A suggested general approach
The main approach to use Parkinson smartwatch could be to instruct your patient to record his status at the watch, for some time, e.g. 2 weeks. Then you open his charts to get an impression of the course of the disease.
Use medication reminders for more compliance. Checking the pictures at each moment may help you to see how creative patients are. Some may need help to choose pictures that remind to take the right medicines.
Questions that may be answered from a diary
- What is the general quality of life: how much green is present in the overall TOTAL chart? More than the period before (use the sliders)?
- Is the first dose adequate? see delayed on
- Is wearing off present? see wearing off. General undertreatment (a lot of yellow) ? Related to depression?
- Is wearing off due to meals? Check the time between meals (blue squares) and pills (purple squares).
- Do dyskinesia occur (any red)? Are they peak dose related or diphasic? Verify it's not tremor, by asking or video.
- Is compliance ok? Irregular intake of pills? set medication reminders!
- Severe On-off fluctuations and craving related to Dopaminergic dysregulation syndrome?
- Any sleep abnormalities (black bars)?
- Off in the afternoon? A siesta may help more than extra levodopa in this case.
- Are any symptoms recorded as clickable events as chosen from symptom list? Are they side effects?
A diary may not always show what you expect. Two common pitfalls: some patients record tremor as red. Ask them, or let them make a short video. Yellow is not always off, it may also be perceived off, e.g. due to depression. Asking about mood may be enough to get this clear, otherwise let the partner score the watch for a week or so. A large discrepancy points to depression.
Depending on the kind of problems, you could now change your treatment plan, and ask the patient to record a week or more before the next visit. Some patients prefer to continue registration all the time, others prefer to take some relief. The watch has been designed for minimal exertion. What matters is finding a balance between burden and having more information. Coaching your patient in using the watch, and actively discussing a treatment plan is usually much appreciated. The system provides direct feedback, which supports this process.
Pharmacological management of response fluctuations is a lot easier if you try to reconstruct levodopa kinetics. The diary will indicate where levodopa is too low (during off perids, yellow) or too high (most dyskinesia, red). Combine these with the moments medication was taken (blue squares), to make an educated guess of the course of the levodopa-levels during a day. Now you may be able to predict what will happen if you change a dose.
Meals interfere with uptake of levodopa. Increasing the time interval between a pill and a meal may increase uptake.
Use the charts to assist you during telephone appointments. Many patients will appreciate it.
Use the charts for feedback. If you saw that a regular intake of pills was previously more effective than randomness, just reviewing those charts will help.
The different types of charts help you to get a quick impression of fluctuations. Save charts with a simple click, e.g. to add them to your electronic patient records. Use the sliders to compare periods.
