Amsterdam, July 20, 2021 - Well over six million people globally have been diagnosed with Parkinson's disease (PD), which has an enormous impact on the lives of patients, their families, and caregivers and is incurring mounting costs for society. This special supplement to the Journal of Parkinson's Disease (JPD), guest-edited by noted experts Anat Mirelman, PhD, E. Ray Dorsey, MD, MBA, Patrik Brundin, MD, PhD, and Bastiaan R. Bloem, MD, PhD, reviews how digital technology is being used to reshape research and clinical care in PD.
Digital health technology is an umbrella term that spans a diverse range of applications, including body-fixed wearable sensors, non-contactable domestic sensors, smartphone apps, and videoconferencing and other telemedicine systems that allow for direct remote interaction between patients and healthcare providers.
"Digital health technology is an important and promising field that is beginning to make a real tangible impact on persons with PD," explained Co-Guest Editor Anat Mirelman, PhD, Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center; and Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel. "This special supplement includes a series of succinct reviews that cover many practical and relevant aspects, such as digital monitoring, telemedicine, digital therapeutics, virtual clinical trials and digital progression biomarkers for clinical trials. All reviews offer both a view of the current state-of-the-art and informed perspectives on future directions."
"Despite the accumulating body of evidence to support the feasibility, utility, and benefits of various digital technology approaches, the use of digital technology in clinical practice has long remained scarce," added Co-Guest Editor and joint JPD Editor-in-Chief Bastiaan R. Bloem, MD, PhD, Radboud University Nijmegen Medical Center; Donders Institute for Brain, Cognition, and Behavior; Department of Neurology, Nijmegen, The Netherlands. "It has taken a contagion to make patients, physicians, and insurers pay better attention. Specifically, the limits on our ability to travel imposed by the ongoing coronavirus pandemic has led to a dramatic increase in the use of digital platforms in a matter of a few months. This change was unprecedented and has been identified as one of the few silver linings of the pandemic."
Important developments highlighted in this supplement include:
The increase in use of digital platforms is transforming neurological care, catalyzing the use of digital technology to maintain continuity of care, and impacting clinical trials. Using wearable sensors, clinicians can still monitor patients' motor symptoms while they are isolated at home and gain insights into behavioral changes and the implications of social distancing on patients' non-motor symptoms.
In clinical research, digital technologies are transforming practice and enhancing the understanding of PD. For example, assessing sleep can now be done in the home, passively, and frequently, expanding the knowledge of sleep disorders in patients with clinically manifest Parkinson's as well as individuals in early stages of the disease.
New tools may also shine a light on features of the disease that have largely been invisible, such as the appraisal of social function, expanded assessments of voice, quantification of tremor, assessment of falls, dyskinesia or freezing of gait, and objective measurement of the response to treatment. This could lead to a better understanding of the disease, its temporal pattern, variability, and impact on individuals bearing its burden.
Technological applications have the potential to reshape the way clinical research is conducted as decentralized trials will expand and even more assessments will transfer from the clinic to the home and mobile devices. Remote digital therapeutics can offer an attractive alternative for intensive interventions such as speech and language therapy, which typically requires frequent visits to clinics.
"There remain significant challenges," noted Dr. Mirelman. "These include the digital divide, the issue of privacy and security, and reimbursement, which requires health insurance companies and other payers to be persuaded by the merits of technology."
"The COVID-19 pandemic has emphasized some of the shortcomings of telemedicine or monitoring approaches, such as the undiminished need for in-person visits, especially for new patients," commented Professor Bloem. "These shortcomings raise yet another question as to what extent digital health technologies will survive when our lives get back to a new normal after this pandemic has resolved.
"We can say with certainty that the digital revolution has definitely started. We can almost be equally certain that this is only the beginning. The future of digital medicine will likely benefit both patients and healthcare in ways that are currently difficult to predict," he concluded.
Parkinson's disease is a slowly progressive disorder that affects movement, muscle control, and balance. It is the second most common age-related neurodegenerative disorder affecting about 3% of the population by the age of 65 and up to 5% of individuals over 85 years of age.