Image shows Tom Isaacs (as a trial participant) undergoing standard movement scores assessments 

It is acknowledged within the research community that our current methods of monitoring and assessing Parkinson's require improvement. This is particularly necessary in the context of clinical trials, where the use of episodic rating scale-based measurements might not be nuanced enough to pick up subtle changes in symptoms that may (or may not) be occuring over time with experimental therapies. Ideally, the measurement of Parkinson’s would be occurring on a more continuous process over long periods of time. This scenerio would allow for a more general measure of the condition over time, and avoid the situation where individuals are being assessed for just one hour on a good day or a bad day. Such methods of assessment should also be unintrusive in the daily life of the individual being measured. The person should forget that they are being assessed, in order to provide a completely unbiased measure. A recent article (Merchant et al, Journal of Parkinson’s Disease) recognised that

There is broad consensus that every ongoing clinical Parkinson’s trial should integrate mobile technology-derived measures, initially on an exploratory level and targeting endpoints previously validated in clearly defined cohorts.

Tremendous research efforts are being made in measuring Parkinson's, and technology is playing a major role. From smart phone applications and wearable devices (which monitor daily-living and the physical aspects of Parkinson's) to the use of artificial intelligence in identifying novel biomarkers in bodily fluids (which may change with the course of the condition), there is a lot of research focused on this need for more accurate measurement of Parkinson's.

One example of wearable technology that could be used for measuring Parkinson’s over a certain time period is a pair of smart glasses being developed by a technology company called Emteq. A pair of glasses are an item that many of us place on our heads without thought, and 60% of the population over the age of 50 wear glasses. Emteq glasses will be capable of monitoring facial expression, voice and assessing gait (walking) as the individual is going about their daily lives. Smart phone applications provide a useful method of measuring Parkinson’s over time as well, and they provide an opportunity for subjective input from the person being assessed. This personal, lived experience information is also important in the assessment of the condition and can be compared with the more objective data being collected by devices (such as the smart glasses).

There is a project getting underway in Bristol using a “smart house” – a house filled with sensors which will enable researchers to provide context to the readings from wearable technology.  The SPHERE House project will help define better objective measures of Parkinson’s that relate to an individual’s life without being burdensome.

Researchers are also exploring the use of biological markers for better measurement of the progression of Parkinson’s. An interesting example of biological biomarkers is research surrounding brain derived exosomes in blood samples (funded by The Cure Parkinson's Trust). During the Phase II clinical trial of Exenatide in Parkinson's (which was a Linked Clinical Trials initiative-associated study), the investigators collected blood samples from participants at each assessment. They then isolated exosomes - small vesicles of material released from brain cells - from those blood samples and analysed their content. By doing this, the investigators were able to assess the drug interactions within the brain over time, providing the researchers with a powerful new tool that could be used to monitor participants in future trials.  

Importantly, this measurement research is being conducted via major collaborative initiatives that pull together the efforts of clinical research centres, biorepositories, data firms, and - most importantly - patients. A good example of this is the Michael J Fox Foundation sponsored Parkinson's Progression Markers Initiative. Large numbers of people with Parkinson’s are volunteering to be thoroughly assessed (including providing biological samples, such as blood), which provide researchers with a rich resource to mine for novel biomarkers that could be used to monitor the condition.

One of the challenging aspects of this research is the adoption and implementation of novel methods of measurement in the clinical setting. Determining which new tests/biomarkers should be used is going to require a great deal of work. The current methods of measuring Parkinson’s have been validated across thousands of clinics around the world, and there are large committees that review data and propose new changes to those methods in incremental steps. Bringing novel measures of Parkinson’s to the clinic is going to require a similar process of validation and improvement. There are efforts already being made to do this with some of the novel approaches being proposed. Most future clinical trials will have sub-studies attached to them that will explore additional 'added value' outcomes. These minor studies will provide clinical validation for the use of a new method, and independent replication will provide further support for adoption.

Thus, while it is recognised that the current methods of measuring Parkinson’s are not perfect, there is a great deal of research being conducted by a large network of collaborating parties to effect valuable change in this area of clinical trial and condition progression measurement.