Brain Tech Lab, Professor Troels Wesenberg Kjaer


Does the response to morning medication predict the ADL-level of the day in Parkinson’s Disease?

Trine Hørmann Thomsen1,2, Troels Wesenberg Kjær, Professor, MD, PhD1,2, Lene Bastrup Jørgensen, MScN, PhD3, Anita Haahr, MScN, PhD4, Kristian Winge, MD,PhD5.

  1. Department of Clinical Neurophysiology and Neurology, Zealand University Hospital, Roskilde, Denmark.
  2. Department of Clinical Medicine, University of Copenhagen, Denmark.
  3. Center of Planned Surgery, Regional Hospital, Silkeborg. Department of Clinical Medicine, University of Aarhus, Denmark
  4. Center for Health promotion and Rehabilitation, VIA University College, Denmark.
  5. Senior Scientific Officer, Novo Nordisk Foundation, Denmark


Background: Individuals with Parkinson`s Disease (PD) often demonstrate bradykinesia during mobility tasks, especially in the morning hours before first intake of levodopa, and have difficulties managing normal Activities of Daily Living (ADLs) (1). Early morning off (EMO) refers to periods with off states in the morning where the severity of bradykinesia is increased and causes a decrease in mobility (2). It is currently considered that off-periods are related to the waning of dopaminergic medication effects (3). Objective measurements from devices capable of continuously recording motor symptoms may help provide insight into the PD patient`s everyday life regarding symptoms and response to medication.


  • Extraction of features from accelerometer measurements to test whether poor response to medication in the morning predicts the overall ADL-level in patients with PD.
  • Assessment of the correlation between change in bradykinesia score (BKS) and the risk of having disabilities within three selected items in the UPDRS Part II.

Methods: In this cross-sectional study the sample consists of 34 patients with light to moderate PD (Hoehn and Yahr scale >1<4). The patients wore an accelerometer (Parkinson KinetiGraph; Global Kinetics Corporation) (4) in a period of 7 days measuring their BKS and response to medication. The Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) Part II was used in the assessment of ADL-limitations (5).

Results: The correlation between UPDRS Part II and BKS-outputs from the algorithm was -0,082 (p < 0.0001), CL:-0.113;-0.042). The individuals experienced disabilities in performing “Speech” (p=0.004) and “Hobbies and other activities” (p=0.038) when being slow or poor responders to Levodopa.

Conclusion: Our findings show that slow response to the medication dosages in the morning is correlated with disabilities in the overall ADL-level in daily life with PD. The findings indicate an overall impact on “real-life” in the limitations of interaction and communication with other people that stress the importance of social activities as therapy tailored patients with PD.

Keywords: Parkinson`s Disease, Early Morning Off, ADLs, Parkinson KinetiGraph, MDS-UPDRS.


  1. Evans, D., Normann, P. Illness representations, coping and psychological adjustment to Parkinson`s Disease. 2009. Psychology&Health, Vol. 24(10).
  2. Pringsheim,T., Jette,N., Frolkis,A., Steeves,TD. The Prevalence of Parkinson`s Disease: a systematic review and metaanalysis. Society of Movement Disorders. 2014. Vol. 29(13), p.1583-90.
  3. Jankovic J. Parkinson’s Disease: Clinical features and diagnosis. J Neurol Neurosurg Psychiatry (2008) 79; 368-376.
  4. Global Kinetics Corporation, Clinical Guidelines and Instructions, GKG Manufacturing Pty Ltd, Australia, 2012.
  5. Goetz CG, Tilley BC, Shaftman SR, et al. Movement Disorder Society-sponsored revision of the

       Unified Parkinson's Disease Rating Scale (MDS-UIPDRS): scale presentation .Mov Disord 2008 No 15(23), p: 2129-2170.

Copyright © All Rights Reserved