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. 2018 Jan 9;1(2):126-135.
doi: 10.1159/000485468. eCollection 2017 Oct-Dec.

Tablet-Based Application for Objective Measurement of Motor Fluctuations in Parkinson Disease

Benjamin D Wissel  1 , Georgia Mitsi  2 , Alok K Dwivedi  3 , Spyridon Papapetropoulos  4 , Sydney Larkin  1 , José Ricardo López Castellanos  1 , Emily Shanks  1 , Andrew P Duker  1 , Federico Rodriguez-Porcel  1 , Jennifer E Vaughan  1 , Lilia Lovera  1 , Ioannis Tsoulos  5 , Athanassios Stavrakoudis  6 , Alberto J Espay  1
Affiliations

Tablet-Based Application for Objective Measurement of Motor Fluctuations in Parkinson Disease

Benjamin D Wissel et al. Digit Biomark. .

Abstract

Background: The motor subscale of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III) has limited applicability for the assessment of motor fluctuations in the home setting.

Methods: To assess whether a self-administered, tablet-based application can reliably quantify differences in motor performance using two-target finger tapping and forearm pronation-supination tasks in the ON (maximal dopaminergic medication efficacy) and OFF (reemergence of parkinsonian deficits) medication states, we recruited 11 Parkinson disease (PD) patients (age, 60.6 ± 9.0 years; disease duration, 12.8 ± 4.1 years) and 11 healthy age-matched controls (age, 62.5 ± 10.5 years). The total number of taps, tap interval, tap duration, and tap accuracy were algorithmically calculated by the application, using the more affected side in patients and the dominant hand in healthy controls.

Results: Compared to the OFF state, PD patients showed a higher number of taps (84.2 ± 20.3 vs. 54.9 ± 26.9 taps; p = 0.0036) and a shorter tap interval (375.3 ± 97.2 vs. 708.2 ± 412.8 ms; p = 0.0146) but poorer tap accuracy (2,008.4 ± 995.7 vs. 1,111.8 ± 901.3 pixels; p = 0.0055) for the two-target task in the ON state, unaffected by the magnitude of coexistent dyskinesia. Overall, test-retest reliability was high (r >0.75) and the discriminatory ability between OFF and ON states was good (0.60 ≤ AUC ≤ 0.82). The correlations between tapping data and MDS-UPDRS-III scores were only moderate (-0.55 to 0.55).

Conclusions: A self-administered, tablet-based application can reliably distinguish between OFF and ON states in fluctuating PD patients and may be sensitive to additional motor phenomena, such as accuracy, not captured by the MDS-UPDRS-III.

Keywords: App-based digital biomarkers; Motor symptoms; Objective monitoring of motor symptoms; Parkinson disease-related motor symptoms.

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Conflict of interest statement

B.D.W. is supported by the NIH (T32GM063483-14). G.M. is the founder and CEO of Apptomics, Inc. A.K.D. is supported by the NIH as a co-investigator (1R01HL125016-01) and as a collaborator (R21 AI118228). He has also been serving as a statistician in 4 CPRIT grants (PP110156, PP140211, PP150031, and PP130083), Coldwell (co-investigator), and MSA Coalition (collaborator) and as a principal investigator in a TTUHSC ELP mini seed grant. He is a director of biostatistics and epidemiology consulting laboratory at the TTUHSC ELP. S.P. is a full-time employee at TEVA Pharmaceuticals and co-chair of the Task Force on Technology for the International Parkinson and Movement Disorder Society. S.K., J.R.L.C., and E.S. have nothing to disclose. A.P.D. has served as a consultant for Merz Pharma, US WorldMeds, and Auspex Pharmaceuticals and has received honoraria from UCB. F.R.-P., J.V., L.L., I.T., and A.S. have nothing to disclose. A.J.E. is the chair of the Task Force on Technology for the International Parkinson and Movement Disorder Society, is supported by the NIH, and has received grant support from Cleveland Medical Devices Inc./Great Lakes NeuroTechnologies, the Davis Phinney Foundation, and the Michael J. Fox Foundation; personal compensation as a consultant/scientific advisory board member for Solvay, Abbott, Chelsea Therapeutics, TEVA, Impax, Merz, Lundbeck, and Eli Lilly; honoraria from TEVA, UCB, the American Academy of Neurology, and the Movement Disorder Society; and publishing royalties from Lippincott Williams & Wilkins, Cambridge University Press, and Springer. He has no financial interests in, nor has received compensation from, iMotor or Apptomics, Inc.

Figures

Fig. 1
Fig. 1
Screenshots of iMotor-based tapping tests. a Two-target test: the participants alternatingly tapped with the index finger, as fast and as accurately as possible, the centers of two concentric circles on the tablet screen. b Pronation-supination test: the participants alternatingly tapped the palmar and dorsal surfaces of their hand as fast as possible on the tablet screen. c Sample patient score report, available immediately to the patient.
See this image and copyright information in PMC

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