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AbstractDigital biomarkers that remotely monitor symptoms have the potential to revolutionize outcome assessments in future disease-modifying trials in Parkinson’s disease (PD), by allowing objective and recurrent measurement of symptoms and signs collected in the participant’s own living environment.
摘要远程监测症状的数字生物标志物有可能通过对参与者自身生活环境中收集的症状和体征进行客观和反复的测量,彻底改变未来帕金森病(PD)疾病缓解试验的结果评估。
This biomarker field is developing rapidly for assessing the motor features of PD, but the non-motor domain lags behind. Here, we systematically review and assess digital biomarkers under development for measuring non-motor symptoms of PD. We also consider relevant developments outside the PD field.
该生物标志物领域正在迅速发展,以评估PD的运动特征,但非运动领域却落后。在这里,我们系统地回顾和评估正在开发的用于测量PD非运动症状的数字生物标志物。我们还考虑了PD领域之外的相关发展。
We focus on technological readiness level and evaluate whether the identified digital non-motor biomarkers have potential for measuring disease progression, covering the spectrum from prodromal to advanced disease stages. Furthermore, we provide perspectives for future deployment of these biomarkers in trials.
我们专注于技术准备水平,并评估已识别的数字非运动生物标志物是否具有测量疾病进展的潜力,涵盖从前驱到晚期疾病阶段的范围。此外,我们为这些生物标志物在试验中的未来部署提供了前景。
We found that various wearables show high promise for measuring autonomic function, constipation and sleep characteristics, including REM sleep behavior disorder. Biomarkers for neuropsychiatric symptoms are less well-developed, but show increasing accuracy in non-PD populations. Most biomarkers have not been validated for specific use in PD, and their sensitivity to capture disease progression remains untested for prodromal PD where the need for digital progression biomarkers is greatest.
我们发现,各种可穿戴设备在测量自主神经功能,便秘和睡眠特征(包括REM睡眠行为障碍)方面显示出很高的前景。神经精神症状的生物标志物不太发达,但在非PD人群中显示出越来越高的准确性。大多数生物标志物尚未被验证用于PD的特定用途,并且它们对捕获疾病进展的敏感性尚未针对前驱PD进行测试,其中对数字进展生物标志物的需求最大。
External validation in real-world environments and large longitudinal cohorts remains necessary for integrating non-motor biomarkers into research, and ultimately also into daily clinical practice..
将非运动生物标志物整合到研究中,并最终整合到日常临床实践中,仍然需要在现实环境和大型纵向队列中进行外部验证。。
IntroductionSince the last decade, the quest for disease-modifying therapies in Parkinson’s disease (PD) has intensified1. Measuring clinical disease progression accurately and objectively during these trials is of great importance to assess treatment efficacy. Currently, gold-standard outcome measures for such trials are the Movement Disorders Society scales for motor symptoms and daily functioning2.
引言自过去十年以来,帕金森病(PD)对疾病缓解疗法的追求不断加强1。在这些试验中准确客观地测量临床疾病进展对于评估治疗效果非常重要。目前,此类试验的金标准结果指标是运动障碍协会运动症状和日常功能量表2。
Use of these scales comes with several challenges: they require substantial assessment time, are conducted episodically and are based on subjective interpretation, which leads to considerable measurement errors over time3.In the past decade, we have seen tangible advancements in the remote digital assessment of the motor symptoms of PD, both in clinical practice and in research settings4,5,6,7,8.
这些量表的使用带来了一些挑战:它们需要大量的评估时间,是偶发性的,并且基于主观解释,随着时间的推移会导致相当大的测量误差3。在过去的十年中,我们在远程数字评估方面取得了实实在在的进展。PD的运动症状,无论是在临床实践中还是在研究环境中4,5,6,7,8。
Digital sensors can monitor symptoms non-invasively and often passively (without need for active human intervention). The quantification of symptoms and signs at a higher frequency and for longer time frames (even continuously for several digital outcomes) makes such digital biomarkers a more objective, more convenient and potentially more sensitive alternative to the episodic in-clinic assessment of disease progression.
数字传感器可以无创地监测症状,通常是被动的(不需要主动的人为干预)。在更高的频率和更长的时间范围内(甚至连续用于几个数字结果)对症状和体征进行量化,使得这种数字生物标志物成为疾病进展临床评估中更客观,更方便且可能更敏感的替代方案。
As such, several digital biomarkers of motor signs have been included in research settings9,10,11.Much less attention has been paid to non-motor symptoms, in both research and clinical practice, apart from olfactory dysfunction as a supportive criterion in the MDS diagnostic criteria12. Yet, non-motor symptoms have a substantial negative impact on quality of life in affected individuals13, precede motor symptoms during the prodromal phase up to two decades14 and are subject to daily fluctuations just as motor symptoms, favoring longitudinal measurement over episod.
。然而,非运动症状对受影响个体的生活质量产生重大负面影响13,在前驱期运动症状之前长达二十年14,并且与运动症状一样每天都会出现波动,有利于纵向测量而不是episod。
Validity of the biomarker versus the (gold-)standard, with a specific focus on discriminant and criterion validity.
生物标志物与(金)标准的有效性,特别关注判别和标准有效性。
Reliability, based on reported test-retest reliability.
可靠性,基于报告的重测信度。
Feasibility, based on the following subdomains: user friendliness (including stigmatization), compliance, implementation and practicality (how easily is it deployed in the participant’s context), based on both quantitative variables and qualitative interpretation. This analysis was conducted together with patient researchers, informed by a roadmap for implementation of patient-centered digital outcomes172..
可行性,基于以下子域:基于定量变量和定性解释的用户友好性(包括污名化),合规性,实施性和实用性(在参与者的背景下部署有多容易)。这项分析是与患者研究人员一起进行的,并根据以患者为中心的数字成果实施路线图172进行的。。
Sensitivity to disease progression, as measured by serial measurements in a longitudinal study, if applicable.
如适用,通过纵向研究中的连续测量来测量对疾病进展的敏感性。
Based on these results, a grade for the stage of development within a specific symptom category was made. The stage of development was based on the Technological Readiness Level (TRL), as defined by the most recent European Union definitions which we adapted to fit the field of digital biomarkers and medical monitoring devices in general (Fig.
根据这些结果,对特定症状类别的发展阶段进行了评分。发展阶段是基于技术准备水平(TRL),正如最新的欧盟定义所定义的那样,我们适应了数字生物标志物和医疗监测设备领域(图)。
2)187. Developmental stages range from development or proof of concept (TRL1, lowest), to public availability or commercialization applied in a longitudinal study (TRL9, highest) via several early and late validation stages in either lab setting or free-living conditions. We assigned a TRL per non-motor symptom or sign separately for the prodromal phase and for the clinically manifest phase.
2) 187年。发展阶段包括从开发或概念验证(TRL1,最低),到在实验室环境或自由生活条件下通过几个早期和晚期验证阶段在纵向研究(TRL9,最高)中应用的公共可用性或商业化。我们分别为前驱期和临床表现期分配了每个非运动症状或体征的TRL。
Finally, using a structured process in which both performance metrics, TRL and applicability in PD were assessed, all authors agreed on a final top 3 of digital biomarkers per non-motor symptom to be presented in one main table. The remainder of the included studies was added to Supplementary Table 2.Fig.
最后,使用一个结构化的过程,其中评估了性能指标,TRL和PD的适用性,所有作者都同意在一个主表中列出每个非运动症状的数字生物标志物的最终前三名。其余纳入的研究被添加到补充表2中。
2Technological readiness level (TRL)190 for digital biomarkers in clinical trials.Full size image.
2临床试验中数字生物标志物的技术准备水平(TRL)190。全尺寸图像。
Data availability
数据可用性
All data generated or analyzed during this study are included in this published article and its supplementary materials. A reference manager file is available from the authors.
本研究期间生成或分析的所有数据均包含在本文及其补充材料中。作者提供了参考管理器文件。
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Download referencesAcknowledgementsJ.M.J.D. is supported by a Therapeutic Pipeline Grant of the Michael J. Fox Foundation (Grant ID MJFF-019201). A.M. receives grants from the Department of Defense of the Israeli Ministry of Justice, the Michael J Fox Foundation, and the EU Joint Program—Neurodegenerative Disease Research.
。M、 J.D.得到了迈克尔·J·福克斯基金会(Grant ID MJFF-019201)的治疗管道资助。A、 M.获得以色列司法部国防部,迈克尔·福克斯基金会和欧盟联合计划神经退行性疾病研究的资助。
Sirwan Darweesh was supported in part by a Parkinson’s Foundation- Postdoctoral Fellowship (PF-FBS-2026) and a Veni award (09150162010183). Bastiaan Bloem has received research support from Biogen, Cure Parkinson’s, Davis Phinney Foundation, Edmond J. Safra Foundation, Gatsby Foundation, Hersenstichting Nederland, Horizon 2020, IRLAB Therapeutics, Maag Lever Darm Stichting, Michael J Fox Foundation, Ministry of Agriculture, Ministry of Economic Affairs & Climate Policy, Ministry of Health, Welfare and Sport, Netherlands Organization for Scientific Research (ZonMw), Not Impossible, Parkinson Vereniging, Parkinson’s Foundation, Parkinson’s UK, Stichting Alkemade-Keuls, Stichting Parkinson NL, Stichting Woelse Waard, Topsector Life Sciences and Health, UCB, Verily Life Sciences, Roche and Zambon.Author informationAuthors and AffiliationsRadboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The NetherlandsJules M.
Sirwan Darweesh得到了帕金森基金会博士后奖学金(PF-FBS-2026)和维尼奖(09150162010183)的部分支持。巴斯蒂安·布洛姆(Bastiaan Bloem)获得了Biogen、治愈帕金森氏症、戴维斯·菲尼基金会、埃德蒙·J·萨弗拉基金会、盖茨比基金会、荷兰赫森斯蒂奇汀、地平线2020、IRLAB Therapeutics、Maag Lever Darm Stichting、迈克尔·J·福克斯基金会、农业部、经济事务与气候政策部、卫生、福利与体育部、荷兰科学研究组织(ZonMw)、并非不可能、帕金森·维伦金(Parkinson Vereniging)、帕金森基金会、帕金森英国、Stichting Alkemade Keuls、Stichting Parkinson NL、Stichting Woelse Waard、Topsector Life Sciences and Health等的研究支持。UCB,Verily Life Sciences,Roche和Zambon。作者信息作者和附属机构荷兰奈梅亨帕金森和运动障碍专业中心神经病学系Donders大脑,认知和行为研究所拉德布德大学医学中心。
Janssen Daalen, Robin van den Bergh, Eva M. Prins, Mahshid Sadat Chenarani Moghadam, Sirwan K. L. Darweesh, Luc J. W. Evers & Bastiaan R. BloemHAN University of Applied Sciences, School of Engineering and Automotive, Health Concept Lab, Arnhem, The NetherlandsRudie van den Heuvel & Jeroen VeenUnshakeableMD, Oshawa, ON, CanadaSoania MathurParkinsonNL, Parkinson Patient Association, Bunnik, The NetherlandsHa.
。
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PubMed Google ScholarContributionsJ.J.D., A.M., B.R.B.: conceptualization – J.J.D., R.B., E.P. M.S.C.M. R.H., J.V., S.M., H.M.: data curation, formal analysis, investigation, review & editing. – J.M.J.D., R.B., E.P., M.S.C.M.: original draft writing – J.M.J.D., R.B., A.M., S.K.L.D., L.E., B.R.B.: design, methodology, review & editing.Corresponding authorsCorrespondence to.
PubMed谷歌学术贡献。J、 D.,A.M.,B.R.B.:概念化-J.J.D.,R.B.,E.P.M.S.C.M.R.H.,J.V.,S.M.,H.M.:数据管理,正式分析,调查,审查和编辑J、 M.J.D.,R.B.,E.P.,M.S.C.M.:原稿写作-J.M.J.D.,R.B.,A.M.,S.K.L.D.,L.E.,B.R.B.:设计,方法,审查和编辑。通讯作者通讯。
Jules M. Janssen Daalen or Bastiaan R. Bloem.Ethics declarations
Jules M.Janssen Daalen或Bastiaan R.Bloem。道德宣言
Competing interests
相互竞争的利益
B.R.B. has received honoraria from serving on the scientific advisory board for Abbvie, Biogen, UCB, and Walk with Path (paid to the institute); has received fees for speaking at conferences from AbbVie, Zambon, Roche, GE Healthcare, and Bial (paid to the institute). A.M. receives consulting fees from Clexio; receives payment for lectures from Biogen; is on the advisory committee of the Michael J Fox Foundation; and is chair of the advisory board of the Michael J Fox Foundation.
B、 R.B.已从Abbvie,Biogen,UCB和Walk with Path的科学顾问委员会获得酬金(支付给研究所);已收到AbbVie,Zambon,Roche,GE Healthcare和Bial(支付给研究所)的会议演讲费。A、 M.从Clexio收取咨询费;收到Biogen的讲座费用;是迈克尔·福克斯基金会咨询委员会的成员;他是迈克尔·福克斯基金会顾问委员会主席。
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Reprints and permissionsAbout this articleCite this articleJanssen Daalen, J.M., van den Bergh, R., Prins, E.M. et al. Digital biomarkers for non-motor symptoms in Parkinson’s disease: the state of the art.
转载和许可本文引用本文Janssen Daalen,J.M.,van den Bergh,R.,Prins,E.M.等人。帕金森病非运动症状的数字生物标志物:最新技术。
npj Digit. Med. 7, 186 (2024). https://doi.org/10.1038/s41746-024-01144-2Download citationReceived: 05 January 2024Accepted: 22 May 2024Published: 11 July 2024DOI: https://doi.org/10.1038/s41746-024-01144-2Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.
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