Parkinson’s Disease: Personalized Pathway of Care for Device-Aided Therapies (DAT) and the Role of Continuous Objective Monitoring (COM) Using Wearable Sensors
Abstract
:1. Introduction
2. Available Infusion Therapies or Device-Aided Therapies (DAT) and Patient Selection
2.1. Selection of the Ideal Patient
2.2. Apomorphine: History and Molecular Structure
2.3. DAT Therapies: Evidence-Based Clinical Motor and Non-Motor Outcomes
2.4. Objective Measurements of Patient Outcomes in Parkinson’s Disease: Rating Scales
2.4.1. MDS-UPDRS Scale
2.4.2. Hoehn and Yahr Rating Scale
2.4.3. Short Parkinson’s Evaluation Scale/Scales for Outcomes in Parkinson’s Disease (SPES/SCOPA)
2.4.4. Non-Motor Symptoms Scale (NMSS)
2.4.5. PDSS (Parkinson’s Disease Sleep Scale)
2.4.6. King’s Parkinson’s Pain Scale (KPSS)
2.4.7. Montreal Cognitive Assessment (MoCA)
2.4.8. Hospital Anxiety and Depression Scale (HADS)
2.4.9. Parkinson’s Disease Questionnaires (PDQ-8 and PDQ-39)
2.4.10. Parkinson’s Disease Questionnaire (PDQ-8)
3. Continuous Objective Monitoring (COM) Using Wearable Sensors and Its Role in Identifying Potential Candidates for Device-Aided Therapies (DAT)
3.1. About PKG
3.2. Glossary of PKG Terms
- Median BKS. The median BKS was the 50th percentile of the BKS for all 6 days the PKG was worn (usually 6 days).
- The interquartile range of the BKS was a measure of the fluctuation of the BKS.
- The percent time in bradykinesia (PTB). Epochs whose BKS lay between 26.1 and 49.4 and whose 25th percentiles of the BKS were >18.5 and 90th percentiles, <80. Additionally, any epoch whose BKS was >49.9 but contained tremor was included.
- Median DKS: This is the 50th percentile for all the days that the PKG was worn. Brisk walking introducing resonant peaks may artificially increase the DKS. An algorithm was used to detect and remove epochs affected in this way.
- Interquartile range of DKS: calculates the median BKS and is a measure of the fluctuation of the DKS.
- Percent time in dyskinesia (PTD): Those DKS used to estimate the median DKS were passed through a median filter (most of the epochs in the filter period must be in the dyskinetic range (DKS > 7) for the centre to be classed as dyskinetic).
- Percent time with tremor (PTT): This was the percentage of 2 min epochs estimated over all the days that the PKG was worn that contained tremor. Tremor is likely to be present if the PTT score is >1%.
- The percent time immobile (PTI): This was the percentage of 2 min epochs with BKS > 80 from all the days that the PKG was worn. These scores were associated with daytime sleep.
- The doses of levodopa/day. These were calculated from the number of reminders programmed into the logger.
3.3. PKG Database and Associated Studies
4. Conclusions
4.1. Clinical Scenario 1
4.1.1. Current PD Medications
- Stalevo (l’dopa, 200 mg carbidopa, 50 mg; entacopone, 200 mg) QDS;
- Sinemet, controlled release, 250 mg (l’dopa, 200 mg; carbidopa, 50 mg) ON;
- Rotigotine, 8 mg (he responded very well initially and then started developing rashes, on rotigotine patches for 3 years);
- Previously tried a dopaminergic regime (selegiline, ropinorole, sinemet, etc.).
4.1.2. Current Ongoing Problems
- Troublesome dyskinesias;
- Unpredictable offs/freezing episodes;
- Attention/memory/cognitive problems;
- Apathy/hallucinations and non-intrusive perceptual issues.
4.2. Clinical Scenario 2
4.2.1. Current PD Medications
- Sinemet PLUS (l’dopa, 100 mg; carbidopa, 25 mg) at 7 am, 10 am, 1 pm, 4 pm, and 7 pm;
- Sinemet, controlled release, 250 mg (l’dopa, 200 mg; carbidopa, 50 mg) at 10 pm;
- Opicopone, 50 mg, 8 pm;
- Previously tried a dopaminergic regime (pramipexole, ropinorole, and entacopone).
4.2.2. Current Ongoing Problems
- Troublesome dyskinesias;
- Unpredictable offs/freezing episodes/falls;
- Cardiovascular, urinary, and gastrointestinal dysfunction;
- Severe sleep-related issues (excessive daytime sleepiness);
- Previous adverse reactions to dopamine agonists.
4.3. Discussion and Outcomes
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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PEN (Figure 4) | PUMP (Figure 4) |
---|---|
Anticipated rescue when required during motor and non-motor “off” periods | Patient considers that rescue doses required too frequently |
When absorption of oral levodopa is impaired or the patient has gastric emptying problems (gastroparesis) | Dyskinesias limit further therapy optimization |
To treat delayed “on” | Simplify complex PD dosing regimens to improve convenience and compliance |
To treat early-morning problems (akinesia and dystonia) | Alternative to surgical therapy or LCIG, if contraindicated, or due to patient preference |
Absorption or gastric emptying of oral levodopa is impaired |
Symptoms That Support Use | Symptoms That Discourage Use |
---|---|
Dyskinesias | Marked ongoing hallucinations/psychosis |
Maintenance insomnia | Impulse-control disorders |
Pronounced therapy-refractory depression | Drug-related daytime somnolence |
Non-motor fluctuations | Orthostatic hypotension |
Dysarthria | Marked ongoing hallucinations/psychosis |
Restless legs |
Symptoms That Support Use | Symptoms That Discourage Use |
---|---|
Dyskinesias | No specific symptoms (like severe dementia) to discourage use; presence of some symptoms may require further investigation |
Drug-related hallucinations and/or delusions in patient history | |
Impulse-control disorders | |
Maintenance insomnia | |
Mild cognitive impairment | |
Pronounced therapy-refractory depression | |
Dysarthria | |
Restless legs |
Symptoms That Support Use | Symptoms That Discourage Use |
---|---|
Dyskinesias | Marked ongoing hallucinations |
Drug-related hallucinations and/or delusions in patient history | Dementia |
Impulse-control disorders | Pronounced therapy-refractory depression |
Maintenance insomnia | Dysphagia |
Non-motor fluctuations | Dysarthria |
L-dopa-unresponsive postural and gait problems, falls | |
Marked ongoing hallucinations |
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Metta, V.; Batzu, L.; Leta, V.; Trivedi, D.; Powdleska, A.; Mridula, K.R.; Kukle, P.; Goyal, V.; Borgohain, R.; Chung-Faye, G.; et al. Parkinson’s Disease: Personalized Pathway of Care for Device-Aided Therapies (DAT) and the Role of Continuous Objective Monitoring (COM) Using Wearable Sensors. J. Pers. Med. 2021, 11, 680. https://doi.org/10.3390/jpm11070680
Metta V, Batzu L, Leta V, Trivedi D, Powdleska A, Mridula KR, Kukle P, Goyal V, Borgohain R, Chung-Faye G, et al. Parkinson’s Disease: Personalized Pathway of Care for Device-Aided Therapies (DAT) and the Role of Continuous Objective Monitoring (COM) Using Wearable Sensors. Journal of Personalized Medicine. 2021; 11(7):680. https://doi.org/10.3390/jpm11070680
Chicago/Turabian StyleMetta, Vinod, Lucia Batzu, Valentina Leta, Dhaval Trivedi, Aleksandra Powdleska, Kandadai Rukmini Mridula, Prashanth Kukle, Vinay Goyal, Rupam Borgohain, Guy Chung-Faye, and et al. 2021. "Parkinson’s Disease: Personalized Pathway of Care for Device-Aided Therapies (DAT) and the Role of Continuous Objective Monitoring (COM) Using Wearable Sensors" Journal of Personalized Medicine 11, no. 7: 680. https://doi.org/10.3390/jpm11070680