Digital Health Revolution: Is it Time for Affordable Remote Monitoring for Parkinson’s Disease?

PARKINSON’S DISEASE IS A COMMON HEALTH CARE PROBLEM WITH SIGNIFICANT SOCIAL AND ECONOMIC IMPLICATIONS More than one million people in the US (five million people worldwide) are believed to have Parkinson’s disease, and its prevalence is expected to double by 2030 (1). The national annual economic burden for Parkinson’s disease in 2010 was estimated at more than $14.4B and is expected to grow substantially due to the increasing aging population (2). Disease prevalence is age-associated, with approximately 1–2% of the population being affected at 65 years (3). The cardinal clinical features of Parkinson’s disease are tremor, bradykinesia, rigidity, and postural instability (4). Parkinson’s disease significantly affects employability and activities of daily living, leading to a reduction in healthrelated quality of life and increases in morbidity and mortality (5, 6). Parkinson’s disease has a substantial impact on patients, caregivers, and the healthcare system, especially as the disease progresses and patients are less able to care for themselves (7). While l-DOPA has resulted in significant improvement in quality of life and reduction in Parkinson’s disease-related mortality (8), a number of motor complications develop in approximately 50% of patients within 3–5 years (9). The most common l-DOPA-induced motor complications include motor fluctuations (e.g., wearing off, unpredictable “off– on” fluctuations) and dyskinesia can be more disabling than the motor symptoms for which treatment was initiated (10). Wearing off applies to rapid reduction in mobility; dyskinesia is expressed as dance-like, random involuntary movements, classified as chorea (typically when “on”) or dystonia (typically when “off”) (11). The pathogenesis of these changes is not well understood (12). These motor fluctuations and dyskinesia are managed with dose adjustment of l-DOPA and/or the co-administration of adjunctive therapies (dopamine agonists, MAO-B inhibitors, or amantadine). To design an appropriate management plan, specialized evaluation is needed. However, access to such care has become increasingly difficult. The most recent WHO atlas of resources for neurological disorders indicates that the lack of access to specialists varies from 0.03 to 4.84 per 100,000 population depending on geographic location (13).