Abstract
The response to levodopa (LR) is important for managing Parkinson’s Disease and is measured with clinical scales prior to (OFF) and after (ON) levodopa. The aim of this study was to ascertain whether an ambulatory wearable device could predict the LR from the response to the first morning dose. The ON and OFF scores were sorted into six categories of severity so that separating Parkinson’s Kinetigraph (PKG) features corresponding to the ON and OFF scores became a multi-class classification problem according to whether they fell below or above the threshold for each class. Candidate features were extracted from the PKG data and matched to the class labels. Several linear and non-linear candidate statistical models were examined and compared to classify the six categories of severity. The resulting model predicted a clinically significant LR with an area under the receiver operator curve of 0.92. This study shows that ambulatory data could be used to identify a clinically significant response to levodopa. This study has also identified practical steps that would enhance the reliability of this test in future studies.
Highlights
Parkinson’s Disease (PD) is a progressive neurodegenerative disorder that affects the frontal lobe, the brainstem and the autonomic nervous system
The aim of this study was to use the model described above to compare the response to levodopa (LR) measured during the levodopa challenge test (LDCT) with the change in motor function following the first morning dose measured by the Parkinson’s Kinetigraph (PKG) over 6 days
We compare the model with the abs∆UPDRS first and with %∆UPDRS and the justification for considering the abs∆ is fully reviewed in the Discussion
Summary
Parkinson’s Disease (PD) is a progressive neurodegenerative disorder that affects the frontal lobe, the brainstem and the autonomic nervous system. Impaired dopamine transmission is a defining feature. Sensors 2019, 19, 5153 of PD and can be treated by pharmacological therapies such as levodopa. Evidence of responsiveness to levodopa provides support for the clinical diagnosis of PD and for assessing the suitability for device assisted therapies such as deep brain stimulation (DBS) and delivery of apomorphine or levodopa by pump. The improvement from OFF to ON is known as the levodopa response (LR). Bradykinesia is a central clinical feature of diminished dopamine transmission and this is assessed, along with tremor and limb rigidity, using a clinical scale known as the Unified Parkinson’s Disease Rating Scale Part III (UPDRS III)
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