Objective: To evaluate the Personal Kinetigraph (PKG) fluctuator score (FS) in detecting motor fluctuations in Parkinson’s disease (PD) patients.

Background: Fluctuations of response to levodopa, including wearing off (WO) and dyskinesias, are common complaints in PD as disease progresses. Due to their variability, identification of motor fluctuations depends on a patient’s ability to identify and report them. The PKG FS algorithm has the potential to quantify the frequency and severity of fluctuations, identifying patients in need of medication adjustment and advanced therapies.   

Methods: We conducted a case-controlled cohort study of 56 PD patients at Cedars-Sinai Medical Center. All subjects met the UK Brain Bank diagnostic criteria for PD. Based on the WO Questionnaire (WOQ9) and UPDRS part IV, subjects were categorized as non-fluctuators (NF, WOQ9<2), early fluctuators (EF, WOQ9≥2), moderate fluctuators (MF, WOQ9≥2 and UPDRS IV.1 and IV.2 <2), and troublesome fluctuators (TF, WOQ9>2 and UPDRS IV.1 and IV.2 ≥ 2). FS mean, standard deviation, and quartile ranges were calculated. One-way ANOVA and contrast t-tests were used to analyse the results of FS. A significance level of p < 0.05 was used. 

Results: Study cohort included 12 NF, 16 EF, 15 MF, and 13 TF. FS were available for 51 patients and significantly differentiated non-dyskinetic (NF+EF, mean FS 6.98) from dyskinetic patients (MF+TF, mean FS 9.128; p <0.01). One-way ANOVA comparing the 4 groups was significant at p = 0.01. Tukey’s test comparing pairs of groups indicate that FS for EF vs TF, and MF vs EF were significantly different. Review of PKGs with peaks of movement consistent with exercise correlated with higher dyskinesia scores in 3 patients, notably all in the NF group. 

Conclusions: Patient-reported dyskinesias correlated with objective FS on the PKG. However, FS differences could not be detected between each fluctuator group, possibly as a result of the subjective nature of reporting wearing-off and grading non-troublesome versus troublesome dyskinesias. In addition, exercise may artificially elevate dyskinesia scores, complicating the analysis of highly functional, physically active patients without motor fluctuations. Despite these limitations, our data support the use of FS as an objective tool to capture motor fluctuations and possibly triage candidates for medication changes or advanced therapies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-personal-kinetigraph-fluctuator-score-identifies-motor-fluctuations-in-parkinsons-disease/