PROJECT SUMMARY/ABSTRACT Parkinson’s disease (PD) is the fastest growing neurological disease, outpacing even Alzheimer’s. A gap in the effective treatment of PD is the reliance on capacity-based clinical assessments, such as the MDS-UPDRS III, to guide clinical decision-making. Clinical ratings, while simple to administer, provide a poor estimation of PD performance of instrumental activities of daily living (IADLs). Declines in IADL performance are of particular importance, as recent population-based cohort studies indicate that IADL decline pre-dates clinical diagnosis of PD by 5-7 years and predict the transition from independence to dependent care settings. In order to advance PD treatment and discovery, objective measures of disease symptoms during the performance of ‘real-world’ IADL scenarios must be created. Augmented reality technology, in which computer-generated images are superimposed in the user’s real-world view, enable the presentation of digital scenarios to replicate IADLs and objectively quantify user’s performance via integrated IMUs and depth camera. The primary aim of this project is to develop an accurate, valid, and reliable augmented reality assessment platform for the quantification of motor and non-motor performance of PD under clinical and IADL augmented reality environments. The proposed Comprehensive Augmented Reality Test (CART) platform for PD will objectively quantify the cardinal motor signs of PD, as well as IADL performance, to facilitate comprehensive treatment of symptoms and precise tracking of disease progression that can eventually be used to optimize medication and deep brain stimulation programming. A multi-disciplinary team of experts in the areas of software and biomedical engineering, neurology, neurosurgery, neuropsychology, physical therapy and statistics will collaborate to develop the CART platform and determine its accuracy, validity and reliability. Particular attention will be spent on quantifying the interplay between motor and cognitive tasks, as dual-tasks performance is linked to gait dysfunction and falls and historically has been overlooked in clinical assessments. Following the development stage, a series of psychometric studies and analyses will be conducted to determine the accuracy, validity and reliability of the CART platform in a cohort of 140 individuals with PD (n=35 in each Hoehn and Yahr Stage I- IV) and 35 age-matched controls. The CART PD platform has the potential to transform the treatment of PD globally by creating an equal emphasis on clinical symptoms and IADL performance through the use of an affordable consumer-available electronic device that is suitable for the integration into treatment delivery systems.