Impact of motor fluctuations on real-life gait in Parkinson's patients

Abstract

Background: People with PD (PWP) have an increased risk of becoming inactive. Wearable sensors can provide insights into daily physical activity and walking patterns.

Research questions: (1) Is the severity of motor fluctuations associated with sensor-derived average daily walking quantity? (2) Is the severity of motor fluctuations associated with the amount of change in sensor-derived walking quantity after levodopa intake?

Methods: 304 Dutch PWP from the Parkinson@Home study were included. At baseline, all participants received a clinical examination. During the follow-up period (median: 97 days; 25-Interquartile range-IQR: 91 days, 75-IQR: 188 days), participants used the Fox Wearable Companion app and streamed smartwatch accelerometer data to a cloud platform. The first research question was assessed by linear regression on the sensor-derived mean time spent walking/day with the severity of fluctuations (MDS-UPDRS item 4.4) as independent variable, controlled for age and MDS-UPDRS part-III score. The second research question was assessed by linear regression on the sensor-derived mean post-levodopa walking quantity, with the sensor-derived mean pre-levodopa walking quantity and severity of fluctuations as independent variables, controlled for mean time spent walking per day, age and MDS-UPDRS part-III score.

Results: PWP spent most time walking between 8am and 1pm, summing up to 72 ± 39 (mean ± standard deviation) minutes of walking/day. The severity of motor fluctuations did not influence the mean time spent walking (B = 2.4 ± 1.9, p = 0.20), but higher age (B = -1.3 ± 0.3, p = < 0.001) and greater severity of motor symptoms (B = -0.6 ± 0.2, p < 0.001) was associated with less time spent walking (F(3216) = 14.6, p < .001, R² = .17). The severity of fluctuations was not associated with the amount of change in time spent walking in relation to levodopa intake in any part of the day.

Significance: Analysis of sensor-derived gait quantity suggests that the severity of motor fluctuations is not associated with changes in real-life walking patterns in mildly to moderate affected PWP.

Keywords: Ambulatory monitoring; Gait quantity; Motor fluctuations; Parkinson’s disease; Wearable devices.