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 "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.
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"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: http://bit.ly/2GEunWX JAMA Neurology, online March 26, 2018.
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