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Arora S, Baig F, Lo C, Barber TR, Lawton MA, Zhan A, Rolinski M, Ruffmann C, Klein JC, Rumbold J, Louvel A, Zaiwalla Z, Lennox G, Quinnell T, Dennis G, Wade-Martins R, Ben-Shlomo Y, Little MA, Hu MT. Smartphone motor testing to distinguish idiopathic REM sleep behavior disorder, controls, and PD. Neurology 2018; 91:e1528-e1538. [PMID: 30232246 PMCID: PMC6202945 DOI: 10.1212/wnl.0000000000006366] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/12/2018] [Indexed: 11/28/2022] Open
Abstract
Objective We sought to identify motor features that would allow the delineation of individuals with sleep study-confirmed idiopathic REM sleep behavior disorder (iRBD) from controls and Parkinson disease (PD) using a customized smartphone application. Methods A total of 334 PD, 104 iRBD, and 84 control participants performed 7 tasks to evaluate voice, balance, gait, finger tapping, reaction time, rest tremor, and postural tremor. Smartphone recordings were collected both in clinic and at home under noncontrolled conditions over several days. All participants underwent detailed parallel in-clinic assessments. Using only the smartphone sensor recordings, we sought to (1) discriminate whether the participant had iRBD or PD and (2) identify which of the above 7 motor tasks were most salient in distinguishing groups. Results Statistically significant differences based on these 7 tasks were observed between the 3 groups. For the 3 pairwise discriminatory comparisons, (1) controls vs iRBD, (2) controls vs PD, and (3) iRBD vs PD, the mean sensitivity and specificity values ranged from 84.6% to 91.9%. Postural tremor, rest tremor, and voice were the most discriminatory tasks overall, whereas the reaction time was least discriminatory. Conclusions Prodromal forms of PD include the sleep disorder iRBD, where subtle motor impairment can be detected using clinician-based rating scales (e.g., Unified Parkinson's Disease Rating Scale), which may lack the sensitivity to detect and track granular change. Consumer grade smartphones can be used to accurately separate not only iRBD from controls but also iRBD from PD participants, providing a growing consensus for the utility of digital biomarkers in early and prodromal PD.
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Affiliation(s)
- Siddharth Arora
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Fahd Baig
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Christine Lo
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Thomas R Barber
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Michael A Lawton
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Andong Zhan
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Michal Rolinski
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Claudio Ruffmann
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Johannes C Klein
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Jane Rumbold
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Amandine Louvel
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Zenobia Zaiwalla
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Graham Lennox
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Tim Quinnell
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Gary Dennis
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Richard Wade-Martins
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Yoav Ben-Shlomo
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Max A Little
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA
| | - Michele T Hu
- From the Oxford Parkinson's Disease Centre (OPDC) (S.A., F.B., C.L., T.R.B., M.R., C.R., J.C.K., J.R., A.L., R.W.-M, M.T.H.), University of Oxford, UK; Engineering and Applied Science (S.A., M.A.L.), Aston University, Birmingham, UK; Somerville College (S.A.), University of Oxford, UK; Nuffield Department of Clinical Neurosciences (F.B., C.L., T.R.B., M.A.L., M.T.H.), University of Oxford, UK; Population Health Sciences (M.A.L.), University of Bristol, UK; andDepartment of Computer Science (A.Z.), Johns Hopkins University, Baltimore; Department of Neurology and Neurophysiology (Z.Z., G.L., M.T.H.), Oxford University Hospitals NHS Trust, UK; Respiratory Support and Sleep Centre (T.Q.), Papworth Hospital, Cambridge, UK; Department of Neurology (G.D.), Royal Hallamshire Hospital, Sheffield, UK; and Media Lab (M.A.L.), Massachusetts Institute of Technology, Cambridge, MA.
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