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An SK, Jang H, Kim HJ, Na DL, Yoon JH. Linguistic, visuospatial, and kinematic writing characteristics in cognitively impaired patients with beta-amyloid deposition. Front Aging Neurosci 2023; 15:1217746. [PMID: 37753065 PMCID: PMC10518411 DOI: 10.3389/fnagi.2023.1217746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Beta-amyloid (Aβ) deposition, a hallmark of Alzheimer's disease (AD), begins before dementia and is an important factor in mild cognitive impairment (MCI). Aβ deposition is a recognized risk factor for various cognitive impairments and has been reported to affect motor performance as well. This study aimed to identify the linguistic, visuospatial, and kinematic characteristics evident in the writing performance of patients with cognitive impairment (CI) who exhibit Aβ deposition. Methods A total of 31 patients diagnosed with amnestic mild cognitive impairment (aMCI) with Aβ deposition, 26 patients with Alzheimer's-type dementia, and 33 healthy control (HC) participants without deposition were administered tasks involving dictation of 60 regular words, irregular words, and non-words consisting of 1-4 syllables. Responses from all participants were collected and analyzed through digitized writing tests and analysis tools. Results In terms of linguistic aspects, as cognitive decline progressed, performance in the dictation of irregular words decreased, with errors observed in substituting the target grapheme with other graphemes. The aMCI group frequently exhibited corrective aspects involving letter rewriting during the task. In terms of visuospatial aspects, the AD group displayed more errors in grapheme combination compared to the HC group. Lastly, in the kinematic aspects, both the aMCI group and the AD group exhibited slower writing speeds compared to the HC group. Discussion The findings suggest that individuals in the CI group exhibited lower performance in word dictation tasks than those in the HC group, and these results possibly indicate complex cognitive-language-motor deficits resulting from temporal-parietal lobe damage, particularly affecting spelling processing. These results provide valuable clinical insights into understanding linguistic-visuospatial-kinematic aspects that contribute to the early diagnosis of CI with Aβ deposition.
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Affiliation(s)
- Seo Kyung An
- Department of Speech-Language Pathology and Audiology, Hallym University, Chuncheon, Republic of Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hye Yoon
- Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, Hallym University, Chuncheon, Republic of Korea
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Vandersteen C, Plonka A, Manera V, Sawchuk K, Lafontaine C, Galery K, Rouaud O, Bengaied N, Launay C, Guérin O, Robert P, Allali G, Beauchet O, Gros A. Alzheimer's early detection in post-acute COVID-19 syndrome: a systematic review and expert consensus on preclinical assessments. Front Aging Neurosci 2023; 15:1206123. [PMID: 37416323 PMCID: PMC10320294 DOI: 10.3389/fnagi.2023.1206123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/31/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction The risk of developing Alzheimer's disease (AD) in older adults increasingly is being discussed in the literature on Post-Acute COVID-19 Syndrome (PACS). Remote digital Assessments for Preclinical AD (RAPAs) are becoming more important in screening for early AD, and should always be available for PACS patients, especially for patients at risk of AD. This systematic review examines the potential for using RAPA to identify impairments in PACS patients, scrutinizes the supporting evidence, and describes the recommendations of experts regarding their use. Methods We conducted a thorough search using the PubMed and Embase databases. Systematic reviews (with or without meta-analysis), narrative reviews, and observational studies that assessed patients with PACS on specific RAPAs were included. The RAPAs that were identified looked for impairments in olfactory, eye-tracking, graphical, speech and language, central auditory, or spatial navigation abilities. The recommendations' final grades were determined by evaluating the strength of the evidence and by having a consensus discussion about the results of the Delphi rounds among an international Delphi consensus panel called IMPACT, sponsored by the French National Research Agency. The consensus panel included 11 international experts from France, Switzerland, and Canada. Results Based on the available evidence, olfaction is the most long-lasting impairment found in PACS patients. However, while olfaction is the most prevalent impairment, expert consensus statements recommend that AD olfactory screening should not be used on patients with a history of PACS at this point in time. Experts recommend that olfactory screenings can only be recommended once those under study have reported full recovery. This is particularly important for the deployment of the olfactory identification subdimension. The expert assessment that more long-term studies are needed after a period of full recovery, suggests that this consensus statement requires an update in a few years. Conclusion Based on available evidence, olfaction could be long-lasting in PACS patients. However, according to expert consensus statements, AD olfactory screening is not recommended for patients with a history of PACS until complete recovery has been confirmed in the literature, particularly for the identification sub-dimension. This consensus statement may require an update in a few years.
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Affiliation(s)
- Clair Vandersteen
- Institut Universitaire de la Face et du Cou, ENT Department, Centre Hospitalier Universitaire, Nice, France
- Laboratoire CoBTeK, Université Côte d'Azur, Nice, France
| | - Alexandra Plonka
- Laboratoire CoBTeK, Université Côte d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
- Département d'Orthophonie, UFR Médecine, Université Côte d'Azur, Nice, France
- Institut NeuroMod, Université Côte d'Azur, Sophia Antipolis, France
| | - Valeria Manera
- Laboratoire CoBTeK, Université Côte d'Azur, Nice, France
- Département d'Orthophonie, UFR Médecine, Université Côte d'Azur, Nice, France
- Institut NeuroMod, Université Côte d'Azur, Sophia Antipolis, France
| | - Kim Sawchuk
- ACTLab, engAGE: Centre for Research on Aging, Concordia University Montreal, Montreal, QC, Canada
| | - Constance Lafontaine
- ACTLab, engAGE: Centre for Research on Aging, Concordia University Montreal, Montreal, QC, Canada
| | - Kevin Galery
- Research Centre of the Geriatric University Institute of Montreal, Montreal, QC, Canada
| | - Olivier Rouaud
- Leenaards Memory Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nouha Bengaied
- Federation of Quebec Alzheimer Societies, Montreal, QC, Canada
| | - Cyrille Launay
- Mc Gill University Jewish General Hospital, Montreal, QC, Canada
| | - Olivier Guérin
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
- Université Côte d'Azur, CNRS UMR 7284/INSERM U108, Institute for Research on Cancer and Aging Nice, UFR de Médecine, Nice, France
| | - Philippe Robert
- Laboratoire CoBTeK, Université Côte d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
- Département d'Orthophonie, UFR Médecine, Université Côte d'Azur, Nice, France
| | - Gilles Allali
- Leenaards Memory Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Beauchet
- Research Centre of the Geriatric University Institute of Montreal, Montreal, QC, Canada
- Mc Gill University Jewish General Hospital, Montreal, QC, Canada
- Departments of Medicine and Geriatric, University of Montreal, Montreal, QC, Canada
| | - Auriane Gros
- Laboratoire CoBTeK, Université Côte d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
- Département d'Orthophonie, UFR Médecine, Université Côte d'Azur, Nice, France
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Wei P. Ultra-Early Screening of Cognitive Decline Due to Alzheimer's Pathology. Biomedicines 2023; 11:biomedicines11051423. [PMID: 37239094 DOI: 10.3390/biomedicines11051423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Alzheimer's pathology can be assessed and defined via Aβ and tau biomarkers. The preclinical period of Alzheimer's disease is long and lasts several decades. Although effective therapies to block pathological processes of Alzheimer's disease are still lacking, downward trends in the incidence and prevalence of dementia have occurred in developed countries. Accumulating findings support that education, cognitive training, physical exercise/activities, and a healthy lifestyle can protect cognitive function and promote healthy aging. Many studies focus on detecting mild cognitive impairment (MCI) and take a variety of interventions in this stage to protect cognitive function. However, when Alzheimer's pathology advances to the stage of MCI, interventions may not be successful in blocking the development of the pathological process. MCI individuals reverting to normal cognitive function exhibited a high probability to progress to dementia. Therefore, it is necessary to take effective measures before the MCI stage. Compared with MCI, an earlier stage, transitional cognitive decline, may be a better time window in which effective interventions are adopted for at-risk individuals. Detecting this stage in large populations relies on rapid screening of cognitive function; given that many cognitive tests focus on MCI detection, new tools need to be developed.
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Affiliation(s)
- Pengxu Wei
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Neuro-Functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing 100176, China
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
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Qi H, Zhang R, Wei Z, Zhang C, Wang L, Lang Q, Zhang K, Tian X. A study of auxiliary screening for Alzheimer’s disease based on handwriting characteristics. Front Aging Neurosci 2023; 15:1117250. [PMID: 37009455 PMCID: PMC10050722 DOI: 10.3389/fnagi.2023.1117250] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
Background and objectivesAlzheimer’s disease (AD) has an insidious onset, the early stages are easily overlooked, and there are no reliable, rapid, and inexpensive ancillary detection methods. This study analyzes the differences in handwriting kinematic characteristics between AD patients and normal elderly people to model handwriting characteristics. The aim is to investigate whether handwriting analysis has a promising future in AD auxiliary screening or even auxiliary diagnosis and to provide a basis for developing a handwriting-based diagnostic tool.Materials and methodsThirty-four AD patients (15 males, 77.15 ± 1.796 years) and 45 healthy controls (20 males, 74.78 ± 2.193 years) were recruited. Participants performed four writing tasks with digital dot-matrix pens which simultaneously captured their handwriting as they wrote. The writing tasks consisted of two graphics tasks and two textual tasks. The two graphics tasks are connecting fixed dots (task 1) and copying intersecting pentagons (task 2), and the two textual tasks are dictating three words (task 3) and copying a sentence (task 4). The data were analyzed by using Student’s t-test and Mann–Whitney U test to obtain statistically significant handwriting characteristics. Moreover, seven classification algorithms, such as eXtreme Gradient Boosting (XGB) and Logistic Regression (LR) were used to build classification models. Finally, the Receiver Operating Characteristic (ROC) curve, accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Area Under Curve (AUC) were used to assess whether writing scores and kinematics parameters are diagnostic.ResultsKinematic analysis showed statistically significant differences between the AD and controlled groups for most parameters (p < 0.05, p < 0.01). The results found that patients with AD showed slower writing speed, tremendous writing pressure, and poorer writing stability. We built statistically significant features into a classification model, among which the model built by XGB was the most effective with a maximum accuracy of 96.55%. The handwriting characteristics also achieved good diagnostic value in the ROC analysis. Task 2 had a better classification effect than task 1. ROC curve analysis showed that the best threshold value was 0.084, accuracy = 96.30%, sensitivity = 100%, specificity = 93.41%, PPV = 92.21%, NPV = 100%, and AUC = 0.991. Task 4 had a better classification effect than task 3. ROC curve analysis showed that the best threshold value was 0.597, accuracy = 96.55%, sensitivity = 94.20%, specificity = 98.37%, PPV = 97.81%, NPV = 95.63%, and AUC = 0.994.ConclusionThis study’s results prove that handwriting characteristic analysis is promising in auxiliary AD screening or AD diagnosis.
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Affiliation(s)
- Hengnian Qi
- Information Engineering Department, Huzhou University, Huzhou, China
| | - Ruoyu Zhang
- Information Engineering Department, Huzhou University, Huzhou, China
| | - Zhuqin Wei
- School of Medicine and Nursing, Huzhou University, Huzhou, China
| | - Chu Zhang
- Information Engineering Department, Huzhou University, Huzhou, China
| | - Lina Wang
- School of Medicine and Nursing, Huzhou University, Huzhou, China
| | - Qing Lang
- Library, Huzhou University, Huzhou, China
- *Correspondence: Qing Lang,
| | - Kai Zhang
- School of Information Engineering, Guangdong Communication Polytechnic, Guangzhou, China
| | - Xuesong Tian
- Cloudbutterfly Technology Co., Ltd., Guangzhou, China
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Fernandes CP, Montalvo G, Caligiuri M, Pertsinakis M, Guimarães J. Handwriting Changes in Alzheimer's Disease: A Systematic Review. J Alzheimers Dis 2023; 96:1-11. [PMID: 37718808 DOI: 10.3233/jad-230438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Handwriting is a complex process involving fine motor skills, kinesthetic components, and several cognitive domains, often impaired by Alzheimer's disease (AD). OBJECTIVE Provide a systematic review of handwriting changes in AD, highlighting the effects on motor, visuospatial and linguistic features, and to identify new research topics. METHODS A search was conducted on PubMed, Scopus, and Web of Science to identify studies on AD and handwriting. The review followed PRISMA norms and analyzed 91 articles after screening and final selection. RESULTS Handwriting is impaired at all levels of the motor-cognitive hierarchy in AD, particularly in text, with higher preservation of signatures. Visuospatial and linguistic features were more affected. Established findings for motor features included higher variability in AD signatures, higher in-air/on-surface time ratio and longer duration in text, longer start time/reaction time, and lower fluency. There were conflicting findings for pressure and velocity in motor features, as well as size, legibility, and pen lifts in general features. For linguistic features, findings were contradictory for error patterns, as well as the association between agraphia and severity of cognitive deficits. CONCLUSIONS Further re-evaluation studies are needed to clarify the divergent results on motor, general, and linguistic features. There is also a lack of research on the influence of AD on signatures and the effect of AD variants on handwriting. Such research would have an impact on clinical management (e.g., for early detection and patient follow-up using handwriting tasks), or forensic examination aimed at signatory identification.
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Affiliation(s)
- Carina Pereira Fernandes
- NCForenses Institute, Porto, Portugal
- Instituto Universitario de Investigación en Ciencias Policiales (IUICP), Universidad de Alcalá, Alcalá de Henares, Spain
| | - Gemma Montalvo
- Instituto Universitario de Investigación en Ciencias Policiales (IUICP), Universidad de Alcalá, Alcalá de Henares, Spain
- Universidad de Alcalá, Departamento de Química Analítica, Química Física e Ingeniería Química, Alcalá de Henares, Spain
| | - Michael Caligiuri
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Michael Pertsinakis
- Ingeniería Química, Alcalá de Henares, Spain
- City Unity College, Athens, Greece
| | - Joana Guimarães
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
- MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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Li K, Ma X, Chen T, Xin J, Wang C, Wu B, Ogihara A, Zhou S, Liu J, Huang S, Wang Y, Li S, Chen Z, Xu R. A new early warning method for mild cognitive impairment due to Alzheimer's disease based on dynamic evaluation of the "spatial executive process". Digit Health 2023; 9:20552076231194938. [PMID: 37654709 PMCID: PMC10467230 DOI: 10.1177/20552076231194938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
Objective Mild cognitive impairment (MCI) due to Alzheimer's disease (AD), as an early stage of AD, is an important point for early warning of AD. Neuropathological studies have shown that AD pathology in pre-dementia patients involves the hippocampus and caudate nucleus, which are responsible for controlling cognitive mechanisms such as the spatial executive process (SEP). The aim of this study is to design a new method for early warning of MCI due to AD by dynamically evaluating SEP. Methods We designed fingertip interaction handwriting digital evaluation paradigms and analyzed the dynamic trajectory of fingertip interaction and image data during "clock drawing" and "repetitive writing" tasks. Extracted fingertip interaction digital biomarkers were used to assess participants' SEP disorders, ultimately enabling intelligent diagnosis of MCI due to AD. A cross-sectional study demonstrated the predictive performance of this new method. Results We enrolled 30 normal cognitive (NC) elderly and 30 MCI due to AD patients, and clinical research results showed that there may be neurobehavioral differences between the two groups in digital biomarkers captured during SEP. The early warning performance for MCI due to AD of this new method (areas under the curve (AUC) = 0.880) is better than that of the Minimum Mental State Examination (MMSE) neuropsychological scale (AUC = 0.856) assessed by physicians. Conclusion Patients with MCI due to AD may have SEP disorders, and this new method based on dynamic evaluation of SEP will provide a novel human-computer interaction and intelligent early warning method for home and community screening of MCI due to AD.
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Affiliation(s)
- Kai Li
- Zhejiang-Japan Digital Diagnosis and Treatment and Equipment of Integrated Traditional Chinese Medicine and Western Medicine for Major Brain Diseases Joint Laboratory, Zhejiang Chinese Medical University, Hangzhou, China
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
- Joint Laboratory of Police Health Smart Surveillance, Zhejiang Police College, Hangzhou, China
| | - Xiaowen Ma
- Zhejiang-Japan Digital Diagnosis and Treatment and Equipment of Integrated Traditional Chinese Medicine and Western Medicine for Major Brain Diseases Joint Laboratory, Zhejiang Chinese Medical University, Hangzhou, China
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Tong Chen
- Department of Neurology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Junyi Xin
- School of Information Engineering, Hangzhou Medical College, Hangzhou, China
| | - Chen Wang
- Zhejiang-Japan Digital Diagnosis and Treatment and Equipment of Integrated Traditional Chinese Medicine and Western Medicine for Major Brain Diseases Joint Laboratory, Zhejiang Chinese Medical University, Hangzhou, China
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Bo Wu
- Zhejiang-Japan Digital Diagnosis and Treatment and Equipment of Integrated Traditional Chinese Medicine and Western Medicine for Major Brain Diseases Joint Laboratory, Zhejiang Chinese Medical University, Hangzhou, China
- School of Computer Science, Tokyo University of Technology, Hachioji City, Tokyo, Japan
| | - Atsushi Ogihara
- Zhejiang-Japan Digital Diagnosis and Treatment and Equipment of Integrated Traditional Chinese Medicine and Western Medicine for Major Brain Diseases Joint Laboratory, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Health Sciences and Social Welfare, Faculty of Human Sciences, Waseda University, Tokorozawa, Japan
| | - Siyu Zhou
- Zhejiang-Japan Digital Diagnosis and Treatment and Equipment of Integrated Traditional Chinese Medicine and Western Medicine for Major Brain Diseases Joint Laboratory, Zhejiang Chinese Medical University, Hangzhou, China
- School of Public health, Hangzhou Normal University, Hangzhou, China
| | - Jiakang Liu
- Zhejiang-Japan Digital Diagnosis and Treatment and Equipment of Integrated Traditional Chinese Medicine and Western Medicine for Major Brain Diseases Joint Laboratory, Zhejiang Chinese Medical University, Hangzhou, China
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shouqiang Huang
- Zhejiang-Japan Digital Diagnosis and Treatment and Equipment of Integrated Traditional Chinese Medicine and Western Medicine for Major Brain Diseases Joint Laboratory, Zhejiang Chinese Medical University, Hangzhou, China
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yujia Wang
- Zhejiang-Japan Digital Diagnosis and Treatment and Equipment of Integrated Traditional Chinese Medicine and Western Medicine for Major Brain Diseases Joint Laboratory, Zhejiang Chinese Medical University, Hangzhou, China
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuwu Li
- Zhejiang-Japan Digital Diagnosis and Treatment and Equipment of Integrated Traditional Chinese Medicine and Western Medicine for Major Brain Diseases Joint Laboratory, Zhejiang Chinese Medical University, Hangzhou, China
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zeyuan Chen
- Joint Laboratory of Police Health Smart Surveillance, Zhejiang Police College, Hangzhou, China
- School of International Studies and Cooperation, Zhejiang Police College, Hangzhou, China
| | - Runlong Xu
- School of Information Engineering, Hangzhou Medical College, Hangzhou, China
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Asci F, Scardapane S, Zampogna A, D’Onofrio V, Testa L, Patera M, Falletti M, Marsili L, Suppa A. Handwriting Declines With Human Aging: A Machine Learning Study. Front Aging Neurosci 2022; 14:889930. [PMID: 35601625 PMCID: PMC9120912 DOI: 10.3389/fnagi.2022.889930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHandwriting is an acquired complex cognitive and motor skill resulting from the activation of a widespread brain network. Handwriting therefore may provide biologically relevant information on health status. Also, handwriting can be collected easily in an ecological scenario, through safe, cheap, and largely available tools. Hence, objective handwriting analysis through artificial intelligence would represent an innovative strategy for telemedicine purposes in healthy subjects and people affected by neurological disorders.Materials and MethodsOne-hundred and fifty-six healthy subjects (61 males; 49.6 ± 20.4 years) were enrolled and divided according to age into three subgroups: Younger adults (YA), middle-aged adults (MA), and older adults (OA). Participants performed an ecological handwriting task that was digitalized through smartphones. Data underwent the DBNet algorithm for measuring and comparing the average stroke sizes in the three groups. A convolutional neural network (CNN) was also used to classify handwriting samples. Lastly, receiver operating characteristic (ROC) curves and sensitivity, specificity, positive, negative predictive values (PPV, NPV), accuracy and area under the curve (AUC) were calculated to report the performance of the algorithm.ResultsStroke sizes were significantly smaller in OA than in MA and YA. The CNN classifier objectively discriminated YA vs. OA (sensitivity = 82%, specificity = 80%, PPV = 78%, NPV = 79%, accuracy = 77%, and AUC = 0.84), MA vs. OA (sensitivity = 84%, specificity = 56%, PPV = 78%, NPV = 73%, accuracy = 74%, and AUC = 0.7), and YA vs. MA (sensitivity = 75%, specificity = 82%, PPV = 79%, NPV = 83%, accuracy = 79%, and AUC = 0.83).DiscussionHandwriting progressively declines with human aging. The effect of physiological aging on handwriting abilities can be detected remotely and objectively by using machine learning algorithms.
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Affiliation(s)
| | - Simone Scardapane
- Department of Information, Electronic and Communication Engineering (DIET), Sapienza University of Rome, Rome, Italy
| | | | | | - Lucia Testa
- Department of Informatic, Automatic and Gestional Engineering (DIAG), Sapienza University of Rome, Rome, Italy
| | - Martina Patera
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marco Falletti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Luca Marsili
- Department of Neurology, Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Antonio Suppa
- IRCCS Neuromed Institute, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- *Correspondence: Antonio Suppa,
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