Objective: This is a service evaluation of the use of the Parkinson’s Kinetigraph (PKG) in the context of a Geriatrician-led movement disorder clinic, with a focus on the effect of frailty on PKG results.

Background: Our clinic has over 18 months experience in using the PKG. This wrist worn device collects data on the motor signs in Parkinson’s disease (PD) generating metrics in an online report, bradykinesia score (BKS) is one example. Studies suggest use of the PKG can improve patient outcomes; one recommendation is increasing treatments to achieve a target BKS of 18.6 [1]. Our clinic cohort has a higher prevalence of multi-morbidity and frailty than a Neurologist-led clinic, such as that in the study.

Method: 60 patients had recent PKGs as part of routine clinical care. The results and demographics were recorded. Rockwood clinical frailty scale (CFS) and Charleston co-morbidity index (CCI) were calculated using clinic documentation.

Results: Of the 60 patients, 5 had a CFS ≥ 5 and are thus considered frail. Mean age was similar in both groups, 72 in the frail and 71 in the non-frail. Mean BKS was higher in the frail group, 36.7 and 31.7 respectively (p=0.329). Of the 60 patients, 19 had a CCI ≥4. Those with more co-morbidities had a significantly higher BKS than those with CCI of less than 4 (35.8 compared to 30.5, p= 0.016).

Conclusion: Frailty is not a barrier to our patients having access to a PKG. There is a suggestion that patients who are frail have higher bradykinesia scores. Using cumulative co-morbidities as a surrogate marker for frailty, we have shown that those with more co-morbidities have higher bradykinesia scores. If being frail in itself can increase the BKS independently of the PD motor symptom control, then the “treat to target” method may not be as beneficial to people with frailty.

References: Farzanehfar P, Woodrow H, Braybrook M, McGregor S, Evans A, Nicklason F, Horne M1. Objective measurement in routine care of people with Parkinson’s disease improves outcomes. NPJ Parkinsons Dis. 2018; 3;10

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluating-the-use-of-parkinsons-kinetigraphs-in-patients-with-parkinsons-disease-and-frailty/