Quantitative Assessment Of Parkinsonian Hand Tremor Based On The UPDRS Scale And Smartphone

Objective:Using smartphones and UPDRS scales to quantify hand tremor in patients with Parkinson's disease(PD),analyze the clinical characteristics of rest tremor in upper limb,and explore the potential of smartphone for PD.Method:We recruited 53 patients with PD in the Neurology Department of First Affiliated Hospital of Kunming Medical University during 2017-2019 and examined each of them by MDS-UPDRS and "smartphone motor examination".We recorded the information of subjects as follow:gender,H-Y scale,medication state,lateralization of onset and handedness.SPSS24 is used to statistically analyze the correlation between the results of "smartphone motor examination"(tremor amplitude and frequency)and UPDRS tremor scores,compare these hand tremor data in the different groups,find the relationship between tremor and other PD motor symptoms.P<0.05 indicates the statistical significance.The results are shown in tables and figures.Result:The amplitude of rest tremor is greater in male than female(UPDRS score non-onset side:P=0.050,smartphone non-onset side:P=0.025),advanced PD patients than early-stage patients(smartphone non-onset side:P=0.045),off-state group than on-state group(UPDRS score onset side:P=0.043,UPDRS score non-onset side:P=0.004,smartphone non-onset side:P=0.008),dominant-side onset group than non-dominant-side onset group(UPDRS score onset side:P=0.002,UPDRS score non-onset side:P=0.036,smartphone non-onset side:P=0.003),onset side than other side(UPDRS score:P=0.012).In the onset side of PD patients,the rest tremor of upper limb is related to ipsilateral motor symptoms as follow:finger tapping(UPDRS score:R=0.281,smartphone:R=0.254),hand movement(UPDRS score:R=0.213,smartphone:R=0.212),pronation-supination movements of hand(UPDRS score:R=0.250),toe tapping(UPDRS score:R=0.189),postural tremor of hand(UPDRS score:R=0.378,smartphone:R=0.304),rest tremor amplitude of lower limb(UPDRS score:R=0.323,smartphone:R=0.356).In the non-onset side of PD patients,the rest tremor of upper limb is related to ipsilateral motor symptoms as follow:rigidity of lower limb(smartphone:R=0.171),finger tapping(smartphone:R=0.174),postural tremor of hand(UPDRS score:R=0.475,smartphone:R=0.340),kinetic tremor of hand(UPDRS score:R=0.329,smartphone:R=0.291),rest tremor amplitude of lower limb(UPDRS score:R=0.224).The rest tremor of upper limb(non-onset side)is related to the contralateral motor symptoms as follow:rigidity of lower limb(smartphone:R=0.179),finger tapping(smartphone:R=0.279),hand movement(smartphone:R=0.276),pronation-supination movements of hand(smartphone:R=0.218),toe tapping(smartphone:R=0.208),leg agility(smartphone:R=0.206),postural tremor ofhand(UPDRS score:R=0.352,smartphone:P=0.247),kinetic tremor of hand(UPDRS score:R=0.159),rest tremor amplitude of lower limb(smartphone:R=0.1 87).The rest tremor of upper limb(non-onset side)is also related to gait(UPDRS score:R=0.254,smartphone:R=0.344)and posture(smartphone:R=0.198)disorder.Conclusion:The amplitude of rest tremor is greater in onset side than other side.Furthermore,the amplitude of rest tremor is greater in male,advanced patients,off-state patients,dominant-side onset patients are greater than female,early-stage patients,on-state patients,non-dominant-side onset patients separately.The hand rest tremor is associated with bradykinesia,rigidity,postural instability and gait difficulty.Our analysis showed that the UPDRS is more sensitive than smartphone in the field of onset side and medication state for PD quantification.On the other side,smartphone is more sensitive and accurate than UPDRS in the field of non-onset side and severity for PD quantification,which is helpful for PD early and differential diagnosis.