Multidimensional Circadian Monitoring by Wearable Biosensors in Parkinson's Disease.

Parkinson's disease (PD) is associated with several non-motor symptoms that may precede the diagnosis and constitute a major source of frailty in this population. The digital era in health care has open up new prospects to move forward from the qualitative and subjective scoring for PD with the use of new wearable biosensors that enable frequent quantitative, reliable, repeatable, and multidimensional measurements to be made with minimal discomfort and inconvenience for patients. A cross-sectional study was conducted to test a wrist-worn device combined with machine-learning processing to detect circadian rhythms of sleep, motor, and autonomic disruption, which can be suitable for the objective and non-invasive evaluation of PD patients. Wrist skin temperature, motor acceleration, time in movement, hand position, light exposure, and sleep rhythms were continuously measured in 12 PD patients and 12 age-matched healthy controls for seven consecutive days using an ambulatory circadian monitoring device (ACM). Our study demonstrates that a multichannel ACM device collects reliable and complementary information from motor (acceleration and time in movement) and common non-motor (sleep and skin temperature rhythms) features frequently disrupted in PD. Acceleration during the daytime (as indicative of motor impairment), time in movement during sleep (representative of fragmented sleep) and their ratio (A/T) are the best indexes to objectively characterize the most common symptoms of PD, allowing for a reliable and easy scoring method to evaluate patients. Chronodisruption score, measured by the integrative algorithm known as the circadian function index is directly linked to a low A/T score. Our work attempts to implement innovative technologies based on wearable, multisensor, objective, and easy-to-use devices, to quantify PD circadian rhythms in huge populations over extended periods of time, while controlling at the same time exposure to exogenous circadian synchronizers.

Disruption of Circadian Rhythms and Delirium, Sleep Impairment and Sepsis in Critically ill Patients. Potential Therapeutic Implications for Increased Light-Dark Contrast and Melatonin Therapy in an ICU Environment.

The confinement of critically ill patients in intensive care units (ICU) imposes environmental constancy throughout both day and night (continuous light, noise, caring activities medications, etc.), which has a negative impact on human health by inducing a new syndrome known as circadian misalignment, circadian disruption or chronodisruption (CD). This syndrome contributes to poor sleep quality and delirium, and may impair septic states frequently observed in critically ill patients. However, and although the bidirectional crosstalk between CD with sleep impairment, delirium and inflammation in animal models has been known for years and has been suspected in ICU patients, few changes have been introduced in the environment and management of ICU patients to improve their circadian rhythmicity. Delirium, the most serious condition because it has a severe effect on prognosis and increases mortality, as well as sleep impairment and sepsis, all three of them linked to disorganization of the circadian system in critically ill patients, will be revised considering the functional organization of the circadian system, the main input and output signals that synchronize the clock, including a brief description of the molecular circadian clock machinery, the non-visual effects of light, and the ICU light environment. Finally, the potential usefulness of increased light/dark contrast and melatonin treatment in this context will be analyzed, including some practical countermeasures to minimize circadian disruption and improve circadian system chronoenhancement, helping to make these units optimal healing environments for patients.

Evaluación de la equivalencia de tres versiones paralelas del Fototest / Evaluation of the equivalence of three parallel versions of the Phototest

Introducción: el Fototest es un test cognitivo muy breve y aplicable a analfabetos que se ha mostrado válido y coste- efectivo en la detección del deterioro cognitivo y la demencia y en el seguimiento de estos pacientes. Las aplicaciones repetidas de un test cognitivo pueden inducir mejorías en el rendimiento debido al fenómeno «efecto de la práctica »; este efecto puede minimizarse con el uso de formas paralelas. Nuestro objetivo es evaluar la equivalencia de tres versiones paralelas del Fototest. Material y métodos: estudio transversal en una muestra de conveniencia; los sujetos se distribuyeron aleatoriamente en tres grupos a los que se aplicó respectivamente la versión original (Fototest- 1) y dos versiones paralelas (Fototest-2 y Fototest-3) del Fototest, que diferían en los objetos por denominar y recordar. Análisis estadístico: estadística descriptiva univariada y comparación entre grupos con ANOVA o χ2 según tipo de variables. Resultados: 223 sujetos (65,3 % mujeres) con una edad de 58,0 ± 16,8 (media ± DE) años, distribuidos aleatoriamente en tres grupos de 75 (Fototest-1), 76 (Fototest-2) y 72 (Fototest-3) sujetos; estos grupos no diferían entre sí en edad, sexo o nivel educativo. No hay diferencias significativas entre los grupos en las puntuaciones parciales (denominación, fluencia hombres, fluencia mujeres, recuerdo libre y recuerdo facilitado), subtotales (fluencia total, recuerdo total) y total del Fototest (Fototest-1: 37,8 ± 5,6, Fototest-2: 36,8 ± 7,5, Fototest-3: 37,4 ± 5,8; p = 0,66). Discusión: las tres versiones del Fototest son equivalentes e intercambiables, lo que puede facilitar la labor del explorador y contrarrestar el «efecto de la práctica » asociado al uso repetido (AU)

Introduction: The Phototest is a very short cognitive test that is applicable to illiterates and has proven to be valid and cost-effective for the detection of cognitive impairment and dementia and for the follow-up of these patients. Repeated applications of a cognitive test may induce improvements in performance due to «practice effects», which can be minimized by the use of parallel forms. Our objective was to evaluate the equivalence of three parallel versions of the Phototest. Material and Methods: Cross-sectional study of a convenience sample; participants were randomly distributed into three groups for the respective application of the original version of the Phototest (Phototest-1) and two parallel versions (Phototest-2 and Phototest-3), which differ in the objects to be named and recalled. Statistical analysis: univariate descriptive statistics and comparison among groups using ANOVA or the chi-square test according to the type of variable. Results: 223 participants (65.3% females) with a mean±SD of 58.0±16.8 yrs were randomly distributed among three groups of 75 (Phototest-1), 76 (Phototest-2) and 72 (Phototest-3) participants, with no significant inter-group differences in age, sex, or educational level. The groups did not significantly differ in partial Phototest scores (naming, fluency of males, fluency of females, free recall or cued recall), subtotal scores (total fluency, total recall) or total scores (Phototest-1: 37.8±5.6, Fototest-2: 36.8±7.5, Fototest-3: 37.4±5.8; p=0.66). Discussion: The three versions of Phototest are equivalent and interchangeable, which can assist the work of the examiner and counteract the 'practice effects' associated with repeated applications (AU)