An Study Of Wearable Devices To Assessmotor Symptoms In Parkinson's Diseaseand Comparative With UPDRS

Background and Objective:Parkinson's disease(PD)is a neurodegenerative disease commonly seen in the elderly.The main pathological changes are the progressive decrease of dopaminergic neurons in substantia nigra and the formation of Lewy body.The main clinical manifestations are tremor,bradykinesia,myotonia,abnormal posture and gait.And accompanied by many non-motor symptoms,such as sensory disorders,autonomic nerve dysfunction,sleep disorders and neuropsychiatric symptoms.Motor symptoms and non-motor symptoms have obvious heterogeneity in different PD patients.All patients with Parkinson's develop bradykinesia,while tremor and myotonia occur in most patients.The variety of non-motor symptoms makes its performance in Parkinson's disease more complicated.Dopaminergic agents have a good effect on the improvement of tremor,myotonia,bradykinesia and other symptoms,but long-term use will inevitably lead to motion fluctuations and different movement disorder.Clinical scales were used to evaluate motor symptoms and therapeutic effects.Studies have shown that the evaluation of motor symptoms by clinical scale lacks obvious reliability,and the use of clinical scale alone cannot continuously evaluate the motor symptoms of PD patients,and the results will be biased or even misunderstood.Wearable devices,by virtue of their automatic data analysis function,make up for the limitation of clinical scale assessment with its advantages of objectivity,accuracy and sensitivity and improve the accuracy of assessment.Wearable devices can keenly detect subtle movement abnormalities,which is conducive to the early diagnosis,differential diagnosis and evaluation of drug efficacy.In addition,wearable devices can achieve long-term and remote monitoring of movement,provide clinicians with comprehensive picture of the patients in an evaluation,and provide a reliable objective basis for optimizing treatment options.Therefore,in order to fully grasp the clinical manifestations,disease progression and dopaminergic reactivity of PD patients,clinicians urgently need accurate and objective evaluation methods to accurately judge the reactivity of PD patients to drugs,guide the adjustment of drug regiments and predict the long-term therapeutic effect of drugs.In this study,the latest research methods at home and abroad were combined to improve the levodopa challenge test.By observing and comparing the dose-effect relationship and the time-effect relationship of drugs,the wearable devices were used to quantitatively evaluate the subjects' motor symptoms and collect relevant movement information.Compared with the traditional UPDRS scoring scale,the reliability of the wearable sensor devices to quantitatively evaluate the movement symptoms of patients with Parkinson's disease was observed.It provides a theoretical basis for objective evaluation of movement symptoms of Parkinson's disease patients.MethodsFrom October 2018 to October 2019 in The First Affiliated Hospital of Henan University and Union Hospital affiliated to Huazhong University of Science and Technology of 90 patients with clinical manifestations of movement symptoms of Parkinson's disease were collected for levodopa challenge test and evaluation of wearable equipment.Basic information of patients was collected before the trial: gender,age,disease course,medication history.Improvement of clinical scale scores: UPDRS,H&Y grade,HAMD,HAMA,MMSE,Mo CA.And improve related clinical examination: blood routine test,macrobiochemistry(blood lipid,electrolyte,liver and kidney function,etc.),electrocardiogram,MRI or CT.In this study,levodopa challenge test was combined with the motor symptom assessment of wearable equipment:1.Levodopa challenge test1)Prior to the test,the administration of dopamine agonist was discontinued for 72 hours,and the administration of levodopa and other anti-Parkinson drugs was discontinued for 24 hours.2)Morning at 7:00 on an empty stomach for UPDRS part? score and the motor symptom assessment of wearable equipment as a baseline.3)Oral domperidone 10 mg,30 min after serving the madopar 250 mg,375 mg(respectively,to test on the first day,the second day of oral,and assessment at 8:00 and 9:00,at 10:00,11:00).Then carries on the UPDRS part? symptoms score and the evaluation of the equipment movement.4)Blood pressure,heart rate,drug intolerance and adverse reactions were monitored.5)Calculate each time point UPDRS part? improvement rate.Improvement rate=(baseline score before medication-lowest score after medication)/ baseline score before taking medication × 100%,a minimal 30% of improvement on UPDRS motor section scores were positive.6)Observation analysis theory review equipment movement assessment and UPDRS part? score correlation and consistency.2.Assess the symptoms of equipment movement1)Before starting,explain the test method to the subjects and identify the tests that need to be done.Let the subject understand the meaning of "start" and "stop" instructions.The examiner demonstrates the procedure to the subject.2)During the test,except for the protective personnel to prevent the subject from falling,no one shall enter the test site.The protective personnel shall avoid blocking the camera.3)Subjects will complete a 5-meter Timed Up and Go test(TUG)and TURN test.TUG: The patient sat on the chair.After the "start" command was given,the patient stood up and walked freely in a straight line to the 5-meter mark.The patient turned around,continued to walk to the chair and sat down.TURN: The patient stood in a 0.7 meter by 0.7 meter square.After the "start" command was given,the patient turned twice to the left,stood still for 10 seconds,and then turned twice to the right.Finally,90 cases were enrolled,all patients completed levodopa challenge test and motor symptom assessment,including 60 cases in PD group and 30 cases in non-PD group.In UPDRS part? improvement rate as evaluation index calculation the receiver-operating characteristic(ROC)curve,and the corresponding sensitivity analysis and specific degrees.The variance analysis of repeated measurements(F test)was used to test the changes of motion parameters over time at different doses,and the sensitivity and specificity of monitoring motion symptoms were analyzed.Kappa analysis was used to verify the consistency of levodopa challenge test and exercise parameter to exercise symptom evaluation test.Results1.Analysis of levodopa challenge test: The area under the ROC curve of madopar at 250 mg and 375 mg were 0.85 and 0.81,respectively.The corresponding optimal threshold values of Youden index were 0.66 and 0.56,respectively.The specificity were 89% and 64%,and the sensitivity were 77% and 91%.UPDRS part? score had significant difference between different time points,the difference is statistically significant(Ftime=203.527,P<0.001).2.Results of variance analysis of repeated measurements of motion parameters: There were significant differences in step length,stride length,stride duration and left and right foot speed between the measurement results at different times,and the differences were statistically significant(P < 0.001).However,there was no significant difference between the two doses of 250 mg and 375mg(P > 0.05).There was no significant difference in step frequency between measurement points at different times(P=0.544),and there was no significant difference between the two measurements of 250 mg and 375mg(P=0.541).3.Consistency check results analysis: Kappa values of UPDRS were 0.634,0.547,and 0.500,respectively,when compared with the consistency of step length,step frequency,and step length.The results were statistically significant(P < 0.001).Kappa values were 0.149 and 0.101,respectively,with no statistical significance(P > 0.05).Conclusions:1.The step length,stride length,stride duration and left and right foot speed of the motion parameters of monitoring equipment have significant differences among the measured results at different time points.After taking madopar,the exercise symptoms of PD patients changed with the changes of dopamine blood drug concentration,and the improvement of exercise symptoms was most obvious when the blood drug concentration reached its peak.2.There was a good consistency between the UPDRS scale score and the gait parameters of monitoring equipment in evaluating the motion symptoms of PD.