Chang Jun Ha, Bhatti Danish, Rizzo Matthew, Uc Ergun Y, Bertoni John, Merickel Jennifer
Department of Neurological Sciences University of Nebraska Medical Center Omaha Nebraska USA.
Department of Internal Medicine University of Central Florida Orlando Florida USA.
Mov Disord Clin Pract. 2023 Jun 12;10(9):1324-1332. doi: 10.1002/mdc3.13803. eCollection 2023 Sep.
Driving is a complex, everyday task that impacts patient agency, safety, mobility, social connections, and quality of life. Digital tools can provide comprehensive real-world (RW) data on driver behavior in patients with Parkinson's disease (PD), providing critical data on disease status and treatment efficacy in the patient's own environment.
This pilot study examined the use of driving data as a RW digital biomarker of PD symptom severity and dopaminergic therapy effectiveness.
Naturalistic driving data (3974 drives) were collected for 1 month from 30 idiopathic PD drivers treated with dopaminergic medications. Prescriptions data were used to calculate levodopa equivalent daily dose (LEDD). The association between LEDD and driver mobility (number of drives) was assessed across PD severity, measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS).
PD drivers with worse motor symptoms based on self-report (Part II: = 0.02) and clinical examination (Part III: < 0.001) showed greater decrements in driver mobility. LEDD levels >400 mg/day were associated with higher driver mobility than those with worse PD symptoms (Part I: = 0.02, Part II: < 0.001, Part III: < 0.001).
Results suggest that comprehensive RW driving data on PD patients may index disease status and treatment effectiveness to improve patient symptoms, safety, mobility, and independence. Higher dopaminergic treatment may enhance safe driver mobility in PD patients with worse symptom severity.
驾驶是一项复杂的日常任务，会影响患者的自主性、安全性、行动能力、社交联系和生活质量。数字工具可以提供关于帕金森病（PD）患者驾驶行为的全面真实世界（RW）数据，在患者自身环境中提供有关疾病状态和治疗效果的关键数据。
本试点研究探讨了将驾驶数据用作PD症状严重程度和多巴胺能治疗效果的RW数字生物标志物。
从30名接受多巴胺能药物治疗的特发性PD驾驶员中收集了1个月的自然驾驶数据（3974次驾驶）。使用处方数据计算左旋多巴等效日剂量（LEDD）。通过运动障碍协会统一帕金森病评定量表（MDS-UPDRS）测量PD严重程度，评估LEDD与驾驶员行动能力（驾驶次数）之间的关联。
根据自我报告（第二部分：=0.02）和临床检查（第三部分：<0.001），运动症状较差的PD驾驶员的驾驶行动能力下降幅度更大。LEDD水平>400mg/天的驾驶员行动能力高于PD症状较差的驾驶员（第一部分：=0.02，第二部分：<0.001，第三部分：<0.001）。
结果表明，关于PD患者的全面RW驾驶数据可能反映疾病状态和治疗效果，以改善患者症状、安全性、行动能力和独立性。更高的多巴胺能治疗可能会提高症状严重程度较差的PD患者的安全驾驶行动能力。
