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An experimental smartphone application could monitor changes in
Parkinson's disease symptoms throughout the day, sending data to doctors to
help them treat patients, U.S. researchers say. "Like diabetes, Parkinson's has variability and symptom
fluctuations, which can also vary the treatment. We can't measure these
fluctuations at home, and you can only do so many measurements in the
clinic," said senior study author Suchi Saria of Johns Hopkins University
in Baltimore.
The app developed by Saria and her colleagues asks patients to complete
five tasks that assess speech, finger tapping, gait, balance and reaction time.
From that, it generates a "mobile Parkinson's Disease score," which
doctors can use to assess symptom severity and adjust medication, the team
writes in JAMA Neurology.
Parkinson's disease is a neurodegenerative disorder that affects
dopamine-producing nerve cells in the brain. Symptoms include tremors, body
stiffness, slow movement and difficulty walking. "This new development is very exciting because this wasn't feasible
even a few years ago," Saria said in a telephone interview. "Patients
seem eager, willing and curious to do this with their phones." The researchers developed their app, HopkinsPD, for Android smartphones
to assess performance on the five tasks as often as patients want to use the
app. The mobile score is based on the types of assessments usually done in
doctor's offices.
To test the app and the scoring system, the researchers recruited 129
patients who completed more than 6,000 smartphone assessments. Scores ranged
from 0 to 100, with higher numbers indicating more severe symptoms.
Participants completed the tasks before and after their first daily dose of
dopamine medication. They also completed standard assessments in the clinic. Symptoms varied by an average of 14 points through the day, information
that could help doctors understand the highs and lows for their Parkinson's
patients.
The team also found a strong correlation between the mobile app score
and the in-office rating scales. On average, the mobile app score also
decreased more than the official scales when dopamine medication was taken,
which could highlight its sensitivity and accuracy in monitoring real-time
symptoms, the authors note.
"The data from the phone aligns beautifully with what we found with
classic instruments in the clinic," Saria said. "It gives us a sense
of patients' motion and movement, like breadcrumbs along the way to understanding
their symptoms."
A limitation of the study is that only five tasks are used to measure
behaviors and symptoms, the authors acknowledge. Additional studies will evaluate whether changes in the app score
represent a significant difference experienced by patients. "We physicians may measure phenomena we think are highly relevant,
but patients may disagree," said Dr. Alberto Espay, director of the James
J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders at
University of Cincinnati in Ohio, who wasn't involved in the study.
"Also, it will be important to determine if the machine-learning
component will require less active entry of data by patients, rendering it
easier to use long-term," Espay said in an email. "Long-term
adherence will be important to ascertain if this application . . . can capture
data for patients in their home settings."
Researchers want to know whether elderly patients and those in
developing countries can use similar apps, said Ye Wang of the National
University of Singapore, who wasn't involved in the current study. "These ubiquitous technologies can and should be used to help
doctors with their diagnosis," Wang told Reuters Health by email. "They are diagnostic aids and are not supposed to replace
doctors," he said. "But perhaps they can be part of the screening
process."
SOURCE: JAMA Neurology
This story was written by Reuters.