Evaluation of Motor Complications in Parkinson’s Disease: Understanding the Perception Gap between Patients and Physicians

Background. Patients with Parkinson’s disease (PD) receiving levodopa treatment often report motor complications including wearing-off (WO), dyskinesia, and morning akinesia. As motor complications are associated with a decrease in patients’ quality of life (QoL), it is important to identify their occurrence and commence immediate management. This study investigated whether differences in the perception of motor complications exist between patients and their physicians in routine clinical practice. Methods. After an Internet-based screening survey, questionnaires were distributed to physicians and their patients in Japan. The 9-item Wearing-Off Questionnaire (WOQ-9) was used to objectively assess the presence of WO; patients with WOQ-9 scores ≥2 were considered to have WO. McNemar’s test was used to compare physician assessment versus WOQ-9 scores, patient self-awareness versus physician assessment, and patient self-awareness versus WOQ-9, separately. Morning akinesia and dyskinesia were assessed by both physician assessment and patient self-awareness with McNemar’s test. QoL was assessed using the 8-item Parkinson’s Disease Questionnaire (PDQ-8) with the Wilcoxon rank-sum test. Results. A total of 235 patients with PD and their 92 physicians participated in this survey. A significant discordance was observed between the WOQ-9 and physician assessment of WO (67.2% vs 46.0%; p < 0.0001 ). Furthermore, patient self-awareness of WO was 35.3% ( p = 0.0004 , vs physician). Morning akinesia (patient, 58.7%; physician, 48.9%; p = 0.0032 ), dyskinesia (patient, 34.0%; physician, 23.4%; p = 0.0006 ), and bodily discomfort (patient, 25.0; physician, 0.0; p = 0.0102 ) of QoL were underrecognized by physicians. Conclusions. This study investigated differences in the perception of WO between patients with PD and their physicians in routine clinical practice and highlighted that patients have a low awareness of the symptoms of WO compared with physician assessments and WOQ-9. Conversely, morning akinesia, dyskinesia, and bodily discomfort were underrecognized by physicians.

Predicting Wearing-Off of Parkinson’s Disease Patients Using a Wrist-Worn Fitness Tracker and a Smartphone: A Case Study

Parkinson’s disease (PD) patients experience varying symptoms related to their illness. Therefore, each patient needs a tailored treatment program from their doctors. One approach is the use of anti-PD medicines. However, a “wearing-off” phenomenon occurs when these medicines lose their effect. As a result, patients start to experience the symptoms again until their next medicine intake. In the long term, the duration of “wearing-off” begins to shorten. Thus, patients and doctors have to work together to manage PD symptoms effectively. This study aims to develop a prediction model that can determine the “wearing-off” of anti-PD medicine. We used fitness tracker data and self-reported symptoms from a smartphone application in a real-world environment. Two participants wore the fitness tracker for a month while reporting any symptoms using the Wearing-Off Questionnaire (WoQ-9) on a smartphone application. Then, we processed and combined the datasets for each participant’s models. Our analysis produced prediction models for each participant. The average balanced accuracy with the best hyperparameters was at 70.0–71.7% for participant 1 and 76.1–76.9% for participant 2, suggesting that our approach would be helpful to manage the “wearing-off” of anti-PD medicine, motor fluctuations of PD patients, and customized treatment for PD patients.

Sigmoid PID based adaptive safe experimentation dynamics algorithm of portable duodopa pump for Parkinson’s disease patients

This paper emphasizes on the development of an appropriate closed-loop control strategy for traditional portable duodopa pump (PDP); thereby ensuring an automated drug infusion without wearing off. In particular, a sigmoid proportional integral derivative (SPID) controller is adopted to control the blood plasma level of dopamine. The parameters of SPID controller are tuned using the adaptive safe experimentation dynamics (ASED) algorithm. The efficiency of the suggested SPID-ASED is evaluated by concerning the convergence plot of the cost function, the amount of dopamine in the blood plasma (BP) of the patient, the statistical analysis of cost function, norm of error and norm of input, and time responses specifications. The simulation results show that the proposed SPID-ASED outperforms the standard PID controller in terms of better control accuracy with minimum overshoot and settling time.

Temporalis muscle thickness as an indicator of sarcopenia is associated with long-term motor outcomes in Parkinson’s disease

Background To investigate the relationship between temporalis muscle thickness (TMT) at baseline as a surrogate marker for sarcopenia and long-term motor outcomes in patients with Parkinson’s disease (PD). Methods We enrolled 249 patients with drug-naïve early-stage PD (119 males and 130 females, follow-up &gt; 3 years). Baseline TMT of each patient was measured on the axial plane of T1-weighted images. The association between baseline TMT and long-term motor outcomes in PD was assessed using Cox regression models for levodopa-induced dyskinesia (LID), wearing-off, and freezing of gait (FOG) and a linear mixed model for the longitudinal increases in levodopa-equivalent dose (LED) per body weight over time. Statistical analyses were performed separately for sex if an interaction effect between TMT and sex was assumed. Results TMT differed substantially between the sexes, and male PD patients had higher TMT (6.69 ± 1.39 mm) than female PD patients (5.64 ± 1.34 mm, p &lt; 0.001). Cox regression models demonstrated that baseline TMT was not associated with the risk of developing LID, wearing-off, or FOG during the follow-up period. The linear mixed model was applied separately for sex and demonstrated that higher TMT at baseline was associated with slower increases in LED per body weight in male PD patients, but not in female PD patients. Conclusions This study demonstrated that baseline TMT could be an indicator of the longitudinal requirement for dopaminergic medications in male patients with PD, suggesting that sarcopenia may have a detrimental effect on disease progression in PD in a sex-specific manner.