Objective: We aim to assess if the use of a wearable sensor can increase the patient and caregiver self-awareness of the first motor fluctuations (MF).

Background: MF occur early in PD but for some patients, self-awareness of wearing-off (WO) or morning akinesia (MA) is still low [1]. Dedicated WO-questionnaires are useful to increase the detection of WO, but wearable sensors could also be helpful in the recognition of the first MF [2].

Method: Retrospective analysis from two PD outpatient clinic databases of PD patients within the first 5 years of disease, who had worn the wearable sensor STAT-ON (June 2019 and February 2022). We selected cases with detailed clinical information regarding the presence of the first MF before and after wearing the sensor.

Results: Thirty patients were included in the analysis (66.6 ± 8.24 years old, 63.3% males). The mean disease duration at the time of wearing the sensor was 4.07 ± 1.0 years and the mean UPDRS-III score was 18.30 ± 6.55. The mean Levodopa dosage was 362 ± 108.16 mg, and the levodopa-equivalent dosage was 474.20 ± 156.17 mg. In 26.6% of the subjects (n=8), WO or MA were well recognized and quantified by the patient, whilst in 40% of the cases (n=12) WO or MA was suspected by the neurologist but not well-recognized by the patient or caregiver. Ten patients (33.33%) denied having WO or MA and these were not suspected by the neurologist either. After wearing the sensor, the STAT-ON confirmed that WO or MA was present in the 40% of the cases in which initial MF were suspected by the patient .Self-awareness increased in almost all the patients and caregivers by understanding the time that WO occurred, except in two cases in which MF were not recognized by the patients. The sensor detected MF in 9/10 cases who had denied having WO or MA. In 6 of these, the  graphical information helped the patient and caregiver to understand and recognize WO and MA, while three patients were still not aware of slowness of movement before levodopa dose intake. In all the cases in which the symptoms of the WO were states as exclusively non-motor (13.33% of the sample), the sensor graphical information showed gait slowness during the OFF time.

Conclusion: Wearable sensors could be a valuable tool for assessment of the first MF, empowering the patient and improving the detection of WO and MA in the daily clinical practice setting.

References: [1] Ogura H, Nakagawa R, Ishido M, et al. Evaluation of Motor complications in Parkinson’s Disease: Understanding the perception gap between patients and physicians. Parkinson’s disease 2021; https:// doi.org/10.1155/2021/1599477.
[2] Farzanehfar P, Woodrow H, Horne M. Assessment of Wearing-Off in Parkinson’s disease using objective measurement. J Neurol 2021; Mar 268(3):914-222; doi: 10.1007/s00415-020-10222.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/improving-the-patient-self-awareness-of-the-first-motor-fluctuations-in-early-parkinsons-disease-with-a-wearable-sensor/