Parkinson's disease home diary: Further validation and implications for clinical trials

Hauser, Robert A.; Deckers, F.; Lehert, Philippe

doi:10.1002/mds.20248

Cited by 168 publications

(149 citation statements)

References 4 publications

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“…Hourly intervals were employed in an attempt to minimise the burden of diary completion, due to concern about the potential negative effect burdensome diaries could have on both diary concordance and accuracy. We do however acknowledge that symptom diaries based on a 30 min interval are widely used in PD research [33] and may provide improved data for future work.…”

Section: Discussionmentioning

confidence: 99%

Unsupervised home monitoring of Parkinson's disease motor symptoms using body-worn accelerometers

Fisher

Hammerla

Ploetz

et al. 2016

Parkinsonism & Related Disorders

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IntroductionCurrent PD assessment methods have inherent limitations. There is need for an objective method to assist clinical decisions and to facilitate evaluation of treatments. Accelerometers, and analysis using artificial neural networks (ANN), have shown potential as a method of motor symptom evaluation. This work describes the development of a novel PD disease state detection system informed by algorithms based on data collected in an unsupervised, home environment. We evaluated whether this approach can reproduce patient-completed symptom diaries and clinical assessment of disease state. Methods34 participants with PD wore bilateral wrist-worn accelerometers for 4 h in a research facility (phase 1) and for 7 days at home whilst completing symptom diaries (phase 2). An ANN to predict disease state was developed based on home-derived accelerometer data. Using a leave-one-out approach, ANN performance was evaluated against patient-completed symptom diaries and against clinician rating of disease state. ResultsIn the clinical setting, specificity for dyskinesia detection was extremely high (0.99); high specificity was also demonstrated for home-derived data (0.93), but with low sensitivity (0.38). In both settings, sensitivity for on/off detection was sub-optimal. ANN-derived values of the proportions of time in each disease state showed strong, significant correlations with patient-completed symptom diaries.

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Section: Discussionmentioning

confidence: 99%

Unsupervised home monitoring of Parkinson's disease motor symptoms using body-worn accelerometers

Fisher

Hammerla

Ploetz

et al. 2016

Parkinsonism & Related Disorders

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“…Parkinsonism was assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) and timed motor tests (7-m Walk and finger tapping), 25 Functional Reach test for balance, 20 total daily levodopa equivalents, 26 and a patient diary. 27 Quality of life. The following scales were used to assess quality of life: Fatigue Severity Scale (FSS), 28 Geriatric Depression Scale, 20 and PD Quality of Life Scale (PDQUALIF).…”

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confidence: 99%

Phase I/II randomized trial of aerobic exercise in Parkinson disease in a community setting

et al. 2014

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Objectives: To (1) investigate effects of aerobic walking on motor function, cognition, and quality of life in Parkinson disease (PD), and (2) compare safety, tolerability, and fitness benefits of different forms of exercise intervention: continuous/moderate intensity vs interval/alternating between low and vigorous intensity, and individual/neighborhood vs group/facility setting. Methods:Initial design was a 6-month, 2 3 2 randomized trial of different exercise regimens in independently ambulatory patients with PD. All arms were required to exercise 3 times per week, 45 minutes per session.Results: Randomization to group/facility setting was not feasible because of logistical factors.Over the first 2 years, we randomized 43 participants to continuous or interval training. Because preliminary analyses suggested higher musculoskeletal adverse events in the interval group and lack of difference between training methods in improving fitness, the next 17 participants were allocated only to continuous training. Eighty-one percent of 60 participants completed the study with a mean attendance of 83.3% (95% confidence interval: 77.5%-89.0%), exercising at 46.8% (44.0%-49.7%) of their heart rate reserve. There were no serious adverse events. Across all completers, we observed improvements in maximum oxygen consumption, gait speed, Unified Parkinson's Disease Rating Scale sections I and III scores (particularly axial functions and rigidity), fatigue, depression, quality of life (e.g., psychological outlook), and flanker task scores (p , 0.05 to p , 0.001). Increase in maximum oxygen consumption correlated with improvements on the flanker task and quality of life (p , 0.05). Conclusions:Our preliminary study suggests that aerobic walking in a community setting is safe, well tolerated, and improves aerobic fitness, motor function, fatigue, mood, executive control, and quality of life in mild to moderate PD. Classification of evidence:This study provides Class IV evidence that in patients with PD, an aerobic exercise program improves aerobic fitness, motor function, fatigue, mood, and cognition. Figure Test; FSS 5 Fatigue Severity Scale; HR max 5 maximal heart rate; HRR 5 heart rate reserve; PD 5 Parkinson disease; PDQUALIF 5 Parkinson's Disease Quality of Life Scale; PIS 5 percent increase score; RT 5 reaction time; UPDRS 5 Unified Parkinson's Disease Rating Scale; Vȯ 2 5 maximum oxygen uptake.

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“…A PD-specific home diary to assess functional status in patients with motor fluctuations and dyskinesia has been validated for use in clinical trials [41, 42]. The diary asks patients to indicate their predominant status over half-hour intervals based on the following categories: ‘asleep’; ‘off’; ‘on’ without dyskinesia; ‘on’ with nontroublesome dyskinesia, and ‘on’ with troublesome dyskinesia [42].…”

Section: Impact Of Dyskinesias On Quality Of Lifementioning

confidence: 99%

Levodopa-Induced Dyskinesias in Parkinson’s Disease: Etiology, Impact on Quality of Life, and Treatments

Encarnacion¹,

Hauser

2008

Eur Neurol

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Levodopa is the most effective agent to alleviate motor dysfunction in Parkinson’s disease but its long-term use is associated with the development of dyskinesias. Although the pathogenic processes behind the development of levodopa-induced dyskinesias are still being elucidated, it appears that chronic administration of this short-lived agent results in nonphysiologic pulsatile stimulation of striatal neurons and abnormal firing patterns in the basal ganglia. Dyskinesias have been associated with decreased quality of life, and a number of methodologies to evaluate severity of dyskinesias are now available. Strategies to avoid, reduce, or eliminate dyskinesias include providing more continuous dopaminergic stimulation, administering an antidyskinetic agent, and surgery. Several new compounds that may provide an antidyskinetic effect are also under investigation.

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Parkinson's disease home diary: Further validation and implications for clinical trials

Cited by 168 publications

References 4 publications

Unsupervised home monitoring of Parkinson's disease motor symptoms using body-worn accelerometers

Unsupervised home monitoring of Parkinson's disease motor symptoms using body-worn accelerometers

Phase I/II randomized trial of aerobic exercise in Parkinson disease in a community setting

Levodopa-Induced Dyskinesias in Parkinson’s Disease: Etiology, Impact on Quality of Life, and Treatments

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