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Tam W, Alajlani M, Abd-Alrazaq A. An Exploration of Wearable Device Features Used in UK Hospital Parkinson Disease Care: Scoping Review. J Med Internet Res 2023; 25:e42950. [PMID: 37594791 PMCID: PMC10474516 DOI: 10.2196/42950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/13/2023] [Accepted: 04/14/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The prevalence of Parkinson disease (PD) is becoming an increasing concern owing to the aging population in the United Kingdom. Wearable devices have the potential to improve the clinical care of patients with PD while reducing health care costs. Consequently, exploring the features of these wearable devices is important to identify the limitations and further areas of investigation of how wearable devices are currently used in clinical care in the United Kingdom. OBJECTIVE In this scoping review, we aimed to explore the features of wearable devices used for PD in hospitals in the United Kingdom. METHODS A scoping review of the current research was undertaken and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The literature search was undertaken on June 6, 2022, and publications were obtained from MEDLINE or PubMed, Embase, and the Cochrane Library. Eligible publications were initially screened by their titles and abstracts. Publications that passed the initial screening underwent a full review. The study characteristics were extracted from the final publications, and the evidence was synthesized using a narrative approach. Any queries were reviewed by the first and second authors. RESULTS Of the 4543 publications identified, 39 (0.86%) publications underwent a full review, and 20 (0.44%) publications were included in the scoping review. Most studies (11/20, 55%) were conducted at the Newcastle upon Tyne Hospitals NHS Foundation Trust, with sample sizes ranging from 10 to 418. Most study participants were male individuals with a mean age ranging from 57.7 to 78.0 years. The AX3 was the most popular device brand used, and it was commercially manufactured by Axivity. Common wearable device types included body-worn sensors, inertial measurement units, and smartwatches that used accelerometers and gyroscopes to measure the clinical features of PD. Most wearable device primary measures involved the measured gait, bradykinesia, and dyskinesia. The most common wearable device placements were the lumbar region, head, and wrist. Furthermore, 65% (13/20) of the studies used artificial intelligence or machine learning to support PD data analysis. CONCLUSIONS This study demonstrated that wearable devices could help provide a more detailed analysis of PD symptoms during the assessment phase and personalize treatment. Using machine learning, wearable devices could differentiate PD from other neurodegenerative diseases. The identified evidence gaps include the lack of analysis of wearable device cybersecurity and data management. The lack of cost-effectiveness analysis and large-scale participation in studies resulted in uncertainty regarding the feasibility of the widespread use of wearable devices. The uncertainty around the identified research gaps was further exacerbated by the lack of medical regulation of wearable devices for PD, particularly in the United Kingdom where regulations were changing due to the political landscape.
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Affiliation(s)
- William Tam
- Insitute of Digital Healthcare, Warwick Manufacturing Group, University of Warwick, Coventry, United Kingdom
| | - Mohannad Alajlani
- Insitute of Digital Healthcare, Warwick Manufacturing Group, University of Warwick, Coventry, United Kingdom
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Marano M, Rosati J, Magliozzi A, Casamassa A, Rappa A, Sergi G, Iannizzotto M, Yekutieli Z, Vescovi AL, Di Lazzaro V. Circadian profile, daytime activity, and the Parkinson's phenotype: A motion sensor pilot study with neurobiological underpinnings. Neurobiol Sleep Circadian Rhythms 2023; 14:100094. [PMID: 37025301 PMCID: PMC10070882 DOI: 10.1016/j.nbscr.2023.100094] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023] Open
Abstract
Circadian rhythm impairment may play a role in Parkinson's disease (PD) pathophysiology. Recent literature associated circadian rhythm features to the risk of developing Parkinson and to its progression through stages. The association between the chronotype and the phenotype should be verified on a clinical and biological point of view. Herein we investigate the chronotype of a sample of 50 PD patients with the Morningness Eveningness Questionnaire and monitor their daily activity with a motion sensor embedded in a smartphone. Fibroblasts were collected from PD patients (n = 5) and from sex/age matched controls (n = 3) and tested for the circadian expression of clock genes (CLOCK, BMAL1, PER1, CRY1), and for cell morphology, proliferation, and death. Our results show an association between the chronotype and the PD phenotype. The most representative clinical chronotypes were "moderate morning" (56%), the "intermediate" (24%) and, in a minor part, the "definite morning" (16%). They differed for axial motor impairment, presence of motor fluctuations and quality of life (p < 0.05). Patients with visuospatial dysfunction and patients with a higher PIGD score had a blunted motor daily activity (p = 0.006 and p = 0.001, respectively), independently by the influence of age and other motor scores. Fibroblasts obtained by PD patients (n = 5) had an impaired BMAL1 cycle compared to controls (n = 3, p = 0.01). Moreover, a PD flat BMAL1 profile was associated with the lowest cell proliferation and the largest cell morphology. This study contributes to the growing literature on CR abnormalities in the pathophysiology of Parkinson's disease providing a link between the clinical and biological patient chronotype and the disease phenomenology.
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Affiliation(s)
- Massimo Marano
- Research Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 21, 00128, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo, 200, 00128, Roma, Italy
- Corresponding author. Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Fondazione Policlinico Universitario Campus Bio-Medico, Viale Alvaro del Portillo 200, 00128, Roma, Italy.
| | - Jessica Rosati
- Fondazione IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Alessandro Magliozzi
- Research Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 21, 00128, Roma, Italy
| | - Alessia Casamassa
- Fondazione IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Alessia Rappa
- Fondazione IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Gabriele Sergi
- Research Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 21, 00128, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo, 200, 00128, Roma, Italy
| | - Miriam Iannizzotto
- Research Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 21, 00128, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo, 200, 00128, Roma, Italy
| | | | | | - Vincenzo Di Lazzaro
- Research Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo, 21, 00128, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo, 200, 00128, Roma, Italy
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Smilowska K, van Wamelen DJ, Bloem BR. The multimodal effect of circadian interventions in Parkinson's disease: A narrative review. Parkinsonism Relat Disord 2023; 110:105309. [PMID: 36797197 DOI: 10.1016/j.parkreldis.2023.105309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The circadian system and its dysfunction in persons with Parkinson's disease (PwP) has a clear impact on both motor and non-motor symptoms. Examples include circadian patterns in motor disability, with worsening of symptoms throughout the day, but also the existence of similar patterns in non-motor symptoms. OBJECTIVE In this narrative review, we discuss the role of the circadian system, we address the role of dopamine in this system, and we summarise the evidence that supports the use of circadian system treatments for motor and non-motor symptoms in PwP. METHODS A systematic search in PubMed and Web of Science database was performed and the final search was performed in November 2021. We included articles whose primary aim was to investigate the effect of melatonin, melatonin agonists, and light therapy in PwP. RESULTS In total 25 articles were retrieved. Of these, 12 were related to bright light therapy and 13 to melatonin or/and melatonin agonists. Most, but not all, studies showed that melatonin and melatonin agonists and light therapy induced improvements in measures of sleep, depression, motor function, and some also cognitive function and other non-motor symptoms. For some of these outcomes, including daytime sleepiness, depressive symptoms, and some motor symptoms, there is level 2 B evidence for the use of circadian treatments in PwP. CONCLUSIONS Treatment with bright light therapy, exogenous melatonin and melatonin agonists seems to have not only positive effects on sleep quality and depression but also on motor function in PwP. Drawbacks in earlier work include the relatively small number of participants and the heterogeneity of outcome measures. Further large and well-designed trials are needed to address these shortcomings and to confirm or refute the possible merits of the circadian system as a treatment target in PwP.
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Affiliation(s)
- Katarzyna Smilowska
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands; Department of Neurology, Regional Specialist Hospital in Sosnowiec, Poland.
| | - Daniel J van Wamelen
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands; King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Basic and Clinical Neuroscience, London, United Kingdom; King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, London, United Kingdom; Parkinson's Foundation Center of Excellence, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.
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Wu L, Li S, Tang Y, Liang X, Xu Z, Hu T, Liu X, Cai M, Liu X. Quality of life: Seasonal fluctuation in Parkinson's disease. Front Neurol 2023; 13:1035721. [PMID: 36686501 PMCID: PMC9846796 DOI: 10.3389/fneur.2022.1035721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/30/2022] [Indexed: 01/06/2023] Open
Abstract
Objective Although the seasonal variation of motor and non-motor symptoms in Parkinson's disease (PD) has been reported, the association between seasonal change and quality of life in patients with Parkinson's disease remains to be explored. Methods We recruited 1,036 patients with PD in this cross-sectional retrospective study. The patients were divided into four groups based on their date of assessment, according to the classical four seasons: group 1: March to May (n = 241); group 2: June to August (n = 259); group 3: September to November(n = 273); group 4: December to February (n = 263). The 39-item Parkinson's Disease Questionnaire (PDQ-39) and other clinical evaluation scales for motor and non-motor symptoms were administered. The determinants of the quality of life (QoL) were analyzed by multiple stepwise regression analyses. Results A significant difference in PDQ-39 was found between group 1 (spring months) and group 3 (autumn months) after correction (p = 0.002). The Unified Parkinson's Disease Rating Scale part III (UPDRS-III) score was higher in group 1 (spring months) than in group 3 (the autumn months) (p = 0.033). The most severe determinant of QoL was the UPDRS-III score in group 1 and the Geriatric Depression Scale (GDS) score in groups 2, 3, and 4. Interpretation The current study reported seasonal fluctuation of QoL in patients with PD, with higher scores during the spring months and lower scores in the autumn months. Since the determinants for QoL also vary by season, clinicians might need to focus on specific factors across seasons before initiating therapy.
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Affiliation(s)
- Lei Wu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Shiyu Li
- State Key Laboratory of Medical Neurobiology, Department of Neurology, Huashan Hospital, National Research Center for Aging and Medicine and National Center for Neurological Disorders, Fudan University, Shanghai, China
| | - Yilin Tang
- State Key Laboratory of Medical Neurobiology, Department of Neurology, Huashan Hospital, National Research Center for Aging and Medicine and National Center for Neurological Disorders, Fudan University, Shanghai, China
| | - Xiaoniu Liang
- State Key Laboratory of Medical Neurobiology, Department of Neurology, Huashan Hospital, National Research Center for Aging and Medicine and National Center for Neurological Disorders, Fudan University, Shanghai, China
| | - Zhiheng Xu
- State Key Laboratory of Medical Neurobiology, Department of Neurology, Huashan Hospital, National Research Center for Aging and Medicine and National Center for Neurological Disorders, Fudan University, Shanghai, China
| | - Tianyu Hu
- State Key Laboratory of Medical Neurobiology, Department of Neurology, Huashan Hospital, National Research Center for Aging and Medicine and National Center for Neurological Disorders, Fudan University, Shanghai, China
| | - Xiaoli Liu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Miao Cai
- Department of Neurology, Zhejiang Hospital, Hangzhou, China,Miao Cai ✉
| | - Xuedong Liu
- Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China,*Correspondence: Xuedong Liu ✉
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Li P, van Wezel R, He F, Zhao Y, Wang Y. The role of wrist-worn technology in the management of Parkinson's disease in daily life: A narrative review. Front Neuroinform 2023; 17:1135300. [PMID: 37124068 PMCID: PMC10130445 DOI: 10.3389/fninf.2023.1135300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder that affects millions of people worldwide. Its slow and heterogeneous progression over time makes timely diagnosis challenging. Wrist-worn digital devices, particularly smartwatches, are currently the most popular tools in the PD research field due to their convenience for long-term daily life monitoring. While wrist-worn sensing devices have garnered significant interest, their value for daily practice is still unclear. In this narrative review, we survey demographic, clinical and technological information from 39 articles across four public databases. Wrist-worn technology mainly monitors motor symptoms and sleep disorders of patients in daily life. We find that accelerometers are the most commonly used sensors to measure the movement of people living with PD. There are few studies on monitoring the disease progression compared to symptom classification. We conclude that wrist-worn sensing technology might be useful to assist in the management of PD through an automatic assessment based on patient-provided daily living information.
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Affiliation(s)
- Peng Li
- Biomedical Signals and Systems (BSS) Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, Netherlands
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- *Correspondence: Peng Li,
| | - Richard van Wezel
- Biomedical Signals and Systems (BSS) Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, Netherlands
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Fei He
- Centre for Computational Science and Mathematical Modelling, Coventry University, Coventry, United Kingdom
| | - Yifan Zhao
- School of Aerospace, Transport and Manufacturing, Cranfield University, Cranfield, United Kingdom
| | - Ying Wang
- Biomedical Signals and Systems (BSS) Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, Netherlands
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Rota S, Urso D, van Wamelen DJ, Leta V, Boura I, Odin P, Espay AJ, Jenner P, Chaudhuri KR. Why do 'OFF' periods still occur during continuous drug delivery in Parkinson's disease? Transl Neurodegener 2022; 11:43. [PMID: 36229860 PMCID: PMC9558383 DOI: 10.1186/s40035-022-00317-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Continuous drug delivery (CDD) is used in moderately advanced and late-stage Parkinson’s disease (PD) to control motor and non-motor fluctuations (‘OFF’ periods). Transdermal rotigotine is indicated for early fluctuations, while subcutaneous apomorphine infusion and levodopa-carbidopa intestinal gel are utilised in advanced PD. All three strategies are considered examples of continuous dopaminergic stimulation achieved through CDD. A central premise of the CDD is to achieve stable control of the parkinsonian motor and non-motor states and avoid emergence of ‘OFF’ periods. However, data suggest that despite their efficacy in reducing the number and duration of ‘OFF’ periods, these strategies still do not prevent ‘OFF’ periods in the middle to late stages of PD, thus contradicting the widely held concepts of continuous drug delivery and continuous dopaminergic stimulation. Why these emergent ‘OFF’ periods still occur is unknown. In this review, we analyse the potential reasons for their persistence. The contribution of drug- and device-related involvement, and the problems related to site-specific drug delivery are analysed. We propose that changes in dopaminergic and non-dopaminergic mechanisms in the basal ganglia might render these persistent ‘OFF’ periods unresponsive to dopaminergic therapy delivered via CDD.
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Affiliation(s)
- Silvia Rota
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK. .,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Daniele Urso
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro, "Pia Fondazione Cardinale G. Panico", 73039, Tricase, Italy
| | - Daniel J van Wamelen
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Valentina Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Iro Boura
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,School of Medicine, University of Crete, Crete, Greece.,Department of Neurology, University Hospital of Heraklion, Crete, Greece
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alberto J Espay
- University of Cincinnati Gardner Neuroscience Institute, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Science and Medicine, King's College London, London, UK.
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
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Tam W, Alajlani M, Abd-alrazaq A. An Exploration of Wearable Device Features Used in UK Hospital Parkinson Disease Care: Scoping Review (Preprint).. [DOI: 10.2196/preprints.42950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND
The prevalence of Parkinson disease (PD) is becoming an increasing concern owing to the aging population in the United Kingdom. Wearable devices have the potential to improve the clinical care of patients with PD while reducing health care costs. Consequently, exploring the features of these wearable devices is important to identify the limitations and further areas of investigation of how wearable devices are currently used in clinical care in the United Kingdom.
OBJECTIVE
In this scoping review, we aimed to explore the features of wearable devices used for PD in hospitals in the United Kingdom.
METHODS
A scoping review of the current research was undertaken and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The literature search was undertaken on June 6, 2022, and publications were obtained from MEDLINE or PubMed, Embase, and the Cochrane Library. Eligible publications were initially screened by their titles and abstracts. Publications that passed the initial screening underwent a full review. The study characteristics were extracted from the final publications, and the evidence was synthesized using a narrative approach. Any queries were reviewed by the first and second authors.
RESULTS
Of the 4543 publications identified, 39 (0.86%) publications underwent a full review, and 20 (0.44%) publications were included in the scoping review. Most studies (11/20, 55%) were conducted at the Newcastle upon Tyne Hospitals NHS Foundation Trust, with sample sizes ranging from 10 to 418. Most study participants were male individuals with a mean age ranging from 57.7 to 78.0 years. The AX3 was the most popular device brand used, and it was commercially manufactured by Axivity. Common wearable device types included body-worn sensors, inertial measurement units, and smartwatches that used accelerometers and gyroscopes to measure the clinical features of PD. Most wearable device primary measures involved the measured gait, bradykinesia, and dyskinesia. The most common wearable device placements were the lumbar region, head, and wrist. Furthermore, 65% (13/20) of the studies used artificial intelligence or machine learning to support PD data analysis.
CONCLUSIONS
This study demonstrated that wearable devices could help provide a more detailed analysis of PD symptoms during the assessment phase and personalize treatment. Using machine learning, wearable devices could differentiate PD from other neurodegenerative diseases. The identified evidence gaps include the lack of analysis of wearable device cybersecurity and data management. The lack of cost-effectiveness analysis and large-scale participation in studies resulted in uncertainty regarding the feasibility of the widespread use of wearable devices. The uncertainty around the identified research gaps was further exacerbated by the lack of medical regulation of wearable devices for PD, particularly in the United Kingdom where regulations were changing due to the political landscape.
CLINICALTRIAL
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van Wamelen DJ, Rota S, Schrag A, Rizos A, Martinez‐Martin P, Weintraub D, Chaudhuri KR. Characterisation of non‐motor fluctuations using the Movement Disorder Society
Non‐Motor
Rating Scale. Mov Disord Clin Pract 2022; 9:932-940. [PMID: 36247921 PMCID: PMC9547143 DOI: 10.1002/mdc3.13520] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/24/2022] [Accepted: 07/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background Non‐motor fluctuations (NMF) in people with Parkinson's disease (PwP) are clinically important yet understudied. Objective To study NMF in PwP using both the Movement Disorder Society Non‐Motor Rating Scale (MDS‐NMS) NMF subscale and wearable sensors. Methods We evaluated differences in overall burden of NMF and of specific NMF across disease durations: <2 years (n = 33), 2–5 years (n = 35), 5–10 years (n = 33), and > 10 years (n = 31). In addition, wearable triaxial sensor output was used as an exploratory outcome for early morning “off” periods. Results Significant between‐group differences were observed for MDS‐NMS NMF total scores (P < 0.001), and specifically for depression, anxiety, fatigue and cognition, with both NMF prevalence and burden increasing in those with longer disease duration. Whereas only 9.1% with a short disease duration had NMF (none of whom had dyskinesia), in PwP with a disease duration of >10 years this was 71.0% (P < 0.001). From a motor perspective, dyskinesia severity increased evenly with increasing disease duration, while NMF scores in affected individuals showed an initial increase with largest differences between 2–5 years disease duration (P < 0.001), with plateauing afterwards. Finally, we observed that the most common NMF symptoms in patients with sensor‐confirmed early morning “off” periods were fluctuations in cognitive capabilities, restlessness, and excessive sweating. Conclusions Non‐motor fluctuations prevalence in PwP increases with disease duration, but in a pattern different from motor fluctuations. Moreover, NMF can occur in PwP without dyskinesia, and in those with NMF the severity of NMF increases most during years 2–5 after diagnosis.
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Affiliation(s)
- Daniel J. van Wamelen
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic & Clinical Neuroscience Division of Neuroscience, King's College London London United Kingdom
- Parkinson Foundation Centre of Excellence at King's College Hospital NHS Foundation Trust; London United Kingdom
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology Centre of Expertise for Parkinson & Movement Disorders Nijmegen the Netherlands
| | - Silvia Rota
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic & Clinical Neuroscience Division of Neuroscience, King's College London London United Kingdom
- Parkinson Foundation Centre of Excellence at King's College Hospital NHS Foundation Trust; London United Kingdom
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences UCL Institute of Neurology, University College London London United Kingdom
| | - Alexandra Rizos
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic & Clinical Neuroscience Division of Neuroscience, King's College London London United Kingdom
- Parkinson Foundation Centre of Excellence at King's College Hospital NHS Foundation Trust; London United Kingdom
| | - Pablo Martinez‐Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED) Carlos III Institute of Health Madrid Spain
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia USA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC) Philadelphia Veterans Affairs Medical Center Philadelphia USA
| | - K. Ray Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic & Clinical Neuroscience Division of Neuroscience, King's College London London United Kingdom
- Parkinson Foundation Centre of Excellence at King's College Hospital NHS Foundation Trust; London United Kingdom
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Lv Y, Xu B, Zhang X, Chen C, Gao Y, Li N. Association of serum cholesterol with Parkinson's disease in a cohort of statin-free individuals. Brain Behav 2022; 12:e2454. [PMID: 34894416 PMCID: PMC8785640 DOI: 10.1002/brb3.2454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/13/2021] [Accepted: 11/21/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The role of serum cholesterol in the pathogenesis of Parkinson's disease (PD) remains unclear. The objective of this study was to assess the association between serum cholesterol and PD in a cohort of statin-free newly diagnosed PD patients. METHODS This retrospective study used fasting lipid profiles obtained from 672 consecutive statin-free newly diagnosed PD individuals and 540 controls. These PD individuals were identified from three medical institutions during 2017-2021, and the controls were identified from three physical examination centers during the same time period. Logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with adjustment of age, sex, and tobacco use history. RESULTS Among 672 PD individuals, 112 were excluded in accordance with the current criteria, leaving 560 PD patients. The multivariate binary logistic regression analysis showed that LDL-C was the only variable contributing to the occurrence of PD (OR 1.39, 95% CI: 1.07-2.31, p < .001) after adjusting for age, sex, and tobacco use history; this association persisted following further adjustment for TC and HDL-C. In the subgroup analysis of the adjusted results of LDL-C after correcting for TC and HDL-C, lower LDL-C was associated with a higher risk of PD. CONCLUSION Among selected populations of statin-free newly diagnosed PD individuals, low LDL-C might be associated with the occurrence of PD.
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Affiliation(s)
- Yukai Lv
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bo Xu
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xuejuan Zhang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chunhuan Chen
- Department of Anaesthesiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yan Gao
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Ning Li
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
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Beckers M, Lees AJ, Nutt JG, Bloem BR. Turning Back the Clock in Parkinson's Disease: Practical Recommendations for Managing Diurnal Symptom Worsening. JOURNAL OF PARKINSONS DISEASE 2021; 11:1471-1473. [PMID: 33967059 DOI: 10.3233/jpd-212711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Milan Beckers
- Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
| | - John G Nutt
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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van Wamelen DJ, Sringean J, Trivedi D, Carroll CB, Schrag AE, Odin P, Antonini A, Bloem BR, Bhidayasiri R, Chaudhuri KR. Digital health technology for non-motor symptoms in people with Parkinson's disease: Futile or future? Parkinsonism Relat Disord 2021; 89:186-194. [PMID: 34362670 DOI: 10.1016/j.parkreldis.2021.07.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is an ongoing digital revolution in the field of Parkinson's disease (PD) for the objective measurement of motor aspects, to be used in clinical trials and possibly support therapeutic choices. The focus of remote technologies is now also slowly shifting towards the broad but more "hidden" spectrum of non-motor symptoms (NMS). METHODS A narrative review of digital health technologies for measuring NMS in people with PD was conducted. These digital technologies were defined as assessment tools for NMS offered remotely in the form of a wearable, downloadable as a mobile app, or any other objective measurement of NMS in PD that did not require a hospital visit and could be performed remotely. Searches were performed using peer-reviewed literature indexed databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane CENTRAL Register of Controlled Trials), as well as Google and Google Scholar. RESULTS Eighteen studies deploying digital health technology in PD were identified, for example for the measurement of sleep disorders, cognitive dysfunction and orthostatic hypotension. In addition, we describe promising developments in other conditions that could be translated for use in PD. CONCLUSION Unlike motor symptoms, non-motor features of PD are difficult to measure directly using remote digital technologies. Nonetheless, it is currently possible to reliably measure several NMS and further digital technology developments are underway to offer further capture of often under-reported and under-recognised NMS.
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Affiliation(s)
- Daniel J van Wamelen
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom; Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, the Netherlands.
| | - Jirada Sringean
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Dhaval Trivedi
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom
| | - Camille B Carroll
- Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Anette E Schrag
- Department of Clinical and Movement Neurosciences, University College London, London, United Kingdom
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Angelo Antonini
- Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Bastiaan R Bloem
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, the Netherlands
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - K Ray Chaudhuri
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom
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