Accurately monitoring motor and non-motor symptoms as well as complications in people with Parkinson's disease (PD) is a major challenge, both during clinical management and when conducting clinical trials investigating new treatments. A variety of strategies have been relied upon including questionnaires, motor diaries, and the serial administration of structured clinical exams like part III of the MDS-UPDRS. To evaluate the potential use of mobile and wearable technologies in clinical trials of new pharmacotherapies targeting PD symptoms, we carried out a project (project BlueSky) encompassing four clinical studies, in which 60 healthy volunteers (aged 23-69; 33 females) and 95 people with PD (aged 42-80; 37 females; years since diagnosis 1-24 years; Hoehn and Yahr 1-3) participated and were monitored in either a laboratory environment, a simulated apartment, or at home and in the community. In this paper, we investigated (i) the utility and reliability of self-reports for describing motor fluctuations; (ii) the agreement between participants and clinical raters on the presence of motor complications; (iii) the ability of video raters to accurately assess motor symptoms, and (iv) the dynamics of tremor, dyskinesia, and bradykinesia as they evolve over the medication cycle. Future papers will explore methods for estimating symptom severity based on sensor data. We found that 38% of participants who were asked to complete an electronic motor diary at home missed~25% of total possible entries and otherwise made entries with an average delay of >4 h. During clinical evaluations by PD specialists, self-reports of dyskinesia were marked bỹ 35% false negatives and 15% false positives. Compared with live evaluation, the video evaluation of part III of the MDS-UPDRS significantly underestimated the subtle features of tremor and extremity bradykinesia, suggesting that these aspects of the disease may be underappreciated during remote assessments. On the other hand, live and video raters agreed on aspects of postural instability and gait. Our results highlight the significant opportunity for objective, high-resolution, continuous monitoring afforded by wearable technology to improve upon the monitoring of PD symptoms.

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Syncope is a common problem which can be remarkably debilitating and associated with high health care costs; its true incidence is difficult to estimate due to variation in definition, differences in population prevalence and under reporting in the general population. The median peak of first syncope is around 15 years with a sharp increase after 70 years.Vasovagal syncope is the commonest cause of syncope for all age groups, but cardiac causes become more common with advancing age. The cumulative incidence of syncope ranges from 5% in females aged 20 to 29, up to 50% in females aged 80 and above. Onethird of medical students report at least one syncopal episode in their life-time. The life-time cumulative incidence of syncope in women is almost twice that of men. Syncope accounts for up to 1-3% of hospital admissions and Emergency Room (ER) visits and in these settings is associated with cardiovascular co-morbidity and cardiovascular pharmacotherapy. In older adults syncope is a major cause of morbidity and mortality with enormous personal and wider health economic costs. Prevalence and incidence figures for syncope in older adults are confounded by an overlap with presentations classified as falls. In addition to injury and increasing dependency, quality-of-life studies consistently show that functional impairment in persons with recurrent syncope is similar to other chronic diseases.

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