A New Prospective, Home-Based Monitoring of Motor Symptoms in Parkinson's Disease

Abstract

Background: Subjective symptoms, which are retrospectively assessed during clinical interviews in the office, may be influenced by patient recall in Parkinson's disease (PD). Prospective collection of subjective data might be an effective tool to overcome this bias.

Objective: We investigated the correspondence between prospectively and retrospectively assessed motor symptoms in PD.

Methods: Forty-two consecutive patients (9 females, 67±9.8 years old) with mild to moderate PD reported their symptoms four times a day for two weeks, using the "SleepFit" application (app) for tablets. This app incorporates a new Visual Analogue Scale assessing global mobility (m-VAS), and the Scales for Outcome in Parkinson Assessment Diary Card (SCOPA-DC). At day 14, the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts II and IV questionnaires were completed at the hospital. Agreement (root mean square difference) and the tendency to under- or overestimate their symptoms by patients (relative difference after normalization) were calculated to compare prospectively vs. retrospectively collected information.

Results: Although agreement was good for overall scores (m-VAS: 10.0%; SCOPA-DC: 18.3%), and for single motor symptoms (involuntary movements, hand dexterity, walking, changing position; each <20%), some individuals with more advanced disease, higher fatigue or worse sleep quality showed poor symptom recall in retrospect. Moreover, a subgroup of patients (16.7%) either over- or underestimated symptom severity.

Conclusions: Regular, prospective monitoring of motor symptoms is suitable in PD patients. SleepFit might be a useful tool in routine practice to identify patients tending to under- or overestimate their symptoms, and for their follow-up.

Keywords: Parkinson disease; ecological momentary assessment; self report; software; symptom assessment.

Fig.1

Comparison between prospective and retrospective patient self-reports of motor symptoms over a period of two weeks. Comparison between m-SCOPA-DC and MDS-UPDRS parts II and IV. A) RMSD Agreement. The dashed line indicates the 20% cutoff for good agreement; B) Percentage Difference. Dashed lines indicate the 20% cutoff for positive and negative thinking, respectively.