Monitoring Parkinson’s: Doctor, my glasses are listening to us

An important aspect of developing new potentially ‘curative’ treatments for Parkinson’s is our ability to accurately test and evaluate them. Current methods of assessing Parkinson’s are basic at best (UPDRS and brain imaging), and if we do not improve our ability to measure Parkinson’s, many of those novel treatments will fail the clinical trial process and forever remain just “potentially” curative. Glasses are a wearable device that the majority of us take for granted. But two technology companies have announced that they are partnering up to focus their combined efforts on making a pair of glasses that could help improve the lives of people with Parkinson’s.  One company focuses on tracking facial expressions, while the other analyses audio.  In today’s post, we will look at how these technologies could be applied to Parkinson’s, and discuss what the companies have planned.

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Looking good. Source: 1zoom

An interesting fact:

Approximately 60% of western populations wear glasses, contact lenses or use some other reading/visual aid (Source). And as we age, this percentage only increases – with the over 75 year olds representing a solid collection within the bespectacled crowd (see graph below).

More women than men wear glasses. Source: CBS

I am in the majority.

But mostly for aesthetic reasons (they make me look smarter than I actually am).

Ok, but what does this have to do with Parkinson’s?

Well, this week two companies announced a collaborative partnership, which has been made possible by a grant from InnovateUK. UK start-up Emteq and Munich-based audEERING are two companies that specialise in technologies that are used for tracking emotional responses.

Emteq focuses on tracking facial expression.

They used technology – called Facial Remote Activity Monitoring Eyewear (or FRAME) – to monitor the activity of muscles around the face over time. This video provides you with a short example:

A common feature of Parkinson’s is a loss of facial expression. Folks with Parkinson’s will sometimes be described as having a ‘mask’-like visage. In addition, they will often have reduced rates of blinking.

Emteq’s FRAME technology can track and monitor all of these facial movements over time, indicating any improvements exhibited with a change of diet, exercise or treatment regime.

Cool, huh?

Meanwhile, AudEERING is an audio analysis firm.

The company this very interested in the development of ‘emotional intelligence‘ for machines – teaching artificial intelligence to read our emotions. But rather than using the face to do this, AudEERING is focused on the voice:

There are many potential applications for this technology, but for us the analysis of voice characteristics over time would be very useful.

What does voice have to do with Parkinson’s?

Individuals with Parkinson’s quite often exhibit hypokinetic dysarthria.

And what on earth is that?

Dysarthria is a group of related speech problems which occur due to disturbances in the muscle control of speech. They result from any impairment of the motor processes involved in the execution of speech.

There are several different types of dysarthria, but hypokinetic dysarthria is the variety that is associated with issues in the basal ganglia.

What is the basal ganglia?

Parkinson’s is associated with the reduction of a chemical called dopamine in the brain.

The dopamine producing neurons live in an area of the brain called the substantia nigra, which is in the lower regions of the brain. These dopamine neurons of the substantia nigra have long branches/projections (called axons) that extend a across the brain and release their dopamine in different areas of the brain. Two of the primary regions of that dopamine is released are areas of the brain called the putamen and the caudate nucleus. These two areas are part of a cluster of areas that are referred to as the basal ganglia.

The projections of the substantia nigra dopamine neurons. Source: MyBrainNotes

The basal ganglia plays an important role in movement. And as you can see in the image below, the putamen and caudate nucleus are key components of the basal ganglia:

The basal ganglia structures (blue) in the human brain. Source: iKnowledge

In Parkinson’s, with the loss of dopamine neurons in the substantia nigra, there is a severe reduction of dopamine being released in the putamen and caudate nucleus, which results in dysfunction in the basal ganglia – giving rise to the inhibition of movement that characterises Parkinson’s.

And this can affect the movement activity associated with the production of speech, resulting in hypokinetic dysarthria.

So hypokinetic dysarthria is associated with problems in the basal ganglia and Parkinson’s is the result of problems in the basal ganglia?

Yes.

Parkinson’s is the most common condition associated with hypokinetic dysarthria.

The inhibition of motor movement characteristic of Parkinson’s affects the speech production process in three main ways:

• Prearticulatory – actual sound production (phonatory and resonant characteristics)
• Prelinguistic – changes in the patterns of stress and intonation in language (articulatory changes and prosodic fluctuations)
• Linguistic – changes in the expected acoustic content of the speech

Often individuals within the Parkinson’s community will comment about their voice going soft and finding that they mumble their words more.

All of these can be measured and monitored, however, and researchers have used these measures to successfully discriminate between people with and without Parkinson’s.

An example of this kind of research can be found in this report here:

Title: Towards the identification of Idiopathic Parkinson’s Disease from the speech. New articulatory kinetic biomarkers.
Authors: Godino-Llorente JI, Shattuck-Hufnagel S, Choi JY, Moro-Velázquez L, Gómez-García JA.
Journal: PLoS One. 2017 Dec 14;12(12):e0189583.
PMID: 29240814                               (This report is OPEN ACCESS if you would like to read it)

In this study, the researchers found that they could differentiate between people with Parkinson’s and those without to an accuracy of approximately 85% by analysing the characteristics of voice.

And other research groups have found similar levels of accuracy (Click here and here to see examples).

Interesting, but what are the two companies planning to do together?

The two companies are going to work together to develop a pair of ‘smart’ glasses, which will combine Emteq’s hardware and facial expression-tracking technology with the artificial intelligence developed by audEERING that is capable of detecting vocal changes.

This is apparently what they will look like:

Source: Emteq

And they plan to develop this new set of glasses for people with Parkinson’s.

Cool.

Indeed.

So what does it all mean?

We urgently need better methods of assessing and monitoring Parkinson’s – both for the general well being of individuals within the affected community, but more importantly for the testing of novel therapies in clinical trials. Once every month, I try to put out a post on research regarding a novel method of assessing Parkinson’s.

To my mind, research efforts on new methods of assessing Parkinson’s are CRITICAL to us providing better therapies in the future. Our current methods of assessing folks with Parkinson’s are limited to standard clinical rating scales and brain imaging techniques, which in the setting of a clinical trial are conducted on a episodic basis and provided limited information.

And ideally, new methods of measuring Parkinson’s will be designed to monitor people continuously and in the home environment, providing a frequency of real life assessment vastly superior to the current standard of assessment. And importantly, these methods of assessment should leave little or no footprint on the life of the individual being monitored. There should be no burden what-so-ever on the individual. And they should require no effort whatsoever from the individual.

Completely unintrusive.

The person being monitored should not even be aware that they are being monitored.

Source: Cloudtweaks

And this is why I like the smart glasses idea being proposed by Emteq and audEERING so much.

I wear glasses everyday and I don’t give them a second thought. I wear them everywhere I go and they could easily be monitoring me as I go about my day.

A pair of smart glasses could potentially be very useful in clinical testing for Parkinson’s. After participants were the glasses for a few weeks (in order to get a solid baseline level of my normal voice and levels of facial activity), a change in their normal routine could be initiated (a treatment, such as a new exercise regime or a dietary supplement), and any changes in their voice or facial expressions could be recorded over time.

The Emteq/audEERING smart glasses will be subject to a clinical trial in the second half of 2019, with plans to make them available for use in 2020.

Watch this space.

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ADDITIONAL: I have been ranting on about this self-monitoring/assessment malarkey for a while now, and I have decided to put my money where my mouth is and actually walk the talk.

Source: Huawei

I recently bought a wristband monitor (the Huawei Band 2 Pro), which is continually monitoring how lazy I am (amongst other things). And I should add that this is not an endorsement of the product – it is method research. I am interested not in the device itself, but rather the experience of using it.

Thus far, I have noticed two things:

1. It is addictive – I am regularly checking how many steps I have taken during the day and trying to better each day (good for my health maybe, but not good for objective measures)
2. Drinking caffeinated green tea in the afternoon/evening reduces my deep stages of sleep (REM is fine, but stage 4/slow wave periods of sleep are badly affected – and this has been demonstrated previously – click here to read more about this).

Stages of sleep. Source: Wikipedia

I will keep you updated on how this self monitoring experiment goes (if anything of interest pops up). And if anyone else has some ideas on self monitoring I’ll be happy to test them…

…I’m just saying…

…Emteq/audEERING that was an offer.

Happy to be your guinea pig.

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The banner for today’s post was sourced from Emteq