Technology in Parkinson's disease: Challenges and opportunities

Abstract

The miniaturization, sophistication, proliferation, and accessibility of technologies are enabling the capture of more and previously inaccessible phenomena in Parkinson's disease (PD). However, more information has not translated into a greater understanding of disease complexity to satisfy diagnostic and therapeutic needs. Challenges include noncompatible technology platforms, the need for wide-scale and long-term deployment of sensor technology (among vulnerable elderly patients in particular), and the gap between the "big data" acquired with sensitive measurement technologies and their limited clinical application. Major opportunities could be realized if new technologies are developed as part of open-source and/or open-hardware platforms that enable multichannel data capture sensitive to the broad range of motor and nonmotor problems that characterize PD and are adaptable into self-adjusting, individualized treatment delivery systems. The International Parkinson and Movement Disorders Society Task Force on Technology is entrusted to convene engineers, clinicians, researchers, and patients to promote the development of integrated measurement and closed-loop therapeutic systems with high patient adherence that also serve to (1) encourage the adoption of clinico-pathophysiologic phenotyping and early detection of critical disease milestones, (2) enhance the tailoring of symptomatic therapy, (3) improve subgroup targeting of patients for future testing of disease-modifying treatments, and (4) identify objective biomarkers to improve the longitudinal tracking of impairments in clinical care and research. This article summarizes the work carried out by the task force toward identifying challenges and opportunities in the development of technologies with potential for improving the clinical management and the quality of life of individuals with PD. © 2016 International Parkinson and Movement Disorder Society.

Keywords: Parkinson's disease; digital biomarkers; digital health; eHealth; precision medicine; remote monitoring; technology; wearable technology.

Figure 1. Schematic representation of a subject undergoing monitoring in the home setting using wearable and ambient sensors

The technology shown includes a wireless unit strapped around the wrist, band-aid like sensors attached to the lower limbs, a wearable camera worn as a pendant, a smart watch, and a mobile phone clipped on the belt used as gateway to relay the data to the cloud to assess specific functions (using its embedded sensors) as well as to communicate with the subject (using customized apps). Ambient sensors and computer technologies are utilized in the home settings to gather additional information or replace wearable sensors when wearable sensors cannot be used. The integration of wearable technology with smart devices enables remote monitoring of patients with PD and real-time feedback to clinicians, family/caregivers, and the patients themselves.