Objective: 1. Evaluate how well levodopa dose frequency and Parkinson’s Kinetigraph (PKG) metrics correspond with the 5-2-1 criteria for identifying Advanced Parkinson Disease (APD)

2. Determine whether PKG measures improve detection of motor fluctuations not captured through routine clinical assessment

Background: Timely identification of APD is essential for optimising therapy and considering advanced therapeutics. The 5‑2‑1 criteria (≥5 daily levodopa doses, ≥2 hours off time, ≥1 hour of troublesome dyskinesia) offers a validated screening tool to identify patients who may have APD. In practice, clinicians often rely on levodopa dosing frequency, as estimating off time and dyskinesia during clinic visits is challenging. PKG data identified off periods and dyskinesia as a surrogate measure for the 5-2-1 criteria.

Method: We analysed 101 patients with available PKG data attending the Parkinson’s clinic at the University Hospital Llandough (S. Wales, UK) from January 2023 to December 2025. Electronic health records (EHR) were reviewed to identify ≥5 daily levodopa doses alongside PKG data. PKG metrics were mapped to the 5‑2‑1 criteria.

Results: Of 101 patients, 21 were excluded due to either incomplete PKG data or atypical Parkinsonism, leaving 80 patients for analysis.

60 PKG patients (average age 73years, range 59-90 years) were taking ≥5 daily levodopa doses, of which 46 (76.7%) were already identified to have APD on EHR.

Using the “5‑dose rule” yielded a sensitivity of 96%, demonstrating strong ability to correctly identify patients with APD, while the specificity was more modest at 56%.

PKG recordings revealed 78 patients experienced at least two hours of daily off time; 59.0% were diagnosed APD on EHR. 32 patients recorded one or more hours of dyskinesia, 75% were classified as having APD on EHR.PKG metrics identified several patients with significant fluctuations not previously labelled as APD.

Conclusion: This analysis demonstrates that levodopa dosing can help identify patients with APD. The “5‑dose rule”  on its own showed high sensitivity but modest specificity, indicating it may serve as a practical trigger for clinicians to evaluate for potential APD.

PKG metrics appear to highlight patients with APD who have not been clinically identified. Role of PKG in earlier recognition of APD needs further evaluation. This may better guide timely therapeutic decisions.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-levodopa-dose-frequency-and-parkinsons-kinetigraph-metrics-for-screening-advanced-parkinsons-disease/