Continuous, objective monitoring of motor signs and symptoms may help improve tracking of disease progression and treatment response in Parkinson’s disease (PD). This study assessed the analytical and clinical validity of multi-sensor smartwatch measurements in hospitalized and home-based settings (96 patients with PD; mean wear time 19 h/day) using a twice-daily virtual motor examination (VME) at times representing medication OFF/ON states. Digital measurement performance was better during inpatient clinical assessments for composite V-scores than single-sensor–derived features for bradykinesia (Spearman |r|= 0.63, reliability = 0.72), tremor (|r|= 0.41, reliability = 0.65), and overall motor features (|r|= 0.70, reliability = 0.67). Composite levodopa effect sizes during hospitalization were 0.51–1.44 for clinical assessments and 0.56–1.37 for VMEs. Reliability of digital measurements during home-based VMEs was 0.62–0.80 for scores derived from weekly averages and 0.24–0.66 for daily measurements. These results show that unsupervised digital measurements of motor features with wrist-worn sensors are sensitive to medication state and are reliable in naturalistic settings.Trial Registration: Japan Pharmaceutical Information Center Clinical Trials Information (JAPIC-CTI): JapicCTI-194825; Registered June 25, 2019.

The coronavirus disease 2019 (COVID-19) pandemic changed the lives of patients with Parkinson's disease (PD) and their caregivers. This study aimed to investigate changes in patient behavior and PD symptoms and their effect on caregiver burden resulting from the COVID-19 pandemic in Japan. Methods: This nationwide, observational, cross-sectional survey included patients with self-reported PD and caregivers (members of the Japan Parkinson's Disease Association). The primary objective was to evaluate changes in behaviors, self-assessed PD symptoms, and caregiver burden from pre-COVID-19 (February 2020) to post-national state of emergency (August 2020 and February 2021). Results: Responses from 1883 patients and 1382 caregivers from 7610 distributed surveys were analyzed. Mean (standard deviation) age of patients and caregivers was 71.6 (8.2) and 68.5 (11.4) years, respectively; 41.6% of patients had a Hoehn and Yahr (HY) scale of 3. Patients (>40.0%) reported decreased frequency of going out. Most patients (>70.0%) reported no change in treatment visit frequency, voluntary training, or rehabilitation and nursing care insurance services. Symptoms worsened for approximately 7-30% of patients; the proportion with HY scale 4-5 increased from pre-COVID-19 (25.2%) to February 2021 (40.1%). Aggravated symptoms included bradykinesia, walking, gait speed, depressed mood, fatigue, and apathy. Caregivers' burden increased because of patients' worsened symptoms and reduced time going out. Conclusion: Control measures during infectious disease epidemics should consider that patients' symptoms may worsen; therefore, patient and caregiver support is needed to reduce burden of care.

Background: As motor symptoms of Parkinson's disease (PD) progress, visits to medical clinics for patients and caregivers become burdensome. Aim:The aim of this study is to examine satisfaction with an integrated digital platform (online medical examination, online medication instruction, drug delivery, and remote patient monitoring) in PD.Methods: This multicenter, prospective, observational pilot study (July 2020-March 2021), comprising face-to-face (weeks 0-4) and online (weeks 5-16) periods, included patients with PD aged ≥20 years capable of visiting a clinic. PD symptoms were collected via a smartwatch and mobile phone. Patient-assessed (primary objective) and caregiver-and physician-assessed (secondary objectives) satisfaction was evaluated using the Client Satisfaction Questionnaire-8 (CSQ-8) and a self-completed questionnaire, respectively. Changes in patient and caregiver burden were also assessed (exploratory objective).Results: Thirty patients, 15 caregivers, and six physicians participated. The mean (SD) age of patients was 66.7 (8.5) years, 63.3% were male, mean (SD) duration of disease was 8.04 (5.4) years. CSQ-8 total mean (SD) score was 25.6 (3.06), 25.7 (3.05), and 23.2 (3.96) at week 0 (n = 30), week 4 (n = 30), and week 16 (n = 29), respectively. Assessment of the individual components of the digital platform indicated a degree of satisfaction with online medical examination and online medication instruction and drug delivery; satisfaction with remote patient monitoring was moderate. During the online period, patient and caregiver burdens were reduced. Conclusion: Patients, caregivers, and physicians were satisfied with the integrated digital platform. Future research to prove the medical usefulness of this platform is required.