Wearable technology offers the potential to more accurately monitor the symptoms of Parkinson’s in real time. Such information could allow for better and more precise management of the condition, as well as providing objective measures for clinical trials exploring novel therapies.
Assessing some of the features of Parkinson’s, however, is not easy. Differentiating jerky involuntary movements like tremor or dyskinesias from planned movements like typing or shaking someone’s hand has proven difficult
Recently, researchers at the tech giant Apple have been applying some focus to this problem and they are now sharing their results with the Parkinson’s community.
In today’s post, we will review a research report presenting the results of the Apple study and discuss other recent events in wearable tech for Parkinson’s.
I used to be an Apple fan back in the day (mid-late 2000s). Wonderful user interface, superb design, lovely innovative products.
But I have to admit: gradually over time I became disenchanted with them.
The products became too expensive, the “Walled garden” mentality around the operating system frustrated me, and there has been a lack of serious innovation (a new iteration on a phone or tablet every year just doesn’t cut it… and now they are thinking of getting into the crowded space of electric cars… yippee, inspiring stuff).
Maybe we came to expect too much from them, but (personal opinion here) I think they lost their fanatical drive in the absence of Steve.
Genetic mutations (or ‘variants’) in the Leucine-rich repeat kinase 2 (or LRRK2; also known as Dardarin) gene are associated with increased risk of Parkinson’s. As a result this gene has become the focus of a lot of genetic research.
But what about LRRK2’s less well-known, rather neglected sibling LRRK1?
In today’s post, we will look at new research that suggests the LRRK siblings could both be involved with Parkinson’s disease.
I recommend to the reader that today’s post should be read with the following music playing in the background:
Inspired by a poem of the same title, English composer Ralph Vaughan Williams wrote ‘The Lark Ascending’ in 1914. It is still to this day, a tune that remains a firm favourite with BBC listeners here in the UK (Source).
On to business:
While the music and the poem are about a songbird, today’s SoPD post deals with a different kind of Lark.
Or should I say LRRK.
This is Sergey Brin.
He was one of the founders of a small company you may have heard of – it’s called “Google”.
Having changed the way the world searches the internet, he is now turning his attention to other projects.
One of those other projects is close to our hearts: Parkinson’s disease.
Self tracking/monitoring has become a popular habit for the general population with the introduction of products like Fitbit and Apple watch.
It is particularly useful for groups like the Parkinson’s community though, who are tired of having just one hour per year of assessments with their neurologist.
In today’s post, we will look at some new tracking/monitoring technologies that are being developed that could have important implications for not only how we assess Parkinson’s disease, but also for how we treat it.
I have recently finished reading ‘Homo Deus‘ by Yuval Noah Harari – the excellent follow-up to his previous book ‘Sapiens‘ (which is an absolute MUST READ!). The more recent book provides an utterly fascinating explanation of how we have come to be where we will be in the future (if that makes any sense).
In the final few chapters, Harari discusses many of the technologies that are currently under development which will change the world we live in (with a lot of interesting and cautionary sections on artificial intelligence – the machines that will know vastly more about us than we know about ourselves).
Of particular interest in this part of the book was a section on the Google-Novartis smart lens.
What is the Google-Novartis smart lens?
In 2014, a company called Alcon, which is a wholly owned subsidiary of Novartis formed a collaboration with the Google offshoot Verily Life Sciences that would focus on developing smart lens.
The initial project is rather ambitious: develop and take to the clinic a glucose-sensing contact lens for people with diabetes. The idea has been particularly championed by Google founder Sergey Brin (a prominent figure within the Parkinson’s community with his significant contributions to Parkinson’s research each year).
People with diabetes have to keep pricking their finger over the course of a day in order to check the levels of insulin in their blood. A less laborious approach would be welcomed by the diabetic world (an estimated 415 million people living with diabetes in the world).
We live in an increasingly interconnected technological world.
One can chose to embrace it or ignore it, but I don’t think anyone can do anything to stop it – the masses seem to desire it.
The benefits of all this technology are many, however, for people with Parkinson’s disease. In today’s post we will look at some of the ways wearable technology can be used to improve the lives of people with Parkinson’s disease.
The great Albert Einstein once said that he feared “the day that technology will surpass our human interaction. The world will have a generation of idiots”.
While there are certainly many examples of this situation playing out in our modern society today, the quote misses the mark with regards to the application and benefits of such technology.
For example, people with Parkinson’s disease can now communicate with people in the Parkinson’s community (like ourselves) from anywhere the world. They can reach out and share not only their experiences, but also what treatments and remedies have worked for them.
And then there are the other less obvious applications of an interconnected world:
A schematic illustrating the limited monitoring of Parkinson’s. Source: Riggare
On her fantastic blog, engineer and ‘proud mother’ Sara Riggare posted the image above to illustrate the ridiculous current situation regarding the monitoring of Parkinson’s disease. In 2014, she spent 8,765 hours in self care, applying her own knowledge and experience to managing her Parkinson’s disease (8,765 being the number of hours in a year) and had just 1 hour with her physician.
The schematic perfectly illustrates perfectly how little monitoring people with Parkinson’s receive in the standard healthcare system.
People like Sara, however, are taking matters into their own hands. She has become an enthusiastic proponent of ‘self tracking’:
Self tracking represents a fantastic opportunity not only for people with Parkinson’s disease to track their progress, but also for researchers to build up large databases of information relating to the disease from which new theories/hypotheses/treatment approaches could be generated.
And this is possible on a global scale, only because we are a generation of idiots living in a fully interconnected world.
Recently the technology company Apple announced that it is working on new devices to help track Parkinson’s disease (Click here and here for more on this). The company already offers ResearchKit – a platform available on their iphone.
Apple, however, is actually coming to this party rather late. The Michael J Fox foundation and computer giant Intel formed a partnership back in 2014 to look at wearable technology (Click here to read more about this).
And there are already dozens of applications that can be used on smart phones and tablets. We have previously discussed one such app from a company called uMotif – Click here to read that post.
In addition, there are other smart phone apps available that readers could try (such as MyTherapyApp) and you can even support new applications as they are being developed (such as Progress Recorder).
What if I don’t have time for entering all the details on the smart phone app?
Not a problem.
Why not just wear a recording sensor? The same way you may wear a piece of jewellery. Simple, easy approach and you can just forget that it is even there.
Would you like an interesting example?
This is Utkarsh Tandon.
He’s a 17 years old student at Cupertino High School. He is also the Founder and CEO of OneRing, an intelligent tool for monitoring Parkinson’s
Yes, you read that correctly – he is just 17 years old. Smart kid, we’ll be watching him.
Why is this technology important?
Until recently out understanding of Parkinson’s has relied entirely on what occurs in the lab and clinic based settings. Now information is being collected 24 hours a day. From sleep quality apps to measuring tremor, all of this technology has several very positive features from the view point of research scientists:
Objective monitoring – rather than subjective measures (eg. clinician’s opinion or subject survey) definitive, replicatable data can be generated.
Continuous monitoring – rather than brief periods of monitoring in an artificial research clinic environment, data can be collected in real world settings on a continuous basis
Data accessibility – rather than pencil and paper collection of results, data can be collected electronically and converted to different formats.
Participant engagement – this included benefits such as getting the community involved with the research, getting feedback about the technology throughout the study, and being able to provide subjects with performance reports on a regular basis.
Is wearable tech only for measuring Parkinson’s disease?
Recently it has also started to aid people with the condition. The best example of this is the story that has most recently captured the attention of the Parkinson’s community here in the UK:
Emma Lawton was diagnosed with Parkinson’s disease at just 29 years of age. Working with Haiyan Zhang (Director of Innovation at Microsoft Research) and colleagues, a bracelet was created that counteracted the tremor in Emma’s wrist.
It’s a good story.
Other tech is helping to make life easier for people with Parkinson’s disease – just have a look at what LiftWare is doing.
The point of this post was to make readers aware of some of the technological resources that are available to them in this modern age. Using these tools, we can quickly collect a vast amount of information regarding all aspects of life for people with Parkinson’s disease. And it also offers folks the opportunity to get involved with research indirectly (if they have a fear of university hospitals!).
There is also another element to all of this recording of information about Parkinson’s disease that is not immediately apparent: we are potentially (and hopefully) the last generations of human being that will be affected by Parkinson’s disease. If current research efforts allow us to block or dramatically slow the condition in the near future, there may not be a disease for our descendants to worry about. While this is a very worthy goal, there is also a responsibility on the current generation to record, document and learn as much as we can about the condition so that those future generations will have information at hand regarding a forgotten medical condition.
Some folks are already doing this in their own creative ways. For example, we recommend all readers subscribe to PD365 – a fantastic project in which David Sangster and Emma Lawton (her of the bracelet described above) will be making one short video each day about life with Parkinson’s disease. Raising awareness about the condition and providing intimate insight into basic daily life with PD.
Here is Emma’s first video:
And here is David’s first video:
And this idea is really important.
Consider the great fire of London in 1666. It is estimated that the fire destroyed the homes of 70,000 of the City’s 80,000 inhabitants (Source: Wikipedia), and yet our best sources of information regarding the events of that catastrophe are limited to just a few books like the diary of Samuel Pepys.
This may seem like a silly example, but the premise stands. Given all of the technology we have available today, it would be a great failure for our generation not to be able to provide a thorough source of information regarding this disease.
That said, have a think about getting involved.
The banner for today’s post was sourced from Raconteur
Having brought us ‘Google’, he is now turning his attention to other projects.
One of these other projects is close to our hearts: Parkinson’s disease.
In 1996, Sergey’s mother started experiencing numbness in her hands. Initially it was believed to be RSI, but then her left leg started to drag. In 1999, following a series of tests, Sergey’s mother was diagnosed with Parkinson’s disease. It was not the first time the family had been affected by the condition: Sergey’s late aunt had also had Parkinson’s disease.
Both Sergey and his mother have had their genome scanned for mutations that increase the risk of Parkinson’s disease. And both of them discovered that they were carrying a mutation on the 12th chromosome, in a gene called Leucine-rich repeat kinase 2 or Lrrk2.
Not everyone with this particular mutation will go on to develop Parkinson’s disease, but Sergey has decided that his chances are 50:50. Being one of the founders of a large company like Google, however, has left Sergey with resources at his disposal. And he has chosen to focus some of those resources on Lrrk2 research (call it an insurance policy).
Today, the fruits of some of that research has been published and the results are really interesting:
Title: Phosphoproteomics reveals that Parkinson’s disease kinase LRRK2 regulates a subset of Rab GTPases Authors: Martin Steger, Francesca Tonelli, Genta Ito, Paul Davies, Matthias Trost, Melanie Vetter, Stefanie Wachter, Esben Lorentzen, Graham Duddy, Stephen Wilson, Marco AS Baptista, Brian K Fiske, Matthew J Fell, John A Morrow, Alastair D Reith, Dario R Alessi, Matthias Mann Journal: Elife 2016;10.7554/eLife.12813 PMID:26824392 (This report is openly available for reading on the Elife website)
So what is Lrrk2?
Also known as dardarin (Basque for ‘trembling‘), Lrrk2 is a gene in our DNA that is responsible for making an enzyme. That Lrrk2 enzyme is involved in many different aspects of cell biology. From cellular remodeling and moving (‘trafficking’) various proteins around in the cell, to protein degradation and stabilization, Lrrk2 has numerous roles.
Discovered in 2004, Lrrk2 was quickly associated with Parkinson’s disease because mutations in this gene are amongst the most common in ‘familial Parkinson’s‘ (where an inherited genetic mutation is present in the sufferer; accounting for about 10-20% of all cases of Parkinson’s disease). The most common mutation of LRRK2 gene is G2019S, which is present in 5–6% of all familial cases of Parkinson’s disease, and is also present in 1–2% of all sporadic cases.
Curiously, mutations in Lrrk2 are also associated with increased risk of Crohn’s disease and cancer.
The structure of Lrrk2 and where various mutations lie. Source:Intech
Given the association with Parkinson’s disease, there have been attempts to develop inhibitors of Lrrk2 as a means of treating the condition. These efforts, however, have been hampered by a poor agreement as to which proteins are interacting with Lrrk2.
The goal of the current study was to identify the key proteins that Lrrk2 acts upon.
What did they discover?
Using various techniques to accomplish their task, the scientists began with 30,000 possible targets and gradually whittled that number down to a small group of Lrrk2 targets.
Most importantly, they found that Lrrk2 is deactivating certain proteins that are called ‘Rabs’. The Rab family are heavily involved with trafficking (and that’s not the mafia drug variety!). Trafficking in cells in moving proteins around within the cell itself. And Lrrk2 was found to deactivate 4 Rab family members (3, 8, 10 and 12).
This is a very important result as not only does it provide us with novel Lrrk2 targets, but it also offers us an excellent tool with which we can determine if Lrrk2 inhibitors are actually working – a functioning Lrrk2 inhibitor will lower the activity of Rab 3, 8 10 & 12 and this can be measured.
The results represent a major leap forward in our understanding of Lrrk2 and a significant return on investment for one Mr Sergey Brin.