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Advanced Parkinson’s disease introduces refractory, unpredictable motor and non-motor fluctuations, troublesome dyskinesia, and unpredictable OFF periods, driven in part by erratic gastric absorption and delayed gastric emptying. Care should be personalized to address both symptom domains, ideally using infusion or device-aided approaches that bypass the gastrointestinal tract, including levodopa–carbidopa intestinal gel, apomorphine infusion, and deep brain stimulation. KinetiGrap (PKG) supports continuous objective monitoring (COM) and helps identify advanced patients for DAT to improve outcomes.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/research-report/","Research & Report",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/parkinsons-disease-personalized-pathway-of-care-for-device-aided-therapies-dat-and-the-role-of-continuous-objective-monitoring-com-using-wearable-sensors/289448/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/parkinsons-disease-personalized-pathway-of-care-for-device-aided-therapies-dat-and-the-role-of-continuous-objective-monitoring-com-using-wearable-sensors/289448.png","ImageObject",300,407,{"name":42,"@type":43},"Alex Sinclair","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-29","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",14,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why does advanced Parkinson’s disease become harder to manage than earlier stages?","Question",{"text":63,"@type":64},"Advanced Parkinson’s disease involves unmanageable, unpredictable motor and non-motor fluctuations that are refractory to standard oral or transdermal therapies, reducing quality of life. It also includes unpredictable OFF periods and troublesome dyskinesias.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What role does gastrointestinal dysfunction play in Parkinson’s disease management?",{"text":68,"@type":64},"GI dysfunction is common in Parkinson’s disease and affects both the upper and lower GI tracts, contributing to problems ranging from dribbling to defecation. As the disease progresses, it is linked with swallowing difficulties, aspiration pneumonia risk, and constipation due to slowed colonic transit.",{"name":70,"@type":61,"acceptedAnswer":71},"How do device-aided therapies and continuous objective monitoring support personalized care?",{"text":72,"@type":64},"The article emphasizes personalized care that can include dopamine replacement plus non-dopaminergic circuits via therapies that bypass the GI tract, such as levodopa–carbidopa intestinal gel, apomorphine infusion, and deep brain stimulation. 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Ray Chaudhuri 1,2  \n􀀁􀀂􀀃􀀁􀀄 􀀆􀀇􀀈  \n􀀁􀀂􀀃􀀄􀀅􀀆􀀇  \nCitation: Metta, V.; Batzu, L.; Leta, V.; Trivedi, D.; Powdleska, A.; Mridula, K.R.; Kukle, P.; Goyal, V.; Borgohain, R.; Chung-Faye, G.; et al. Parkinson's Disease: Personalized Pathway of Care for Device-Aided Therapies (DAT) and the Role of Continuous Objective Monitoring (COM) Using Wearable Sensors. J. Pers. Med. 2021, 11, 680. [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)jpm11070680  \nAcademic Editor: David Alan Rizzieri  \nReceived: 17 June 2021  \nAccepted: 14 July 2021  \nPublished: 19 July 2021  \nPublisher's Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.  \nCopyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) .  \n1 Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London WC2R 2LS, UK; [l.batzu@nhs.net](l.batzu@nhs.net) (L.B.); [Valentina.leta@nhs.net](Valentina.leta@nhs.net) (V.L.); [dhaval.trivedi1@nhs.net](dhaval.trivedi1@nhs.net) (D.T.); [aleksandra.powdlewska@nhs.net](aleksandra.powdlewska@nhs.net) (A.P.); [Guy.chung-faye@nhs.net](Guy.chung-faye@nhs.net) (G.C.-F.); [Ray.chaudhuri@nhs.net](Ray.chaudhuri@nhs.net) (K.R.C.)  \n2 Parkinson's Foundation Centre of Excellence, King's College Hospital, London SE5 9RS, UK  \n3 Nizams Institute of Medical Sciences, Hyderabad 500082, India; [rukminimridula@gmail.com](rukminimridula@gmail.com) (K.R.M.); [b_rupam@hotmail.com](b_rupam@hotmail.com) (R.B.)  \n4 Vikram Hospitals, Benguluru 560052, India; [drprashanth.lk@gmail.com](drprashanth.lk@gmail.com)  \n5 Medanta Institute of Neurosciences, New Delhi 122001, India; [drvinaygoyal@gmail.com](drvinaygoyal@gmail.com)  \n* [Correspondence: Vinod.metta@nhs.net](Correspondence: Vinod.metta@nhs.net)  \nAbstract: Parkinson's disease (PD) is a chronic, progressive neurological disorder and the second most common neurodegenerative condition. Advanced PD is complicated by erratic gastric absorption, delayed gastric emptying in turn causing medication overload, and hence the emergence of motor and non-motor fluctuations and dyskinesia, which is initially predictable and then becomes unpredictable. As the patient progresses to the advanced stage, advanced Parkinson's disease (APD) is characterized by refractory motor and non motor fluctuations, unpredictable OFF periods, and troublesome dyskinesias. The management of APD is a complex affair. There is growing recognition that GI dysfunction is common in PD, with virtually the entire GI system (the upper and lower GI tracts) causing problems from dribbling to defecation. The management of PD should focus on personalized care addressing both motor and non-motor symptoms, ideally including not only dopamine replacement but also associated non-dopaminergic circuits, particularly focusing on noradrenergic, serotonergic, and cholinergic therapies bypassing the gastrointestinal tract (GIT) by infusion or device-aided therapies (DAT), including levodopa–carbidopa intestinal gel infusion, apomorphine subcutaneous infusion, and deep brain stimulation, which are available in many countries for the management of the advanced stage of Parkinson's disease (APD). The PKG (KinetiGrap) can be used as a continuous objective monitoring (COM) aid, as a screenin","cbCaihY1SUh9zU4B","https://ap.wps.com/l/cbCaihY1SUh9zU4B","pdf",4958668,"English","# Introduction\n## Advanced Parkinson’s disease and the 5-2-1 motor paradigm\n## Challenges in managing advanced Parkinson’s disease\n## Gastrointestinal dysfunction and symptom burden","[{\"question\":\"Why does advanced Parkinson’s disease become harder to manage than earlier stages?\",\"answer\":\"Advanced Parkinson’s disease involves unmanageable, unpredictable motor and non-motor fluctuations that are refractory to standard oral or transdermal therapies, reducing quality of life. It also includes unpredictable OFF periods and troublesome dyskinesias.\"},{\"question\":\"What role does gastrointestinal dysfunction play in Parkinson’s disease management?\",\"answer\":\"GI dysfunction is common in Parkinson’s disease and affects both the upper and lower GI tracts, contributing to problems ranging from dribbling to defecation. As the disease progresses, it is linked with swallowing difficulties, aspiration pneumonia risk, and constipation due to slowed colonic transit.\"},{\"question\":\"How do device-aided therapies and continuous objective monitoring support personalized care?\",\"answer\":\"The article emphasizes personalized care that can include dopamine replacement plus non-dopaminergic circuits via therapies that bypass the GI tract, such as levodopa–carbidopa intestinal gel, apomorphine infusion, and deep brain stimulation. It also highlights KinetiGrap (PKG) as a continuous objective monitoring (COM) aid to screen for advanced PD patients suitable for device-aided therapies.\"}]","Parkinson's Disease - Personalized Pathway of Care for Device-Aided Therapies (DAT) and the Role of Continuous Objective Monitoring (COM) Using Wearable Sensors | PDF",48]