How to assess movement abnormalities in patients with parkinson’s disease using daily-living technology?

Keywords: Movement measurements, Parkinson’s disease, Daily living environment, Disease progression, Disruption of normal motor control (e.g. gait, balance, tremor), Classification of movement, Signal analysis, Pattern recognition Technological development, IoT, Good Clinical Practice (GCP)

Focus Area
An estimated six million people world-wide have Parkinson’s. Classic symptoms include muscle rigidity, tremor, slowness of movement and balance problems. These are known as motor symptoms. Non-motor symptoms are also common and include depression, dementia, pain, sleep problems and dysfunction in the body’s autonomic systems (digestion, blood pressure etc.). Both types of symptoms make PD difficult to live with, especially as the disease progresses and the severity of symptoms increases.

PD usually develops in people in their late 50s and early 60s, though rarer forms of the disease can develop before the age of 40.
Because the risk of developing PD increases with age, the fact that more people are now living into old age means that the overall number of people with PD is also rising.

Treatment for PD normally involves drug therapy and, in some cases, surgery. In addition to this, physical exercise, diet, complementary therapies, emotional support and strong relationships all play important roles.

Several questionnaires are currently used for assessment of motor and non-motor symptoms in PD, the most well established being the Unified Parkinson’s Disease Rating Scale (UPDRS). The ratings are often subjective and scored on a scale of e.g. 0-5 or 0-100. These are used today for evaluating efficacy of a new drug therapy. We see a great need for more objective measures. See link below for more information on questionnaires used for PD.

About Lundbeck: Lundbeck is a global pharmaceutical company highly committed to improving the quality of life of people living with psychiatric and neurological disorders. For this purpose, Lundbeck is engaged in the research, development, production, marketing and sale of pharmaceuticals across the world. The company’s products are targeted at the disease areas depression, schizophrenia, PD and Alzheimer’s disease.

Challenge
For Lundbeck to develop new drug therapies for PD, it is important that we can measure various aspects of the disease, which are important to the patient, and in this challenge, we are considering the motor aspects of PD.

This challenge is to identify and create ways of reliably measuring movements, especially abnormal movements, in a daily living environment (e.g. in the patient’s home) with as little as possible burden for the PD patient.

• There should be limited impact on the patients when measurements are being acquired and stored, preferably when performing everyday tasks.
• Can these measurements be made using some of the many products, we all use as part of daily living? Maybe the measurements could be tracked with devices most of us have access to, e.g. smartphones including cameras, digital watches, or it could be a sensor device made for the purpose?
• How will we know if a movement is normal and hence how can we classify abnormal movements? The abnormal movements (or inability to move) are the ones, we try to reduce (in numbers or duration) with our drug therapies and it is therefore important we can classify movements into ‘normal’ and ‘abnormal’ movements.
• Abnormal movement measurements may be associated with a high degree of variability, so a challenge will be to reliably classify these movements despite said variability. In other words, a robust methodology must be applied.

Considerations

Ultimately, Lundbeck wish to include the measurements of motor symptoms in our clinical studies for development of new drug therapies for PD. The reliability of the measurements must therefore be high. In addition, the price for obtaining these measurements should be kept low, so the costs will not impact the willingness to use these. We realize it is not realistic to develop a complete solution in the timeframe of this challenge but hope it could lead to further development of a final product.

Links/access

• Understanding Parkinson’s disease: parkinsons-disease
• Common symptoms of Parkinson’s disease: what-is-parkinsons/symptoms/ and understanding-parkinsons/living-with-pd/
• Questionnaires for PD:about-parkinson-s/symptoms/rating-scales/
• TED Talk by a PD patient: Ted-Talk
• Wearable Devices: Revolutionary Tools for Parkinson’s Research: 3-FoxInsightWearables-EducationtoActionrevised.pdf