Feasibility of Smartphone-Based Testing of Interference in Parkinson’s Disease

Abstract

Background: Interference refers to learned associations and established behaviors “interfering” with response to new material. It forms a core pillar of executive functions, which are commonly affected in Parkinson’s disease (PD). Cognitive interference test (CIT) forms part of a smartphone application designed for ambulatory assessment in PD. Objective: The aims of this study were to establish that CIT could effectively demonstrate interference and would perform comparably to the Stroop Color-Word Test Victoria version (VST) despite PD-related motor impairment. Methods: Ninety-nine patients with PD were recruited. Initial evaluation included CIT, VST, Montreal cognitive assessment (MOCA), and Movement Disorders Society-sponsored revision of the ­Unified Parkinson’s Disease Rating Scale (MDS-UPDRS-III). A group of patients underwent repeat assessment within 2 weeks. Thirty-four healthy controls were recruited for comparison. Results: Patients’ mean age was 66.2 years, disease duration was 8.7 years, on-state MDS-UPDRS-III was 22, and MOCA total score was 27. CIT effectively generated interference, whereby the total time taken to complete the incongruent task was 20% longer compared to that of the baseline task. CIT key test items demonstrated convergent validity to VST (r = 0.478–0.644, p < 0.0001) and satisfactory repeatability (intraclass correlation coefficient 0.46–0.808, p ≤ 0.0002). Performance on key CIT test parameters deteriorated with increasing age (r = 0.225–0.478, p < 0.01) and MDS-UPDRS-III total score (r = 0.354–0.481, p < 0.0001). When compared to controls and patients with less motor impairment, patients MDS-UPDRS-III > 30 took longer to complete CIT and VST and had lower MOCA-attention sub-score, implying that the degree of motor impairment could not be the sole explanation for reduced CIT performance. Conclusions: We established that despite motor impairment, the novel approach of using smartphone technology to test interference in PD patients is feasible.

Parkinson's Disease Remote Patient Monitoring During the COVID-19 Lockdown

“…However, this was not a validation study and its primary objective was to evaluate the usability and the compliance of a smartphone app for PD RPM. At the same time, it was possible to associate several quantified motor and cognitive outcomes to available disease severity indexes (disease duration, UPDRS-III total score, H&Y; Supplementary Materials), as also previously reported (10)(11)(12). Interestingly some of the motor and cognitive parameters-in particular TUG test datawere not associated to age but specific to the PD condition (Supplementary Table 3).…”

Feasibility and usability of a non‐immersive virtual reality tele‐cognitive app in cognitive rehabilitation of patients affected by Parkinson's disease

“…During the COVID‐19 pandemic, in fact, the possibility of supporting patients with telerehabilitation protocols via mobile health, independent of their geographical location, could represent a positive opportunity, considering its accessibility and high motivational power based on the integration of playfulness and gamification 20–22 . Finally, mobile health is flexible, as its use is independent of time and place, and thus adaptable to the daily life of patients 23,24 .…”

“…During the COVID‐19 pandemic, in fact, the possibility of supporting patients with telerehabilitation protocols via mobile health, independent of their geographical location, could represent a positive opportunity, considering its accessibility and high motivational power based on the integration of playfulness and gamification. 20 , 21 , 22 Finally, mobile health is flexible, as its use is independent of time and place, and thus adaptable to the daily life of patients. 23 , 24 It should be considered that previous studies have reported that patients who consider therapy to be useful and motivating show greater therapeutic adherence and involvement in therapy, especially in distant rehabilitation.…”