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The emergence of large longitudinal primary care datasets has allowed detailed exploration of the full range of early motor and non-motor symptoms that predate PD, while being free from the biases that many traditional observational studies have suffered from.28 Alongside, advances in wearable technology, and the availability of remote testing, will aid objective measurement of emerging motor dysfunction in those at risk of PD.37 A variety of measuring devices have been developed, including software applications which harness information on activity and motion (and in some cases speech) captured by smart phones and tablet-devices, custom-built sensors that measure gait, bradykinesia, dyskinesia and nocturnal movements, keyboard-based speed and accuracy tests, as well as custom-built home-testing devices (for examples of these, see online supplementary material). Many of these devices demonstrate high sensitivity and specificity in differentiating patients with PD from controls, and are likely to see increasing use in clinical practice to guide decision-making. Despite the indication that objective motor dysfunction occurs prior to diagnosis in PD, currently there are few examples of the application of remote or wearable devices in prediagnostic PD. A major foreseeable hurdle is ensuring that validation and regulatory approval for software and devices will keep abreast of rapid and continuous change in available technology.38
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