Parkinson's Monitoring: Why Is It So Far Behind

Parkinson’s Disease is the fastest-growing neurological condition in the world. Currently, around 166,000 people in the UK live with Parkinson’s, and that number is expected to reach 173,000 in 2030.

Yet despite its prevalence and morbidity, there are huge gaps in patient care, particularly when it comes to monitoring. Compared to other lifelong conditions like Diabetes, Parkinson’s monitoring seems decades behind.

Why is this the case, and what’s being done about it?

Why Is Monitoring Important?

Parkinson’s is a neurodegenerative condition, meaning that it worsens over time. However, the degeneration rate is not the same for everyone—it takes hold faster in some people compared to others. The rate of progression varies depending on a myriad of factors, including age, medication, and the Parkinson’s subtype.

By monitoring individuals closely, neurologists may in future determine the rate of neural degeneration, giving patients a clearer and personalised outlook on the condition. With more objective insights and data points, we hope to better orchestrate care and treatment to control the disease’s progression.

Symptoms and the severity of those symptoms vary from person to person. Real-time monitoring will show how symptoms fluctuate throughout the day in response to treatment. Monitoring charts enable clinicians to fine-tune treatments, dosage, and medication schedules, resulting in more effective control and management of the condition.

In a nutshell, monitoring is key to a more personalised approach to Parkinson’s treatment. It helps people living with Parkinson’s and their healthcare providers make data-driven decisions to manage symptoms, boost their wellbeing and generally improve their quality of life.

The Outdated Ways Parkinson’s Is Being Monitored

Today, most people living with Parkinson’s rely on in-person exams to monitor symptoms and progression. Once or twice a year, a clinician checks their symptoms, how the condition is affecting their life, and how they’re responding to treatment.

Calling these routine check-ups “monitoring” is a bit of a stretch, given the huge intervals between exams and the subjective means clinicians use to gauge the status of the condition. There’s another problem, too. Given the long-standing shortage of Parkinson’s care clinicians in the UK, access to specialised care, even on a yearly or biyearly basis, is not guaranteed.

The closest a person living with Parkinson’s can get to monitoring is a personal symptom diary. A Parkinson’s diary (e.g., a Hauser Diary) does have its merits. However, it lacks the objectiveness of a reliable health monitoring system since it only collates a person’s self-reported experiences. It also places the monitoring burden on the person living with Parkinson’s and only tracks a narrow band of Parkinson’s symptoms.

To a large extent, people living with PD have limited ability to: track their symptoms, monitor progress, and gauge the effectiveness of medication.

The Vision of Parkinson’s Monitoring

So, what does effective Parkinson’s monitoring look like?

What people living with Parkinson’s need is a monitoring system similar to that for people living with diabetes : a continuous glucose monitors (CGM). A CGM comprises a small sensor inserted under the skin, on the back of the arm, that measures blood glucose levels in interstitial fluid. It then sends the measurements to a special receiver or straight to a smartphone.

A CGM gives real-time measurements of glucose levels in the blood allowing low and high readings to be tracked and treated efficiently as either of them could lead to a medical emergency. Even better, it can be linked to an insulin pump in what’s called a hybrid closed-loop system. The CGM sends glucose level data to the insulin pump, which then calculates how much insulin is needed at any given time, it removes the burden figuring when to administer injections.

If such a system were constructed for Parkinson’s, it would be a game changing monitoring tool. It would equip clinicians with valuable, detailed, and accurate health insights to personalise treatment with the right medications, dosage and therapies. Plus, it could give a clear picture of how PD is progressing and how symptoms are changing, effectively giving more control.

The New Frontier in Parkinson’s Monitoring… We’re Getting There

Over the years, tech companies have developed and deployed different technologies for real-time Parkinson’s monitoring. Progress on this front, though slow, is promising.

Systems like the StimSense and PD Track developed by SERG Technologies are pushing closer to the Parkinson’s monitoring vision. At its core, StimSense has a wearable sensor that measures tremors, rigidity, and bradykinesia. The data is then processed into standardised symptom severity l scores and fed into existing Deep Brain Stimulation (DBS) tools.

SERG is working towards an adaptive closed-loop system, where data from the sensor drives both DBS programming and medication titration. That would be similar to how a CGM works with an insulin pump in a hybrid closed-loop system.

Rather than relying on bi-annual in-clinic interpretation of Parkinson’s symptoms, people living with Parkinson’s can simply look at the monitor’s data to check symptom frequency and severity scores. The beauty of it is that it can all be done remotely in parts, reducing the need for in-person clinical assessments. And it, of course, relieves the monitoring burden of Parkinson’s patients.

As new technologies evolve, particularly in neuroscience, Parkinson’s monitoring will only become more accessible, convenient, and reliable.