Objective real-world mobility patterns in Parkinson's disease: Driving and walking after levodopa dosing

Levodopa is the primary treatment for motor symptoms in Parkinson's disease (PD), yet its real-world effects on activities of daily living (ADLs) across the day remain unclear. This study used continuous real-world monitoring to examine how levodopa dosing influences walking (basic ADL) and driving (instrumental ADL) in individuals with PD.

In a four-week observational study, 24 participants with early-stage PD underwent continuous monitoring of walking and driving using in-vehicle sensors, wrist-worn actigraphy, and medication logs. Activity was analyzed in 30-min intervals up to 4 h post-dose. Mixed-effects models assessed associations between time since last dose and activity, stratified by morning (wake to 1 p.m.) and afternoon (1 p.m. to bedtime), adjusting for age, sex, employment, motor severity, and levodopa equivalent daily dose (LEDD).

Morning activity increased significantly post-medication, peaking at 120-150 min. Afternoon activity declined: driving likelihood decreased by 120 min, and walking declined by 180 min, reaching the lowest levels at 210-240 min. Higher motor symptom severity (MDS-UPDRS Part III) was associated with reduced walking but not driving.

Real-world mobility data reveal distinct time-of-day patterns in levodopa's effects. Morning doses yielded greater benefit, while afternoon effects diminished. Aligning medication timing with functional demands and integrating continuous monitoring may improve PD management.