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. 2022 Apr 19;11(9):2275.
doi: 10.3390/jcm11092275.

Intraoperative Quantification of MDS-UPDRS Tremor Measurements Using 3D Accelerometry: A Pilot Study

Annemarie Smid  1 , Jan Willem J Elting  2   3 , J Marc C van Dijk  1 , Bert Otten  4 , D L Marinus Oterdoom  1 , Katalin Tamasi  1   5 , Tjitske Heida  6 , Teus van Laar  2   3 , Gea Drost  1   2
Affiliations

Intraoperative Quantification of MDS-UPDRS Tremor Measurements Using 3D Accelerometry: A Pilot Study

Annemarie Smid et al. J Clin Med. .

Abstract

The most frequently used method for evaluating tremor in Parkinson’s disease (PD) is currently the internationally standardized Movement Disorder Society—Unified PD Rating Scale (MDS-UPDRS). However, the MDS-UPDRS is associated with limitations, such as its inherent subjectivity and reliance on experienced raters. Objective motor measurements using accelerometry may overcome the shortcomings of visually scored scales. Therefore, the current study focuses on translating the MDS-UPDRS tremor tests into an objective scoring method using 3D accelerometry. An algorithm to measure and classify tremor according to MDS-UPDRS criteria is proposed. For this study, 28 PD patients undergoing neurosurgical treatment and 26 healthy control subjects were included. Both groups underwent MDS-UPDRS tests to rate tremor severity, while accelerometric measurements were performed at the index fingers. All measurements were performed in an off-medication state. Quantitative measures were calculated from the 3D acceleration data, such as tremor amplitude and area-under-the-curve of power in the 4−6 Hz range. Agreement between MDS-UPDRS tremor scores and objective accelerometric scores was investigated. The trends were consistent with the logarithmic relationship between tremor amplitude and MDS-UPDRS score reported in previous studies. The accelerometric scores showed a substantial concordance (>69.6%) with the MDS-UPDRS ratings. However, accelerometric kinetic tremor measures poorly associated with the given MDS-UPDRS scores (R2 < 0.3), mainly due to the noise between 4 and 6 Hz found in the healthy controls. This study shows that MDS-UDPRS tremor tests can be translated to objective accelerometric measurements. However, discrepancies were found between accelerometric kinetic tremor measures and MDS-UDPRS ratings. This technology has the potential to reduce rater dependency of MDS-UPDRS measurements and allow more objective intraoperative monitoring of tremor.

Keywords: MDS-UPDRS; Parkinson’s disease; accelerometer; intraoperative; quantification; tremor.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Accelerometer positioned at the base of the right index finger.
Figure 2
Figure 2
Boxplots of the PAUCtremor between 4–6 Hz of the postural (a), kinetic (b), and rest tremor (c) tests in the healthy group and the patient population (per MDS-UPDRS score). The PAUCtremor between 4–6 Hz per second of the rest tremor test in all groups is given in boxplot (d).
Figure 3
Figure 3
Boxplots of the total amplitude of the postural (a), kinetic (b), and rest tremor (c) tests, and of the Ttremor of the constancy of rest tremor test (d) in the healthy group and the patient population (per MDS-UPDRS score).
Figure 4
Figure 4
Contingency tables of the given MDS-UPDRS scores and calculated accelerometry (ACC) scores of the tremor tests in the patient population.
See this image and copyright information in PMC

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