Transforming Parkinson's disease clinical management with integrated digital health technologies

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Parkinson's disease (PD) is an incurable and progressive neurological disorder, which is growing fast in prevalence due to an ageing population. The problem is that the effect of Levodopa (L-dopa), the standard drug used to treat PD, wears off after ~90 min. In addition, the drug's therapeutic effect is limited since only 1-5% of L-dopa reaches the brain. Therefore, medication levels fluctuate significantly and patients require multiple L-dopa doses over a 24-h period. When medication is working, patients experience significant improvement of their PD symptoms which include stiffness, slowness, and tremors. However, at low medication levels patients experience "off periods" and high medication levels result in debilitating uncontrolled movements. As PD progresses, "off periods" become more frequent (typically 2-5h/day) and patients lose critical function such as speech and mobility. At this stage patients are fully reliant on carers or healthcare personnel, leading to high incidence of depression and substantial out-of-pocket expenditure for care. There are some wearable devices on the market to remind PD patients when to take medication but their functionality is limited. In this proposal, we will develop a package of digital tools for the remote monitoring and improved clinical management of PD. This will comprise wearables that can monitor the mobility and motor symptoms of PD patients and a device that can monitor in real-time levels of L-dopa by measuring interstitial fluid, the fluid just below the skin. Algorithms and software will be developed to replace the current rigid "one-size-fits-all" medication regime with adaptive, personalized medication levels. In the future, we will integrate these digital tools to have a single wearable device that can determine the optimized drug regime for PD patients. This platform is unique because it can measure both medication levels and symptoms in real-time from the comfort of the patient's home. It will bring significant benefits to PD patients by improving their medication adherence, better informed clinical-decision making, and improving their independence by reducing length and frequency of "off periods". We will work closely with patients, carers, clinicians, and local policy makers to ensure the intended wearable is fit for the purpose. In the future, it is envisaged that this platform can be extended to monitoring of other therapeutics and will improve medication adherence for patients managing multiple (chronic) conditions.