Remote real time digital monitoring fills a critical gap in the management of Parkinson's disease

Abstract

People with Parkinson's disease (PWP) face significant gaps in care. Limited neurologist access, infrequent clinic visits, and inadequate symptom measurement culminate in suboptimal therapy and high morbidity. Quantitative Digitography (QDG) provides validated, digital metrics of the three cardinal motor signs in Parkinson's disease (PD) in real-time from 30 seconds of a mobility task on a digitography device and can be used remotely or in clinical settings. This study demonstrates the feasibility and clinical relevance of 30-day remote QDG monitoring. Participants showed excellent compliance and found the system easy to use. The QDG Mobility Score demonstrated meaningful correlation with Activities of Daily Living (ADLs), captured motor complexities across a broad PD duration, and tracked motor changes from small therapy adjustments. QDG offers providers and PWP an accessible, objective, and real-time tool to remotely monitor motor symptoms, optimize treatment, and address care gaps created by infrequent clinic visits and subjective symptom assessment.

Fig. 1. QDG mobile application use and task execution.

a Workflow for mobile application account set-up. b QDG task initiation and setup instructions. c QDG mobility task execution.

Fig. 2. QDG compliance, user experience, and correlation with ADLs.

a Compliance with a test performed on at least 16/30 days; b Adherence to testing once-daily (N = 25) and twice-daily (N = 24), c User reported difficulty ratings with performing QDG (0 = extremely easy, 10 = extremely difficult). For visualization purposes, responses were categorized as Extremely Easy (0–2), Moderately Easy (3–5), Moderately Difficult (6–8), or Extremely Difficult (9–10); d Spearman correlation between QDG Mobility Scores and MDS-UPDRS Part II scores (ρ = −0.61 [95% CI: −0.88, −0.16], p = 0.004, n = 20); confidence intervals were calculated using bootstrapping.

Fig. 3. QDG across the range of PD duration.

QDG traces and Mobility Scores (MS) from the more and less affected sides of representative participants with different durations of PD (−1 month, 0 months, 5, 10, 15, and 20 years). Each QDG trace displays the amplitude of lever strikes (millimeters) over time (seconds); the blue and red strikes represent the index and middle fingers on right hand traces (vice versa on left hand). A normal MS (>92) is in green and abnormal in red. The –1- and 0-month traces are off therapy, while 5- to 20-year traces are on therapy.

Fig. 4. QDG dashboard showing Mobility Scores.

a Participant 1 [adapted from ref. ] and b Participant 2’s more affected left-hand scores. Green circles indicate normal values, red circles abnormal values. Dashed lines mark therapy adjustments.

Fig. 5. QDG remote at-home study protocol.

During the visits, the MDS-UPDRS II and questionnaires on QDG system usability, design feedback, and PD symptom tracking were administered.