Evaluation of morning bradykinesia in Parkinson’s disease in a United States cohort using continuous objective monitoring

•The Personal KinetiGraph® detected morning bradykinesia in 85% of US individuals.•After the first carbidopa/levodopa dose, 64% had continued morning bradykinesia.•Morning bradykinesia was severe in levodopa-responsive individuals.•Data suggest that some US individuals with PD may be undertreated or need additional treatment. Bradykinesia in Parkinson’s disease is a marker for clinical levodopa responsiveness, with persistent bradykinesia reflecting suboptimal response. We objectively measured prevalence and severity of morning bradykinesia using the Personal KinetiGraph® (PKG®). Retrospective evaluation of a large global database of de-identified PKG assessments from individuals (N=12,840) in routine clinical care in the United States (US; n=3288). Median bradykinesia scores (mBKS) and median dyskinesia scores (mDKS) were calculated using a validated algorithm and previously established targets to evaluate percent time in bradykinesia, levodopa responsiveness, and prevalence and severity (0–5; 5=highest severity) of morning bradykinesia. mBKS was above target (≥26) in 65% of all individuals, and mDKS was above target (≥7) in 3%. Elevated percent time in bradykinesia occurred in 79%. Among individuals where levodopa responsiveness could be evaluated (n=1933), 31% had a significant response (≥1.15 postdose decrease in severity). Morning bradykinesia was identified in 85% of individuals with available morning data (1298/1524), and 64% (954/1501) experienced continued bradykinesia after the first daily levodopa dose. Morning bradykinesia was severe (4.0–4.7) in levodopa-responsive individuals regardless of percent time spent in bradykinesia. Elevated mBKS was very common in the US. Most individuals taking levodopa had morning bradykinesia that persisted even after the first daily dose, and severity was high, indicating a need for additional treatment options.