Objective: To integrate a handheld device with standardised graphical tasks into clinical assessment for automated objective motor symptoms rating with digital record keeping in Parkinson’s disease (PD). The study assessed the validity to measure and analyze features of neuromuscular processes in PD to quantify subtle changes in motor symptoms and provide outcome measures.

Background: The most widely used method to assess motor symptoms in PD is UPDRS-III. However, UPDRS has limited sensitivity and there are challenges with intra- and inter-operator variability. An objective test for rating subtle changes in PD motor symptoms would be valuable in aiding the healthcare professional (HCP) in patient monitoring.

Method: Data were recorded with the pen device, intended for use by HCP to measure and analyse features of neuromuscular processes in PD, expressed as digital biomarkers. Computational methods combined biomarkers into easily interpretable scores for bradykinesia, tremor and micrographia as well as PD probability scores. The scores were calculated and visualised for 148 patients and compared with UPDRS. For 14 PD patients with a PD diagnosis, the Purdue pegboard test was performed as reference measure to assess response to dopaminergic medication [1].

Results: Bradykinesia measures strongly correlated with Purdue peg board test. The device provided higher resolution tremor measurement than UPDRS and quantified tremor when not visible with the naked eye. Movement time decreased significantly after taking medication. Tremor was less severe or absent after taking medication. Subtle improvements of hand function after taking medication were hard to detect with UPDRS- III and graphical tasks are more suitable to detect subtle changes in upper limb function. A frozen algorithm correctly identified PD patients in the ON-state with hardly visible motor symptoms.

Conclusion: We conclude that the pen device with standardised graphical tasks provides a valid method for objective and accurate quantification of motor symptoms in PD. It is valid to assess subtle changes in motor symptoms that help objectively monitor motor symptoms with higher accuracy and increased granularity alongside UPDRS. Moreover, the method was perceived as an acceptable routine clinical tool that could easily be used at home in the absence of an examiner.

References: [1] Smits, E. J., Tolonen, A. J., Cluitmans, L., van Gils, M., Zietsma, R. C., Borgemeester, R. W. K., … Maurits, N. M. (2017). Graphical Tasks to Measure Upper Limb Function in Patients With Parkinson’s Disease: Validity and Response to Dopaminergic Medication. IEEE Journal of Biomedical and Health Informatics, 21(1), 283-289. DOI: 10.1109/JBHI.2015.2503802

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MDS Abstracts - https://www.mdsabstracts.org/abstract/novel-quantitative-measures-with-standardised-graphical-tasks-to-objectively-assess-subtle-changes-in-fine-motor-skill-in-diagnosing-and-monitoring-of-parkinsons-disease/