Wearable Devices Quantitatively Assess Drug Response In Parkinson’s Disease Patients

Background and ObjectiveParkinson’s disease(PD)is a common dyskinesia and neurodegenerative disease,which is more common in middle-aged and elderly people.Its pathological manifestations include the loss of dopaminergic neurons in the substantia nigra compacta(SNpc)and the production of The Lewy body in residual neurons.The clinical manifestations of Parkinson’s disease are more complex.In addition to the classic motor symptoms:bradykinesia,muscle rigidity,resting tremor and abnormal posture and gait,it also includes sleep disorders,sensory disorders,mental and cognitive dysfunction,and autonomic disorders.Parkinson’s disease is mainly treated with levodopa,and a good response to levodopa drugs is a typical manifestation of Parkinson’s disease.Clinically,Madopar is used for load test to evaluate the responsiveness of PD patients to levodopa drugs,and it is often used for PD diagnosis,differential diagnosis,and preoperative evaluation of deep brain stimulation(DBS).Clinically,the third part of the Unified Parkinson’s Disease Score Scale(UPDRS-Ⅲ)is used to evaluate the motor symptoms of patients before and after taking levodopa drugs.It is generally believed that the improvement rate of UPDRS-Ⅲ score before and after taking the drug is more than 30%,and the patient is considered to have a good response to the drug,that is,the levodopa challenge test is positive.However,this assessment method has shortcomings:(1)The current levodopa challenge test is usually completed as a mobile test,and the patient needs to go to the hospital in the early morning "off period" state,which causes a lot of inconvenience for the patient.(2)The results of the patient’s motor symptoms assessment depend on the professional knowledge of the clinician,the assessors need to be personally trained,and the assessment results between different assessors have poor consistency(3)It takes a long time to complete a levodopa stress test standard evaluation(4)The UPDRS scale adopts a hierarchical scoring system,and the result of the scoring has a "floor/ceiling effect".In recent years,with the emergence of so-called micro-electromechanical systems,the miniaturization of electromechanical technology has gradually matured,resulting in many portable devices using sensors such as accelerometers,gyroscopes,and magnetometers.In particular,sensor-based wearable devices can continuously capture motion for a long time in a controlled and free-living environment,which can overcome the limitations of many clinical scale evaluations.Wearable device refers to a type of portable device that can directly collect exercise data when worn on the body.Compared with clinical scales,it has higher sensitivity,accuracy and reproducibility,and makes it more complex and changeable.It becomes more feasible to objectively capture movement and non-motion changes.At present,many studies have shown that wearable devices have good sensitivity and specificity in identifying patients with tremor,slow movement,frozen gait,etc.,and also show great research value in the early diagnosis and differential diagnosis of PD patients.Therefore,this study intends to use wearable devices to quantitatively evaluate the levodopa stress test of clinical patients,collect the patient’s exercise parameters,and analyze and compare them with the clinical traditional UPDRS score scale,and look for those that can be used to evaluate the levodopa load.The indicators of the test results provide a basis for future research and clinical practice to objectively evaluate the motor symptoms of Parkinson’s disease.MethodsTwenty-eight patients with Parkinson-like motor performance were enrolled in the Union Hospital of Huazhong University of Science and Technology in Wuhan from September 2020 to January 2021.According to the inclusion criteria,they were divided into PD group and Non-PD group.Collect the basic information of the patient:such as name,gender,age,education,occupation,height,weight,home address and contact information,etc.;and the patient’s disease history:such as age of onset,course of disease,first-onset location,first-onset symptoms,medication plan,etc.,And score the patients with corresponding scales(such as Hoehn-Yahr staging,MMSE,MoCA,HAMA,etc.).All enrolled patients completed the levodopa stress test and the collection of exercise parameters by wearable devices.The patient’s motion parameter collection process uses the time up and go test(TUG)and the turning test(TURN).Pearson or Spearman analysis is used to analyze the motion parameters and UPDRS-Ⅲ scores of wearable devices;the UPDRS-Ⅲ scores and sports parameter indexes before and after taking the medicine are analyzed by the statistical analysis of paired design data,when the variable difference is normal at the time,the paired design t test was used,and the Wilcoxon signed rank test was used for differences that did not conform to normality.All the above data are statistically analyzed using SPSS24.0 software,P<0.05 is statistically significant.Results1.The UPDRS-Ⅲ score of the PD group before taking Madopar was(44.39±18.17)points,the UPDRS-Ⅲ score of the Non-PD group was(23.60±11.14)points,and the UPDRS-Ⅲ scores of the PD group after taking Madopar were(24.78± 12.20)points,the UPDRS-Ⅲ score of the Non-PD group was(18.60±8.50)points;the UPDRS-Ⅲscore of the two groups after taking the medicine was significantly lower than before the medicine(P<0.001)2.Correlation analysis:the average velocity of the left and right feet,the peak angular velocity of the left and right calves,the peak angular velocity during the turning process,the average angular velocity during the turning process,and the peak angular velocity of the trunk sagittal plane are negatively correlated with the UPDRS-Ⅲ score(r=-0.279,p=0.037;r=-0.339,p=0.011;r=-0.396,p=0.003;r=-0.426,p=0.001;r=-0.401,P=0.002);the movement parameters of the side limbs with severe symptoms Correlation analysis with UPDRS-Ⅲ scores showed that severe side step length,severe side foot velocity,severe side step length,severe side calf angle maximum,and calf angular velocity peak were significantly negatively correlated(r=-0.297,p=0.026;r=0.293,p=0.028;r=-0.295,p=0.027;r=-0.341,p=0.010;r=-0.333,p=0.012)3.Analyz the movement parameters before and after the levodopa test in the PD group:the peak angular velocity during the steering process,the peak angular velocity of the left and right calves,the minimum value of the waist sagittal angle,and the maximum value of the waist sagittal angle after taking the medicine were compared with those before taking the medicine.Significant increase,P<0.05;The relative deviation of left and right leg swing phase and the relative deviation of left and right leg support phase after taking the medicine are lower than before taking the medicine,P<0.05;The motion parameters of the severe side of the PD group were compared before and after taking the medicine,and the severe side calf angular velocity was obtained.The peak value increased compared with the previous one,P<0.05;ConclusionsExperiments have shown that wearable devices can be used in the quantitative assessment of the motor symptoms of Parkinson’s patients.The average speed during walking,the peak angular velocity,and the step length and stride length of the severe side have a good correlation with the clinical scale.Movement parameters such as peak angular velocity during steering and relative deviation of left and right leg swing phases can be used to reflect the drug response of PD patients to levodopa,which pro vides new exploration and basis for the precise management of Parkinson’s disease.