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Quantitative mobility measures complement the MDS-UPDRS for characterization of Parkinson disease heterogeneity

By Emily J. Hill, Carl Grant Mangleburg, Isabel Alfradique-Dunham, Brittany Ripperger, Amanda Stillwell, Hiba Saade, Sindhu Rao, Oluwafunmiso Fagbongbe, Rainer von Coelln, Arjun Tarakad, Christine Hunter, Robert J Dawe, Joseph Jankovic, Lisa M. Shulman, Aron S. Buchman, Joshua M. Shulman

Posted 17 Aug 2020
medRxiv DOI: 10.1101/2020.08.16.20175596

Introduction: Emerging technologies show promise for enhanced characterization of Parkinson Disease (PD) motor manifestations. We evaluated quantitative mobility measures from a wearable device compared to the conventional motor assessment, the Movement Disorders Society-Unified PD Rating Scale part III (motor MDS-UPDRS). Methods: We evaluated 176 subjects with PD (mean age 65, 65% male, 66% H&Y stage 2) at the time of routine clinic visits using the motor MDS-UPDRS and a structured 10-minute motor protocol, which included a 32-ft walk, Timed Up and Go (TUG), and standing posture with eyes closed, while wearing a body-fixed sensor (DynaPort MT, McRoberts BV). Regression models examined 12 quantitative mobility measures for associations with (i) motor MDS-UPDRS, (ii) motor subtype (tremor dominant vs. postural instability/gait difficulty), (iii) Montreal Cognitive Assessment (MoCA), and (iv) physical functioning disability (PROMIS-29). All analyses included age, gender, and disease duration as covariates. Models iii-iv were secondarily adjusted for motor MDS-UPDRS. Results: Quantitative mobility measures from gait, TUG transitions, turning, and posture were significantly associated with motor MDS-UPDRS (7 of 12 measures, p<0.05) and subtype (6 of 12 measures, p<0.05). Compared with motor MDS-UPDRS, several quantitative mobility measures accounted for ~1.5-fold increased variance in either cognition or physical functioning disability. Among minimally-impaired subjects within the bottom quartile of motor MDS-UPDRS, including subjects with normal gait exam, the measures captured substantial residual motor heterogeneity. Conclusion: Clinic-based quantitative mobility assessments using a wearable sensor captured features of motor performance beyond those obtained with the motor MDS-UPDRS and may offer enhanced characterization of disease heterogeneity.

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