## 4 Discussion  
The level of ADL and quality of life of patients with PD are not only determined by the severity of motor symptoms, but also affected by concurrent nonmotor symptoms, such as cognitive impairment and psychiatric symptoms [23; 24]. Thus, treatment of PD requires a comprehensive and objective assessment of both motor and nonmotor symptoms. However, no such assessment method has been established. Instead, examinations are often performed through interviews with the patients and their families, consultation with specialists, and questionnaires. Unfortunately, assessments performed in the examination room or based on patient self-reports are of limited value. The motor symptoms of PD vary according to the mental status of the patient and the surrounding environment at the time of assessment. Particularly, gait disturbance (e.g., freezing of gait) may often appear to be alleviated under the effects of attention and other factors during assessment at a hospital visit, and tends to be underestimated. Assessments based on patient self-reports are marred by the fact that patients often do not recognize their own symptoms. In fact, although bradykinesia and gait disturbance greatly affect ADL, some patients are less likely to recognize those symptoms compared with tremor [25]. With regard to motor fluctuation (e.g., wearing off), because patients subjectively perceive on-off changes, data obtained from the PD home diaries are often dissociated from the actual status. Considered together, the above background highlights a deficiency in the clinical assessment of PD at present and stresses the need for objective assessment of the status of PD patients during ADL and the response to treatment. The MIMAMORI-Gait is a portable motion recorder designed for long-term continuous measurement, and has been approved in Japan for clinical assessment of gait disturbance and the amount of movement in patients with various diseases--such as PD, progressive supranuclear palsy, and vascular parkinsonism--and has been confirmed to be useful clinically [12; 13; 14; 15; 26]. The present study was carried out to determine the association between the amount of overall movement over the 24 h measured by the MIMAMORI-Gait and motor symptoms of patients with PD assessed at the outpatient clinic by the UPDRS. We selected patients with untreated PD in this study to exclude problems related to diurnal variations in symptoms and motor complications due to antiparkinsonian agents. The results showed that the amount of overall movement measured with MIMAMORI-Gait was significantly associated with the scores of clinician-monitored motor evaluation and patient self-evaluation of ADL with UPDRS. \begin{table}
\begin{tabular}{c c c c} \hline \hline
**Assessment of Motor Symptoms** & **B (SE)** & \(\beta\) & \(p\) **Value** \\ \hline Modified Hoehn and Yahr stage & \(-0.044(0.023)\) & \(-0.260\) & \(0.059\) \\ Unified Parkinson’s Disease Rating Scale part II score & \(-0.013\) (\(0.003\)) & \(-0.506\) & \(<\)0.001 \\ Unified Parkinson’s Disease Rating Scale part III score & \(-0.005\) (\(0.002\)) & \(-0.347\) & \(0.010\) \\ \hline B (SE), unstandardized regression coefficient (standard error); \(\beta\), standardized regression coefficient. & & \\ \end{tabular}
\end{table} 
Table 2: Association of the amount of overall movement measured by MIMAMORI-Gait with the modified Hoehn and Yahr stage and UPDRS scores based on models adjusted for age, sex, and disease duration. In addition to the motor status, the amount of movement of patients with PD is also influenced by several other factors, such as cognitive function, psychiatric symptoms (e.g., depression and apathy), and autonomic symptoms. In this study, the amount of overall movement measured by MIMAMORI-Gait was more strongly associated with the UPDRS part II score than the part III score. In other words, the finding suggests that measurement with this device reflects the overall level of ADL rather than the severity of elemental motor symptoms.