Objective monitoring of motor symptom severity and their progression in Parkinson's disease using a digital gait device.

Digital technologies for monitoring motor symptoms of Parkinson's Disease (PD) underwent a strong evolution during the past years. Although it has been shown for several devices that derived digital gait features can reliably discriminate between healthy controls and people with PD, the specific gait tasks best suited for monitoring motor symptoms and especially their progression, remain unclear. Furthermore, the potential benefit as endpoint in a clinical trial context has not been investigated so far. In this study we employed a digital gait device manufactured by Portabiles HCT, which has been used by 339 patients within the LuxPark cohort (n = 161, Luxembourg) as well as within routine clinical care visits at the University Medical Center Erlangen (n = 178, Erlangen, Germany). Linear (mixed) models were used to assess the association of task-specific digital gait features with disease progression and motor symptom severity measured by several clinical scores. Furthermore, we employed machine learning to evaluate whether digital gait assessments were prognostic for patient-level motor symptom progression. Overall, digital gait features derived from Portabiles digital gait device were found to effectively monitor motor symptoms and their longitudinal progression. At the same time the prognostic performance of digital gait features was limited. However, we could show a strong reduction in required sample size, if digital gait features were employed as surrogates for traditional endpoints in a clinical trial context. Thus, Portabiles digital gait device provides an effective way to objectively monitor motor symptoms and their progression in PD. Furthermore, the digital gait device bears strong potential as an alternative and easily assessable endpoint predictor in a clinical trial context.