With the ever-increasing integration of technology into nearly every aspect of modern life, its applications in medicine continue to expand, including in the area of Parkinson disease (PD).
A recent randomized controlled trial of 195 patients with PD, for example, found that physician care delivered via telemedicine into patients’ homes was as effective as in-person care.1 Additional emerging research supports the benefits of other digital tools in this patient population.
In a review published online in the Journal of Parkinson’s Disease, Clint Hansen, PhD, of the Department of Neurology at Christian-Albrechts-Universität Kiel and the University Hospital Schleswig-Holstein, Campus Kiel in Kiel, Germany, and colleagues explored current and future directions regarding the use of technologies such as the electronic health record (EHR) and wearable sensors in PD management.2
Although many institutions and private practices have replaced paper-based medical records with EHRs, there are often limitations on how these are used in clinical decision making. This is likely to change significantly within the next decade, as most “countries with established health structures will then have nationwide provision of innovative EHRs with cloud storage solutions, and most of these EHRs will be patient-controlled,” Dr Hansen and colleagues noted.
In addition, they wrote, EHRs will “communicate with clinical data warehouses that consolidate hospital- and practice-derived data, with population health analytics databases that will provide information about disease risk and prevention, and with digital technology that is used by… the patient.”2 They also expect that moving forward, data protection laws will become more stringent, thus reducing the risk for privacy violations and increasing patient acceptance of EHRs.
With the growing use of digital devices to provide personalized feedback on measures of health, including those worn on the wrist or contained in shoes, it is conceivable that similar tools could be designed to facilitate the continuous monitoring of disease manifestations in patients with PD. These systems “will most probably be easily and widely used and not [require] an active interaction with the user, will be approved by regulatory authorities and the costs will be covered by health insurances,” noted Dr Hansen and colleauges.2
As a template for such devices intended for application in PD, the authors pointed to continuous subcutaneous glucose monitors that are used in patients with diabetes. Other possibilities include integrated detection systems in hearing aids, glasses, and earphones to allow patient interaction with the environment; analysis of mobility data such as reaction times and multitasking ability; insertable cardiac monitors; use of a smartphone as an accelerometer platform to gauge the treatment efficacy of deep brain stimulation; and remote assessment of autonomic features and gut motility. Many of these systems should be easily individualized to each patient.
In another review published in the same journal issue, the authors propose the use of a sensor-based system to analyze gait and detect falls in patients with PD, which would include decision support based on big data sources.3 One benefit of this type of approach is the “standardization of real-life medical data derived from individual patients into longitudinal multimodal disease trajectories…[which] will allow matching and clustering of different patient trajectories for individualized prediction about the expected treatment efficacy of particular interventions,” wrote Jochen Klucken, MD, of the Department of Molecular Neurology at Friedrich-Alexander University, and colleagues, in the Journal of Parkinson’s Disease. “Ultimately, the growing amount of medical data derived from individualized real-life treatment contexts will enable academic and industrial research to further improve objective outcomes and better tailor individual care.”
To glean further insights pertaining to the use of digital health technology in the realm of PD, Neurology Advisor spoke briefly with Alberto J. Espay, MD, MSc, professor of neurology and director and endowed chair of the James J. and Joan A. Gardner Center for Parkinson’s Disease and Movement Disorders at the University of Cincinnati Academic Health Center. Dr Espay is also chair of the Movement Disorders Society Task Force on Technology, which promotes the development of digital health systems that will achieve the goals mentioned above.4
Neurology Advisor: What is a key example of how digital health technologies could be used to improve PD care?
Dr Espay: Digital health technologies have the capacity of capturing intraday fluctuations with the kind of granularity that no scales, diaries, or questionnaires can.
Neurology Advisor: How can clinicians support these developments?
Dr Espay: Clinicians can stimulate their patients’ participation in a variety of technology-integration projects through many organizations. This is a great time to participate and contribute.
There will be a variety of ongoing studies aimed at developing a new version of the diary in electronic format for the digital age, integrated with mobile health technologies (“e-diary/tracker”). This is being coordinated through the Task Force on Technology of the International Parkinson’s and Movement Disorders Society. Efforts such as these are ongoing or will soon occur in many countries in the world.
Neurology Advisor: What should be next steps in terms of research or development in this area?
Dr Espay: The future development of a unifying platform for integrating and synchronizing the data from multiple technologies, one of the goals of the Movement Disorders Society Technology Task Force, could provide the most comprehensive picture of patients’ function than anything we currently have.
Neurology Advisor: Would you like to note any additional takeaways on the topic?
Dr Espay: Technology offers us the means to improving the ends of health care delivery. In the future it will weave seamlessly into patients’ lives to enhance the capture of data, help anticipate periods in which changes are needed, and empower patients to apply strategies to enhance their quality of life.
References
1. Beck CA, Beran DB, Biglan KM, et al. National randomized controlled trial of virtual house calls for Parkinson disease. Neurology. 2017;89(11):1152-1161.
2. Hansen C, Sanchez-Ferro A, Maetzler W. How mobile health technology and electronic health records will change care of patients with Parkinson’s disease. J Parkinsons Dis. 2018;8(Suppl 1):S41-S45.
3. Klucken J, Krüger R, Schmidt P, Bloem BR. Management of Parkinson’s disease 20 years from now: towards digital health pathways. J Parkinsons Dis. 2018;8(Suppl 1):S85-S94.
4. Espay AJ, Bonato P, Nahab FB, et al. Technology in Parkinson’s disease: challenges and opportunities.Mov Disord. 2016;31(9):1272-1282.