Affiliations: [a]
King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, United Kingdom
| [b] Parkinson Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, United Kingdom
| [c]
Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; department of neurology; Nijmegen, the Netherlands
Correspondence:
[*]
Correspondence to: Daniel J. van Wamelen, MD, PhD, King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, United Kingdom. E-mail: [email protected].
Note: [1] These authors contributed equally to this work
Abstract: Background:Several small-scale studies have shown that motor performance in Parkinson’s disease (PD) fluctuates throughout the day. Studies specifically focusing on de novo patients are, however, lacking. Objective:To evaluate the effect of clock time on motor performance in de novo drug-naïve patients with PD. Methods:We retrieved MDS-UPDRS III scores for 421 de novo PD patients from the PPMI cohort and stratified them into three groups based on time of assessment: group 1) 7:00–10:00; group 2) 10:00–13:00, and group 3) 13:00–18:00. Groups were compared using Kruskal-Wallis test and results corrected for multiple testing. In addition, we obtained 27 wearable sensor reports, objectively capturing bradykinesia scores in a home setting over a 6-day continuous period, in 12 drug-naïve patients from the Parkinson’s Kinetigraph Registry held at King’s College Hospital London. Time spent in severe bradykinesia scores were broken down into five daytime (06:00–21:00) three-hourly epochs and scores compared using the Friedman test. Results:There were no group differences in demographic or other clinical variables for the cross-sectional analysis. MDS-UPDRS III total scores worsened significantly during the course of the day (median 18 (group 1); 20 (group 2); and 23 (group 3); p = 0.001). In the longitudinal wearable sensor cohort, diurnal variations were present in percentage of time spent in severe bradykinesia (p < 0.001) with the lowest percentage during the 09:00–12:00 epoch (69.56±16.68%), when most patients are awake and start daily activity, and the highest percentage during the 18:00–21:00 epoch (73.58±16.35%). Conclusion:This exploratory study shows the existence of a diurnal pattern of motor function in patients with de novo PD. The results obtained were corroborated by objective measurements in a small longitudinal cohort confirming a similar diurnal motor score variation.
Keywords: Parkinson’s disease, circadian rhythm, diurnal rhythm, bradykinesia, motor
