How Far Do the Complaints of Patients with Parkinson’s Disease Reflect Motor Fluctuation? Quantitative Analysis Using a Portable Gait Rhythmogram

Abstract

In advanced-stage Parkinson's disease (PD), motor fluctuation is a frequent and disabling problem. Assessment of motor fluctuation depends on patient's subjective self-statement. We examined whether the subjective fluctuation matched the objective motor fluctuation defined by gait disorders. Using a new device, the portable gait rhythmogram, we recorded gait cadence and acceleration continuously over the 24-hour period in 54 patients with PD and 17 normal controls, for the quantitative evaluation of motor fluctuation. The patients were asked to estimate motor fluctuation every hour. In 44 of 54 patients, changes in the cadence were associated with simultaneous changes in acceleration. We examined the subjective fluctuation in these 44 patients who were confirmed to have motor fluctuation. Nineteen (82.7%) of 23 patients who felt no fluctuation showed distinct gait disorders. During off time, they walked with marked short or bradykinetic stepping. No matching changes were observed in either the cadence or acceleration in 11 (52.4%) of 21 patients who perceived motor fluctuation. No synchronization was noted in 30 (68.2%) of the 44 patients, between the times of subjectively assessed motor fluctuation and those of quantitative analysis of gait disorder. This discrepancy suggests that the objective continuous recording of the cadence and acceleration is necessary to understand motor fluctuation.

Kinematic analysis of 24-hour recording of walking pattern in patients with vascular parkinsonism

“…The PGR does not only allow measurement of the cycle of gait-induced accelerations, but also the amplitude of such accelerations, which correlated with floor reaction forces. Thus, quantitative analysis of the gait acceleration cycle and amplitude measured by the PGR allows characterization of the bradykinematic features of gait disorders in PD patients, as described in detail in our previous reports [16,[20][21][22][23].…”

A Newly Developed Wearable Device for Continuous Measurement of Gait- Induced Accelerations in Daily Activities

“…The PGR is a trunk-mounted small device (size, 8×6×2 cm, weight, 80 g) ( Figure 1) housing an acceleration sensor with automatic gait detection algorithm, in which gait induced-accelerations are extracted from limb and trunk movements using a mathematical algorithm; the "pattern matching method" [13][14][15][16][17][18][19][20]. …”

“…Based on the capability of the PGR for long-term monitoring, we monitored changes in gait abilities in PD patients. The continuous recording provided new findings on motor fluctuation in PD [13,19]. Dopamine-replacement therapy at the early stage of PD decreases motor and non-motor complications.…”

“…To provide a better assessment of gait while the patient is at home and for quantitative evaluation of gait fluctuation, we recorded gait cycle and acceleration continuously over the 24-hr period in 54 patients with PD and 17 controls [19]. The patients were also asked to estimate motor fluctuation every hour with diaries.…”

Challenges in detecting disease modification in Parkinson's disease clinical trials

“…While these questionnaires are thought to provide a global indicator of function, further work is needed to validate their usage as measure of disease progression. Patient diaries as end points in clinical trials have been associated with reduced compliance, recall bias and diary fatigue, particularly in patients with cognitive dysfunction and depression [71], and often do not correlate with quantitative objective assessments [72,73]. Stage of disease can also influence the usefulness of the questionnaires.…”