{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T18:28:27Z","timestamp":1791224907013,"version":"4.1.0"},"reference-count":24,"publisher":"SAGE Publications","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JHD"],"published-print":{"date-parts":[[2021,6,9]]},"abstract":"<jats:p>Background: Current Huntington\u2019s disease (HD) measures are limited to subjective, episodic assessments conducted in clinic. Smartphones can enable the collection of objective, real-world data but their use has not been extensively evaluated in HD. Objective: Develop and evaluate a smartphone application to assess feasibility of use and key features of HD in clinic and at home. Methods: We developed GEORGE\u00ae, an Android smartphone application for HD which assesses voice, chorea, balance, gait, and finger tapping speed. We then conducted an observational pilot study of individuals with manifest HD, prodromal HD, and without a movement disorder. In clinic, participants performed standard clinical assessments and a battery of active tasks in GEORGE. At home, participants were instructed to complete the activities thrice daily for one month. Sensor data were used to measure chorea, tap rate, and step count. Audio data was not analyzed. Results: Twenty-three participants (8 manifest HD, 5 prodromal HD, 10 controls) enrolled, and all but one completed the study. On average, participants used the application 2.1 times daily. We observed a significant difference in chorea score (HD: 19.5; prodromal HD: 4.5, p\u200a=\u200a0.007; controls: 4.3, p\u200a=\u200a0.001) and tap rate (HD: 2.5 taps\/s; prodromal HD: 8.9 taps\/s, p\u200a=\u200a0.001; controls: 8.1 taps\/s, p\u200a=\u200a0.001) between individuals with and without manifest HD. Tap rate correlated strongly with the traditional UHDRS finger tapping score (left hand: r\u200a=\u200a\u20130.82, p\u200a=\u200a0.022; right hand: r\u200a=\u200a\u20130.79, p\u200a=\u200a0.03). Conclusion: GEORGE is an acceptable and effective tool to differentiate individuals with and without manifest HD and measure key disease features. Refinement of the application\u2019s interface and activities will improve its usability and sensitivity and, ideally, make it useful for clinical care and research.<\/jats:p>","DOI":"10.3233\/jhd-200452","type":"journal-article","created":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T14:42:15Z","timestamp":1617115335000},"page":"293-301","source":"Crossref","is-referenced-by-count":20,"title":["GEORGE\u00ae: A Pilot Study of a Smartphone Application for Huntington\u2019s Disease"],"prefix":"10.1177","volume":"10","author":[{"given":"Emma M.","family":"Waddell","sequence":"first","affiliation":[{"name":"Center for Health+Technology, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik","family":"Dinesh","sequence":"additional","affiliation":[{"name":"Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey L.","family":"Spear","sequence":"additional","affiliation":[{"name":"Center for Health+Technology, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly J.","family":"Elson","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine, Emory University, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Wagner","sequence":"additional","affiliation":[{"name":"Center for Health+Technology, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Curtis","sequence":"additional","affiliation":[{"name":"UR Health Lab, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Mitten","sequence":"additional","affiliation":[{"name":"UR Health Lab, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher G.","family":"Tarolli","sequence":"additional","affiliation":[{"name":"Center for Health+Technology, University of Rochester Medical Center, Rochester, NY, USA"},{"name":"Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Ray","family":"Dorsey","sequence":"additional","affiliation":[{"name":"Center for Health+Technology, University of Rochester Medical Center, Rochester, NY, USA"},{"name":"Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie L.","family":"Adams","sequence":"additional","affiliation":[{"name":"Center for Health+Technology, University of Rochester Medical Center, Rochester, NY, USA"},{"name":"Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"issue":"3","key":"10.3233\/JHD-200452_ref1","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1097\/00005053-199303000-00008","article-title":"Cognitive and motor correlates of everyday functioning in early Huntington\u2019s disease","volume":"181","author":"Rothlind","year":"1993","journal-title":"J Nerv Ment Dis"},{"issue":"4","key":"10.3233\/JHD-200452_ref2","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1038\/nrneurol.2014.24","article-title":"Huntington disease: Natural history, biomarkers and prospects for therapeutics","volume":"10","author":"Ross","year":"2014","journal-title":"Nat Rev Neurol"},{"issue":"2","key":"10.3233\/JHD-200452_ref3","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1002\/mds.870110204","article-title":"Unified Huntington\u2019s Disease Rating Scale: Reliability and consistency","volume":"11","author":"Huntington Study Group","year":"1996","journal-title":"Mov Disord"},{"issue":"5","key":"10.3233\/JHD-200452_ref4","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1001\/jamaneurol.2014.4524","article-title":"Novel methods and technologies for 21st-century clinical trials: A review","volume":"72","author":"Dorsey","year":"2015","journal-title":"JAMA Neurol"},{"key":"10.3233\/JHD-200452_ref5","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.gaitpost.2018.03.047","article-title":"Identifying balance impairments in people with Parkinson\u2019s disease using video and wearable sensors","volume":"62","author":"Stack","year":"2018","journal-title":"Gait Posture"},{"key":"10.3233\/JHD-200452_ref6","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/b978-0-12-801893-4.00018-3","article-title":"Motor outcome measures in Huntington disease clinical trials","volume":"144","author":"Reilmann","year":"2017","journal-title":"Handb Clin Neurol"},{"issue":"1","key":"10.3233\/JHD-200452_ref7","doi-asserted-by":"publisher","first-page":"69","DOI":"10.3233\/JHD-190375","article-title":"A longitudinal wearable sensor study in Huntington\u2019s disease","volume":"9","author":"Dinesh","year":"2020","journal-title":"J Huntingtons Dis"},{"issue":"6","key":"10.3233\/JHD-200452_ref8","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1016\/j.parkreldis.2015.02.026","article-title":"Detecting and monitoring the symptoms of Parkinson\u2019s disease using smartphones: A pilot study","volume":"21","author":"Arora","year":"2015","journal-title":"Parkinsonism Relat Disord"},{"issue":"7","key":"10.3233\/JHD-200452_ref11","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1001\/jamaneurol.2018.0809","article-title":"Using smartphones and machine learning to quantify Parkinson disease severity: The mobile Parkinson disease score","volume":"75","author":"Zhan","year":"2018","journal-title":"JAMA Neurol"},{"issue":"1","key":"10.3233\/JHD-200452_ref12","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1186\/s12911-018-0714-7","article-title":"Characterizing patient compliance over six months in remote digital trials of Parkinson\u2019s and Huntington disease","volume":"18","author":"Cohen","year":"2018","journal-title":"BMC Med Inform Decis Mak"},{"key":"10.3233\/JHD-200452_ref13","doi-asserted-by":"publisher","first-page":"30942","DOI":"10.1109\/access.2018.2840327","article-title":"Meta-classifiers in Huntington\u2019s disease patients classification, using iPhone\u2019s movement sensors placed at the ankles","volume":"6","author":"Acosta-Escalante","year":"2018","journal-title":"IEEE Access."},{"key":"10.3233\/JHD-200452_ref14","first-page":"A50","article-title":"F29 Validation of a novel smartphone-based cogntive assessment tool designed for remote assessment of cognitive functioning in huntington\u2019s disease","volume":"89","author":"McLaren","year":"2018","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"1","key":"10.3233\/JHD-200452_ref15","doi-asserted-by":"publisher","first-page":"25","DOI":"10.4103\/0972-2327.175425","article-title":"The story of George Huntington and his disease","volume":"19","author":"Bhattacharyya","year":"2016","journal-title":"Ann Indian Acad Neurol"},{"issue":"4","key":"10.3233\/JHD-200452_ref17","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"10.3233\/JHD-200452_ref18","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The Timed \u201cUp & Go\u201d: A test of basic functional mobility for frail elderly persons","volume":"39","author":"Podsiadlo","year":"1991","journal-title":"J Am Geriatr Soc"},{"key":"10.3233\/JHD-200452_ref19","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.gaitpost.2016.11.033","article-title":"Are the average gait speeds during the 10 meter and 6 minute walk tests redundant in Parkinson disease?","volume":"52","author":"Duncan","year":"2017","journal-title":"Gait Posture"},{"key":"10.3233\/JHD-200452_ref20","doi-asserted-by":"publisher","DOI":"10.1109\/WNYIPW.2016.7904834"},{"issue":"1","key":"10.3233\/JHD-200452_ref23","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.gaitpost.2012.05.028","article-title":"Analysis of gait and balance through a single triaxial accelerometer in presymptomatic and symptomatic Huntington\u2019s disease","volume":"37","author":"Dalton","year":"2013","journal-title":"Gait Posture"},{"issue":"6","key":"10.3233\/JHD-200452_ref24","doi-asserted-by":"publisher","first-page":"1594","DOI":"10.1007\/s00415-020-09725-3","article-title":"Gait variability as digital biomarker of disease severity in Huntington\u2019s disease","volume":"267","author":"Ga\u00dfner","year":"2020","journal-title":"J Neurol"},{"issue":"3","key":"10.3233\/JHD-200452_ref25","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1249\/MSS.0b013e3181b7f3e1","article-title":"Finger tapping ability in healthy elderly and young adults","volume":"42","author":"Aoki","year":"2010","journal-title":"Med Sci Sports Exerc"},{"issue":"11","key":"10.3233\/JHD-200452_ref26","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1089\/tmj.2017.0215","article-title":"Validation of freezing-of-gait monitoring using smartphone","volume":"24","author":"Kim","year":"2018","journal-title":"Telemed J E Health"},{"issue":"22","key":"10.3233\/JHD-200452_ref27","doi-asserted-by":"publisher","first-page":"e2042","DOI":"10.1212\/wnl.0000000000008541","article-title":"Motor speech patterns in Huntington disease","volume":"93","author":"Diehl","year":"2019","journal-title":"Neurology"},{"issue":"14","key":"10.3233\/JHD-200452_ref28","doi-asserted-by":"publisher","first-page":"3273","DOI":"10.1016\/j.neuropsychologia.2012.09.011","article-title":"Speech acoustic markers of early stage and prodromal Huntington\u2019s disease: A marker of disease onset?","volume":"50","author":"Vogel","year":"2012","journal-title":"Neuropsychologia"},{"key":"10.3233\/JHD-200452_ref29","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/b978-0-12-801893-4.00006-7","article-title":"Cognitive and behavioral changes in Huntington disease before diagnosis","volume":"144","author":"Paulsen","year":"2017","journal-title":"Handb Clin Neurol"}],"container-title":["Journal of Huntington's Disease"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/JHD-200452","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:55:59Z","timestamp":1777452959000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/JHD-200452"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,9]]},"references-count":24,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3233\/jhd-200452","relation":{},"ISSN":["1879-6397","1879-6400"],"issn-type":[{"value":"1879-6397","type":"print"},{"value":"1879-6400","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,9]]}}}