By Smaranda Codreanu
Globally, due to an increase in life quality and expectancy, neurological impairments seem to have increased in prevalence. Parkinson's disease is the second most common neurodegenerative disease, affecting over 6 million people worldwide, especially people over the age of 60. Over time, the cause has been identified as the destruction of the substantia nigra in the nervous system. However, no precise biomarkers can be used routinely to assist in diagnosis, thus the diagnosis is based on the symptoms of muscle rigidity, tremor, insomnia and postural instability. Treatment includes a gradual progression of different drugs and increasing the dose accordingly as the body gets used to the medication. The key feature is that the treatment is supposed to delay the onset of symptoms and preserve the patient’s autonomy for as many years as possible. Of course, the practitioner sets dates for regular check-ups, but sometimes these dates are too far apart from each other and optimal control of the disease cannot be reached. Thus, the moment when the symptoms (fluctuation, wearing-off phenomena) worsen cannot be pinpointed, leading to a lack of satisfaction on both sides.
In the era of technology, we use the internet to call our friends across the globe and a multitude of apps and smart devices to track everything from how long we sleep to how many steps we are walking a day. So why can’t technology be the solution for better monitoring Parkinson's? We have the proper devices to regularly check the gait, tremor and sleep in Parkinson's disease, providing a tool for decision-making in the clinical setting by capturing data from everyday activities in an objective manner. The ability to remotely capture behavioural data and use it to optimize treatment strategies could make a great difference in the quality of living.
So far even with big players in this game like Intel and the Michael J. Fox Foundation and smaller teams from research labs all around the globe, we’ve yet to reach a consensus on how to best approach the monitoring of Parkinson’s. Most smart devices have tried different approaches to monitor the gait and tremor, starting from wearing just a smartwatch to wearing an assembly of multiple sensors placed on the thigh and trunk. These sensors are then tied down to an accelerometer to measure step length and frequency and a gyroscope is worn on the wrist to track the tremor. The newest additions go as far as using insoles for plantar pressure and step monitoring. In the end, they all aim to be unobtrusive, and cost-efficient, with a longer battery life, to increase patients’ compliance.
If you think that all these seem too good to be true, you are most definitely right. All the studies have rather small samples of patients (think dozens), only include patients with early onset or mild symptoms and the algorithms used by the devices often have trouble distinguishing between tremor and intention movements. Throw into this mix sensitive medical data, high costs and moderate compliance at best and you might understand why we have had ongoing debates on how to approach wearables for the better part of the last 8 years.
Although it seems like I have painted a rather dire image of the current state-of-the-art technologies for monitoring Parkinson’s, the bottom line is that the wearables have proven to be efficient on small study samples and they allow us to collect objective longitudinal raw data for the first time. Moreover, distinguishing between tremor and intention movement will be easier for the algorithms once they have larger sets of data. Based on this, the algorithms can learn actively from the subject’s habits and activities and can thus offer a personalised approach to monitoring from the comfort of their own home. The practitioners and researchers are easily pinged in the scenario of worsening symptoms or abnormalities from the baseline. This is followed by a sooner check-up and adjustment of treatment where it is needed, ensuring improved life quality for the patients.
We have a very long way to go in order for all these technological advances to be standardised and approved by FDA and EMA for daily use on a larger scale, but we are making progress one step at a time by asking ourselves: how can we do better for patients suffering of a disease without a cure in sight?
Further Reading
1. Adams, J.L., Dinesh, K., Snyder, C.W. et al. A real-world study of wearable sensors in Parkinson’s disease. npj Parkinsons Dis. 7, 106 (2021). https://doi.org/10.1038/s41531-021-00248-w.
2. Channa A, Popescu N, Ciobanu V. Wearable Solutions for Patients with Parkinson's Disease and Neurocognitive Disorder: A Systematic Review. Sensors (Basel). 2020 May 9;20(9):2713. doi: 10.3390/s20092713. PMID: 32397516; PMCID: PMC7249148.
3. Rovini, E.; Maremmani, C.; Cavallo, F. A Wearable System to Objectify Assessment of Motor Tasks for Supporting Parkinson’s Disease Diagnosis. Sensors 2020, 20, 2630. https://doi.org/10.3390/s2009263