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The Hoehn and Yahr scale (HY) ( Hoehn and Yahr, 1967) instead includes stages 1–5, and it is used to assign an overall score to the patient on the basis of the pathological progress. During the test for PD diagnosis, in fact, the neurologist watches the patient perform specific tasks and assigns scores for each of them as required and defined in the Unified Parkinson's Disease Rating Scale (UPDRS) ( Fahn and Elton, 1987) or its updated version, the Movement Disorder Society-sponsored revision of the UPDRS (MDS-UPDRS) ( Goetz et al., 2008). This is particularly true when co-factors such as greater age, poor cognition, and worse mobility are manifested ( Hu et al., 2011). Today, PD diagnosis is based on the assessment of motor (and non-motor) symptoms, typically during neurological visual examinations, but the diagnostic methods and disease progression monitoring approaches remain suboptimal for PD management ( Kassubek, 2014). Furthermore, the study of the pre-motor phase could lead the research for predictive biomarkers and risk or protective factors for PD ( Tolosa and Pont-Sunyer, 2011 Palma and Kaufmann, 2014). Recent studies demonstrate that several NNMs (e.g., rapid eye movement sleep behavior disorders, hyposmia, constipation, depression) are correlated to the neuropathological changes in the brain and they can anticipate the motor manifestations of the disease by 5–7 years. Currently, experts recognize the need to redefine the research criteria for the diagnosis of this complex disease by considering clinical features, pathological findings, and genetics or molecular mechanisms ( Mirelman et al., 2011 Berg et al., 2013). Over the past three decades, the knowledge of PD has increased significantly, with particular interest on the pre-motor phase and novel therapeutic and diagnostic approaches ( Korczyn and Gurevich, 2010). The disease is difficult to detect and treat promptly, as it shows a wide variability in the clinical expression ( Fahn, 2008) as well as in the somatic symptom progression ( Dickson and Grünewald, 2004 Caslake et al., 2013 de Lau et al., 2014 Szewczyk-Krolikowski et al., 2014). Some NMMs (e.g., sleep disorders, bladder disturbances, gastrointestinal symptoms, olfactory symptoms) may occur throughout the entire course of the disease, even if cognitive symptoms such as hallucinations and dementia tend to occur late in the PD. Although the pathology is generally diagnosed on the basis of these motor symptoms, many non-motor manifestations (NMMs) are commonly evident and they may sometimes be more disabling of motor disturbances, such as olfactory disturbances, autonomic dysfunction, sleep fragmentation, depression, and dementia ( Wolters, 2008). Parkinson's disease (PD) is a complex neurodegenerative disorder that has a usually asymmetric onset, characterized by typical motor symptoms as bradykinesia, hypo-/akinesia, muscular rigidity, and resting tremor ( Fahn, 2008). Results: Finally, 136 papers were fully evaluated and included in this review, allowing a wide overview of wearable devices for the management of Parkinson's disease.
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Study eligibility criteria: Since 1,429 articles were found, accurate definition of the exclusion criteria and selection strategy allowed identification of the most relevant papers. Data sources: The research was conducted within three databases: IEEE Xplore ®, Science Direct ®, and PubMed Central ®, between January 2006 and December 2016. The concept is to obtain an overview of the pathology at each stage of development, from the beginning of the disease to consider early symptoms, during disease progression with analysis of the most common disorders, and including management of the most complicated situations (i.e., motor fluctuations and long-term remote monitoring). Objectives: This review focuses on wearable devices for PD applications and identifies five main fields: early diagnosis, tremor, body motion analysis, motor fluctuations (ON–OFF phases), and home and long-term monitoring. The most promising trends involve sensor devices, which are low cost, low power, unobtrusive, and accurate in the measurements, for monitoring and managing the pathology. Many works in literature discuss the effects of the disease.
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The disease significantly affects quality of life of those affected. Neurologia, Ospedale delle Apuane (AUSL Toscana Nord Ovest), Massa, Italyīackground: Parkinson's disease (PD) is a common and disabling pathology that is characterized by both motor and non-motor symptoms and affects millions of people worldwide.
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