To assess the effects of dopaminergic treatment motor fluctuations on real-world life-space mobility (walking, driving) in Parkinson's disease (PD) patients using sensor data.

Motor fluctuations in PD, characterized by ON/OFF periods, affect daily functioning. Traditional assessments such as diaries offer limited insights into these fluctuations, while real-world measures, such as driving and walking data, may provide a more precise understanding of daily motor function and associated life-space mobility..

Over one month, 25 PD participants (median HY stage = 2, mean age = 67 years, 17 males) used vehicle sensors to monitor driving and logged their medication use. Wrist-worn actigraphy recorded step counts (proxy for motor fluctuations) and sleep-wake patterns. Mixed-effect logistic regression models analyzed driving likelihood and mixed-effect linear regression models analyzed step counts in 30-minute intervals, from 30 minutes before to 4 hours after dopaminergic medication, across three periods: (1) wake-up to bedtime, (2) wake-up to 1PM, and (3) 1PM to bedtime.

Participants were more likely to drive 90-150 minutes post-medication throughout the day (OR = 1.14–1.76, p < 0.05). In the morning, driving likelihood increased 60-150 minutes post-medication (OR = 1.37–1.76, p < 0.05), but decreased in the afternoon 150-210 minutes post-medication (OR = 0.62–0.64, p < 0.05) after adjusting for MDS-UPDRS motor score and levodopa-equivalent daily dose (LEDD). Step counts increased 30-210 minutes post-medication (indexing ON periods) throughout the day and morning (b = 20.13 – 76.92, p < 0.05), with declines (indexing OFF periods) in the afternoon between 180-240 minutes (b = -52.18 – -33.12, p < 0.05).

PD patients experienced increased walking activity and driving during likely ON periods, with reduced afternoon mobility in likely OFF periods during which driving also decreased. Real-world sensor data effectively and independently captured these fluctuations and associated changes in life-space mobility, offering valuable insights for personalizing PD treatment strategies.