a fluctuator or non-fluctuator. ResultsUsing this approach, a normal range of PTB and PTD based on Control subject was developed. The level of PTB and PTD experienced by people with PD was compared with their levels of fluctuation. There was a correlation (Pearsons ρ=0.4) between UPDRS II scores and PTB: the correlation between Parkinson Disease Questionnaire scores and UPDRS Total scores and PTB and slightly lower. PTB and PTD fell in response to treatment for bradykinesia or dyskinesia (respectively) with greater sensitivity than clinical scales.ConclusionsThis approach provides an objective assessment of the severity of fluctuations in Parkinsons Disease that could readily easily be used in routine care and in clinical trials.

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Longitudinal Change and Progression Indicators Using the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale in Two Independent Cohorts with Early Parkinson’s Disease

Journal of Parkinson s Disease ◽

10.3233/jpd-212860 ◽

2021 ◽

pp. 1-16

Author(s):

Michael Bartl ◽

Mohammed Dakna ◽

Sebastian Schade ◽

Tamara Wicke ◽

Elisabeth Lang ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Clinical Trials ◽

Rating Scale ◽

De Novo ◽

Longitudinal Change ◽

Single Center ◽

Square Roots ◽

Disease Rating

Background: The MDS-Unified Parkinson’s disease (PD) Rating Scale (MDS-UPDRS) is the most used scale in clinical trials. Little is known about the predictive potential of its single items. Objective: To systematically dissect MDS-UPDRS to predict PD progression. Methods: 574 de novo PD patients and 305 healthy controls were investigated at baseline (BL) in the single-center DeNoPa (6-year follow-up) and multi-center PPMI (8-year follow-up) cohorts. We calculated cumulative link mixed models of single MDS-UPDRS items for odds ratios (OR) for class change within the scale. Models were adjusted for age, sex, time, and levodopa equivalent daily dose. Annual change and progression of the square roots of the MDS-UDPRS subscores and Total Score were estimated by linear mixed modeling. Results: Baseline demographics revealed more common tremor dominant subtype in DeNoPa and postural instability and gait disorders-subtype and multiethnicity in PPMI. Subscore progression estimates were higher in PPMI but showed similar slopes and progression in both cohorts. Increased ORs for faster progression were found from BL subscores I and II (activities of daily living; ADL) most marked for subscore III (rigidity of neck/lower extremities, agility of the legs, gait, hands, and global spontaneity of movements). Tremor items showed low ORs/negative values. Conclusion: Higher scores at baseline for ADL, freezing, and rigidity were predictors of faster deterioration in both cohorts. Precision and predictability of the MDS-UPDRS were higher in the single-center setting, indicating the need for rigorous training and/or video documentation to improve its use in multi-center cohorts, for example, clinical trials.

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Quantitative wearable sensors for objective assessment of Parkinson's disease

Movement Disorders ◽

10.1002/mds.25628 ◽

2013 ◽

Vol 28 (12) ◽

pp. 1628-1637 ◽

Cited By ~ 179

Author(s):

Walter Maetzler ◽

Josefa Domingos ◽

Karin Srulijes ◽

Joaquim J. Ferreira ◽

Bastiaan R. Bloem

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Objective Assessment ◽

Wearable Sensors

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Muscle strength and executive function as complementary parameters for the assessment of impairment in Parkinson's disease

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20130175 ◽

2013 ◽

Vol 71 (12) ◽

pp. 948-954

Author(s):

Dannyel Barbirato ◽

Alessandro Carvalho ◽

Narahyana Bom de Araujo ◽

Jose Vicente Martins ◽

Andrea Deslandes

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Executive Function ◽

Disease Severity ◽

Rating Scale ◽

Motor Impairment ◽

Cognitive Status ◽

Cognitive Capacity ◽

Response To Treatment ◽

The Relationship

Objective To evaluate the relationship between the quantitative results of functional and cognitive performance of patients with Parkinson's disease (PD) and disease severity; and to study the relationship between patients' functional and cognitive capacity and motor impairment (Unified Parkinson's Disease Rating Scale - UPDRS III). Method Twenty-nine subjects clinically diagnosed with PD were classified into three groups according to disease severity using the modified Hoehn and Yahr Scale (H&Y). They were submitted to functional (Senior Fitness Test) and neuropsychological tests. Stepwise regression analysis showed a significant association between H&Y and upper limb strength (r 2 =0.30; p=0.005) and executive function (r 2 =0.37; p=0.004). In relation to UPDRS III, there was a significant association between lower limb strength (r 2 =0.27; p=0.010) and global cognitive status (r 2 =0.24; p=0.024). Conclusion The implementation of simple tests of functional capacity associated with neuropsychological testing can help to assess disease severity and motor impairment, and can be used to monitor the response to treatment in PD.

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The Smart-Insole Dataset: Gait Analysis Using Wearable Sensors with a Focus on Elderly and Parkinson’s Patients

Sensors ◽

10.3390/s21082821 ◽

2021 ◽

Vol 21 (8) ◽

pp. 2821

Author(s):

Chariklia Chatzaki ◽

Vasileios Skaramagkas ◽

Nikolaos Tachos ◽

Georgios Christodoulakis ◽

Evangelia Maniadi ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Gait Analysis ◽

Rating Scale ◽

Wearable Sensors ◽

The Elderly ◽

Detection Algorithm ◽

Timed Up And Go ◽

Computer Scientists ◽

Smart Insole

Gait analysis is crucial for the detection and management of various neurological and musculoskeletal disorders. The identification of gait events is valuable for enhancing gait analysis, developing accurate monitoring systems, and evaluating treatments for pathological gait. The aim of this work is to introduce the Smart-Insole Dataset to be used for the development and evaluation of computational methods focusing on gait analysis. Towards this objective, temporal and spatial characteristics of gait have been estimated as the first insight of pathology. The Smart-Insole dataset includes data derived from pressure sensor insoles, while 29 participants (healthy adults, elderly, Parkinson’s disease patients) performed two different sets of tests: The Walk Straight and Turn test, and a modified version of the Timed Up and Go test. A neurologist specialized in movement disorders evaluated the performance of the participants by rating four items of the MDS-Unified Parkinson’s Disease Rating Scale. The annotation of the dataset was performed by a team of experienced computer scientists, manually and using a gait event detection algorithm. The results evidence the discrimination between the different groups, and the verification of established assumptions regarding gait characteristics of the elderly and patients suffering from Parkinson’s disease.

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Meta-analysis of Placebo-controlled Clinical Trials of Safinamide and Entacapone as Add-on Therapy to Levodopa in the Treatment of Parkinson’s Disease

European Neurological Review ◽

10.17925/enr.2015.10.01.15 ◽

2015 ◽

Vol 10 (01) ◽

pp. 15 ◽

Cited By ~ 8

Author(s):

Jörg Schnitker ◽

Thomas Müller ◽

◽

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Clinical Trials ◽

Rating Scale ◽

Meta Analysis ◽

Search Term ◽

Motor Complications ◽

Controlled Clinical Trials ◽

Total Incidence ◽

Double Blinded

Chronic levodopa (L-dopa) treatment of Parkinson’s disease (PD) patients is sooner or later associated with the onset of motor complications, for example wearing off and dyskinesia. PD patients with motor complications usually require the addition of further PD drugs to reduce these L-dopa side effects and enhance its efficacy. Entacapone is an available catechol-O-methyltransferase (COMT) inhibitor, which was extensively investigated as add-on to L-dopa/dopadecarboxylase inhibitor (DDCI) application in PD patients. Safinamide, a watersoluble, orally active a-aminoamide derivative, which modulates dopaminergic and glutamatergic neurotransmission with a unique dual mechanism of action, has been studied in two placebo-controlled clinical trials as add-on therapy to L-dopa in fluctuating PD patients. To date, there are no head-to-head clinical trials comparing the efficacy of safinamide and entacapone in the clinic. The aim of this meta-analysis was to determine effect sizes of safinamide and entacapone as add-on treatment to L-dopa in fluctuating PD patients. A systematic search of the literature on entacapone trials up to the end of September 2014 was first conducted on the MEDLINE and EMBASE databases in order to identify appropriate studies. Definition criteria for inclusion were prospective, randomised, placebocontrolled and double-blinded trials on the efficacy and safety of entacapone or safinamide in fluctuating L-dopa-treated PD patients. Four studies for entacapone and two trials on safinamide were considered. Data from the safinamide trials were provided by Zambon and therefore safinamide’ was not used as a search term. Safinamide and entacapone treatment was comparable in terms of the main efficacy variables (offtime, percentageontime, Unified Parkinson’s Disease Rating Scale). Significant advantages in favour of safinamide were shown in terms of the total incidence of adverse events (AEs) in comparison to placebo, the study discontinuation due to AEs and deaths and in the risk differences of the AEs versus placebo, particularly for nausea, vomiting, diarrhoea, dizziness, urine abnormality and shortness of breath. The odds ratio (OR) of 0.907 for any AE corresponds to an overall AE rate of 68.7 % for safinamide whereas the OR of 2.089 to an overall AE rate of 84.4 % for entacapone.

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A-WEAR Bracelet for Detection of Hand Tremor and Bradykinesia in Parkinson’s Patients

Sensors ◽

10.3390/s21030981 ◽

2021 ◽

Vol 21 (3) ◽

pp. 981

Author(s):

Asma Channa ◽

Rares-Cristian Ifrim ◽

Decebal Popescu ◽

Nirvana Popescu

Keyword(s):

Older Adults ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rating Scale ◽

Objective Assessment ◽

Spectral Features ◽

Motor Symptoms ◽

Healthy Controls ◽

Clinical Environment ◽

Hand Tremor

Parkinson’s disease patients face numerous motor symptoms that eventually make their life different from those of normal healthy controls. Out of these motor symptoms, tremor and bradykinesia, are relatively prevalent in all stages of this disease. The assessment of these symptoms is usually performed by traditional methods where the accuracy of results is still an open question. This research proposed a solution for an objective assessment of tremor and bradykinesia in subjects with PD (10 older adults aged greater than 60 years with tremor and 10 older adults aged greater than 60 years with bradykinesia) and 20 healthy older adults aged greater than 60 years. Physical movements were recorded by means of an AWEAR bracelet developed using inertial sensors, i.e., 3D accelerometer and gyroscope. Participants performed upper extremities motor activities as adopted by neurologists during the clinical assessment based on Unified Parkinson’s Disease Rating Scale (UPDRS). For discriminating the patients from healthy controls, temporal and spectral features were extracted, out of which non-linear temporal and spectral features show greater difference. Both supervised and unsupervised machine learning classifiers provide good results. Out of 40 individuals, neural net clustering discriminated 34 individuals in correct classes, while the KNN approach discriminated 91.7% accurately. In a clinical environment, the doctor can use the device to comprehend the tremor and bradykinesia of patients quickly and with higher accuracy.

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An Integrated Multi-Sensor Approach for the Remote Monitoring of Parkinson’s Disease

Sensors ◽

10.3390/s19214764 ◽

2019 ◽

Vol 19 (21) ◽

pp. 4764 ◽

Cited By ~ 3

Author(s):

Giovanni Albani ◽

Claudia Ferraris ◽

Roberto Nerino ◽

Antonio Chimienti ◽

Giuseppe Pettiti ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Remote Monitoring ◽

Rating Scale ◽

Population Aging ◽

Neurological Diseases ◽

Low Cost ◽

Wearable Sensors ◽

Cost Effective ◽

The Body

The increment of the prevalence of neurological diseases due to the trend in population aging demands for new strategies in disease management. In Parkinson’s disease (PD), these strategies should aim at improving diagnosis accuracy and frequency of the clinical follow-up by means of decentralized cost-effective solutions. In this context, a system suitable for the remote monitoring of PD subjects is presented. It consists of the integration of two approaches investigated in our previous works, each one appropriate for the movement analysis of specific parts of the body: low-cost optical devices for the upper limbs and wearable sensors for the lower ones. The system performs the automated assessments of six motor tasks of the unified Parkinson’s disease rating scale, and it is equipped with a gesture-based human machine interface designed to facilitate the user interaction and the system management. The usability of the system has been evaluated by means of standard questionnaires, and the accuracy of the automated assessment has been verified experimentally. The results demonstrate that the proposed solution represents a substantial improvement in PD assessment respect to the former two approaches treated separately, and a new example of an accurate, feasible and cost-effective mean for the decentralized management of PD.

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Measurement of Step Angle for Quantifying the Gait Impairment of Parkinson’s Disease by Wearable Sensors: Controlled Study (Preprint)

10.2196/preprints.16650 ◽

2019 ◽

Author(s):

Jingying Wang ◽

Dawei Gong ◽

Huichun Luo ◽

Wenbin Zhang ◽

Lei Zhang ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dual Task ◽

Rating Scale ◽

Wearable Sensors ◽

Challenge Test ◽

Initial Step ◽

Controlled Study ◽

Walking Test ◽

Single Task

BACKGROUND Gait impairments including shuffling gait and hesitation are common in people with Parkinson’s disease (PD), and have been linked to increased fall risk and freezing of gait. Nowadays the gait metrics mostly focus on the spatiotemporal characteristics of gait, but less is known of the angular characteristics of the gait, which may provide helpful information pertaining to the functional status and effects of the treatment in PD. OBJECTIVE This study aimed to quantify the angles of steps during walking, and explore if this novel step angle metric is associated with the severity of PD and the effects of the treatment including the acute levodopa challenge test (ALCT) and deep brain stimulation (DBS). METHODS A total of 18 participants with PD completed the walking test before and after the ALCT, and 25 participants with PD completed the test with the DBS on and off. The walking test was implemented under two conditions: walking normally at a preferred speed (single task) and walking while performing a cognitive serial subtraction task (dual task). A total of 17 age-matched participants without PD also completed this walking test. The angular velocity was measured using wearable sensors on each ankle, and three gait angular metrics were obtained, that is mean step angle, initial step angle, and last step angle. The conventional gait metrics (ie, step time and step number) were also calculated. RESULTS The results showed that compared to the control, the following three step angle metrics were significantly smaller in those with PD: mean step angle (F1,48=69.75, P<.001, partial eta-square=0.59), initial step angle (F1,48=15.56, P<.001, partial eta-square=0.25), and last step angle (F1,48=61.99, P<.001, partial eta-square=0.56). Within the PD cohort, both the ALCT and DBS induced greater mean step angles (ACLT: F1,38=5.77, P=.02, partial eta-square=0.13; DBS: F1,52=8.53, P=.005, partial eta-square=0.14) and last step angles (ACLT: F1,38=10, P=.003, partial eta-square=0.21; DBS: F1,52=4.96, P=.003, partial eta-square=0.09), but no significant changes were observed in step time and number after the treatments. Additionally, these step angles were correlated with the Unified Parkinson's Disease Rating Scale, Part III score: mean step angle (single task: r=–0.60, P<.001; dual task: r=–0.52, P<.001), initial step angle (single task: r=–0.35, P=.006; dual task: r=–0.35, P=.01), and last step angle (single task: r=–0.43, P=.001; dual task: r=–0.41, P=.002). CONCLUSIONS This pilot study demonstrated that the gait angular characteristics, as quantified by the step angles, were sensitive to the disease severity of PD and, more importantly, can capture the effects of treatments on the gait, while the traditional metrics cannot. This indicates that these metrics may serve as novel markers to help the assessment of gait in those with PD as well as the rehabilitation of this vulnerable cohort.

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29 Shedding light on the relationship between dyskinesia and impulsive compulsive behaviour disorders in Parkinson’s disease

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2020-bnpa.46 ◽

2020 ◽

Vol 91 (8) ◽

pp. e20.1-e20

Author(s):

Lucia Ricciardi ◽

Andrea De Angelis ◽

Chiara Siri ◽

Malcon Horne ◽

Alison Leake ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dopamine Agonists ◽

Rating Scale ◽

Psychiatric Symptoms ◽

Structured Interview ◽

Percent Time ◽

Binary Regression Analysis ◽

Compulsive Behaviour ◽

The Relationship

ObjectivesImpulsive compulsive behaviour disorders (ICB) and dyskinesia are common and disabling complications occurring during the course of Parkinson’s disease (PD). Their pathophysiology is not clear yet, however an association has been suggested. In the present study we aimed to evaluate the relationship between the presence of dyskinesia objectively detected using a wearable device and the presence of active and past ICB in PD patients.MethodsPatients’ demographic and clinical characteristics were gathered, PD medications were converted in total levodopa equivalent daily dose (LEDD) and LEDD dopamine-agonists. Patients were assessed with: Unified PD Rating Scale (UPDRS) parts I-IV and Rusk Dyskinesia Rating Scale (RDRS). To objectively measure dyskinesia we used a wearable devise, the Parkinson’s KinetiGraph™ system (PKG®), an accelerometry-based system for automated assessment of dyskinesia and bradykinesia. Past and active ICB were diagnosed with a semi-structured interview.Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale (QUIP-RS) was employed to rate ICB severity. Psychiatric symptoms were evaluated including depression, anxiety, apathy and impulsivity.ResultsFifty-five PD patients were evaluated (36 males, mean age 60.7±6.7; mean disease duration 10.5±4.9). Twenty-five patients (45%) had dyskinesia as per PKG ‘Percent Time in Dyskinesia’ score. Nineteen patients had ICB (34%). There was no difference in active/past ICB between patients with and without dyskinesia (p=0.8 and 0.6). Patients with dyskinesia had higher LEDD dopamine-agonists (p=0.005), UPDRS-IV (p=0.02), RDRS (p=0.002). There was no difference between groups in psychiatric symptoms. We categorized patients in 3 groups (none, mild/moderate and severe dyskinesia) and we found no difference among groups in any demographic, clinical, psychiatric and behavioural variable except for LEDD dopamine-agonists (p=0.004), UPDRS-IV (p=0.06), RDRS (p=0.004).Binary regression analysis did not show any association between the presence of dyskinesia and ICB, depression, anxiety, apathy and impulsivity.ConclusionOur data suggest that ICB and dyskinesia are common but unrelated disorders in PD.

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