Standardized handwriting to assess bradykinesia, micrographia and tremor in Parkinson's disease

E J Smits (Corresponding Author), Antti Tolonen, Luc Cluitmans, Mark van Gils, B A Conway, R C Zietsma, K L Leenders, N M Maurits

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Abstract

Objective: To assess whether standardized handwriting can provide quantitative measures to distinguish patients diagnosed with Parkinson's disease from age- and gender-matched healthy control participants. Design: Exploratory study. Pen tip trajectories were recorded during circle, spiral and line drawing and repeated character ‘elelelel’ and sentence writing, performed by Parkinson patients and healthy control participants. Parkinson patients were tested after overnight withdrawal of anti-Parkinsonian medication. Setting: University Medical Center Groningen, tertiary care, the Netherlands. Participants: Patients with Parkinson's disease (n = 10; mean age 69.0 years; 6 male) and healthy controls (n = 10; mean age 68.1 years; 6 male). Interventions: Not applicable. Main Outcome Measures: Movement time and velocity to detect bradykinesia and the size of writing to detect micrographia. A rest recording to investigate the presence of a rest-tremor, by frequency analysis. Results: Mean disease duration in the Parkinson group was 4.4 years and the patients were in modified Hoehn-Yahr stages 1–2.5. In general, Parkinson patients were slower than healthy control participants. Median time per repetition, median velocity and median acceleration of the sentence task and median velocity of the elel task differed significantly between Parkinson patients and healthy control participants (all p<0.0014). Parkinson patients also wrote smaller than healthy control participants and the width of the ‘e’ in the elel task was significantly smaller in Parkinson patients compared to healthy control participants (p<0.0014). A rest-tremor was detected in the three patients who were clinically assessed as having rest-tremor. Conclusions: This study shows that standardized handwriting can provide objective measures for bradykinesia, tremor and micrographia to distinguish Parkinson patients from healthy control participants.
Original languageEnglish
Number of pages8
JournalPLoS ONE
Volume9
Issue number5
DOIs
Publication statusPublished - 2014
MoE publication typeA1 Journal article-refereed

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Handwriting
Hypokinesia
Parkinson disease
Tremor
Parkinson Disease
Healthy Volunteers
Netherlands
Tertiary Healthcare
Trajectories
drug therapy
trajectories
experimental design

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Smits, E J ; Tolonen, Antti ; Cluitmans, Luc ; van Gils, Mark ; Conway, B A ; Zietsma, R C ; Leenders, K L ; Maurits, N M. / Standardized handwriting to assess bradykinesia, micrographia and tremor in Parkinson's disease. In: PLoS ONE. 2014 ; Vol. 9, No. 5.
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title = "Standardized handwriting to assess bradykinesia, micrographia and tremor in Parkinson's disease",
abstract = "Objective: To assess whether standardized handwriting can provide quantitative measures to distinguish patients diagnosed with Parkinson's disease from age- and gender-matched healthy control participants. Design: Exploratory study. Pen tip trajectories were recorded during circle, spiral and line drawing and repeated character ‘elelelel’ and sentence writing, performed by Parkinson patients and healthy control participants. Parkinson patients were tested after overnight withdrawal of anti-Parkinsonian medication. Setting: University Medical Center Groningen, tertiary care, the Netherlands. Participants: Patients with Parkinson's disease (n = 10; mean age 69.0 years; 6 male) and healthy controls (n = 10; mean age 68.1 years; 6 male). Interventions: Not applicable. Main Outcome Measures: Movement time and velocity to detect bradykinesia and the size of writing to detect micrographia. A rest recording to investigate the presence of a rest-tremor, by frequency analysis. Results: Mean disease duration in the Parkinson group was 4.4 years and the patients were in modified Hoehn-Yahr stages 1–2.5. In general, Parkinson patients were slower than healthy control participants. Median time per repetition, median velocity and median acceleration of the sentence task and median velocity of the elel task differed significantly between Parkinson patients and healthy control participants (all p<0.0014). Parkinson patients also wrote smaller than healthy control participants and the width of the ‘e’ in the elel task was significantly smaller in Parkinson patients compared to healthy control participants (p<0.0014). A rest-tremor was detected in the three patients who were clinically assessed as having rest-tremor. Conclusions: This study shows that standardized handwriting can provide objective measures for bradykinesia, tremor and micrographia to distinguish Parkinson patients from healthy control participants.",
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Standardized handwriting to assess bradykinesia, micrographia and tremor in Parkinson's disease. / Smits, E J (Corresponding Author); Tolonen, Antti; Cluitmans, Luc; van Gils, Mark; Conway, B A; Zietsma, R C; Leenders, K L; Maurits, N M.

In: PLoS ONE, Vol. 9, No. 5, 2014.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Standardized handwriting to assess bradykinesia, micrographia and tremor in Parkinson's disease

AU - Smits, E J

AU - Tolonen, Antti

AU - Cluitmans, Luc

AU - van Gils, Mark

AU - Conway, B A

AU - Zietsma, R C

AU - Leenders, K L

AU - Maurits, N M

PY - 2014

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N2 - Objective: To assess whether standardized handwriting can provide quantitative measures to distinguish patients diagnosed with Parkinson's disease from age- and gender-matched healthy control participants. Design: Exploratory study. Pen tip trajectories were recorded during circle, spiral and line drawing and repeated character ‘elelelel’ and sentence writing, performed by Parkinson patients and healthy control participants. Parkinson patients were tested after overnight withdrawal of anti-Parkinsonian medication. Setting: University Medical Center Groningen, tertiary care, the Netherlands. Participants: Patients with Parkinson's disease (n = 10; mean age 69.0 years; 6 male) and healthy controls (n = 10; mean age 68.1 years; 6 male). Interventions: Not applicable. Main Outcome Measures: Movement time and velocity to detect bradykinesia and the size of writing to detect micrographia. A rest recording to investigate the presence of a rest-tremor, by frequency analysis. Results: Mean disease duration in the Parkinson group was 4.4 years and the patients were in modified Hoehn-Yahr stages 1–2.5. In general, Parkinson patients were slower than healthy control participants. Median time per repetition, median velocity and median acceleration of the sentence task and median velocity of the elel task differed significantly between Parkinson patients and healthy control participants (all p<0.0014). Parkinson patients also wrote smaller than healthy control participants and the width of the ‘e’ in the elel task was significantly smaller in Parkinson patients compared to healthy control participants (p<0.0014). A rest-tremor was detected in the three patients who were clinically assessed as having rest-tremor. Conclusions: This study shows that standardized handwriting can provide objective measures for bradykinesia, tremor and micrographia to distinguish Parkinson patients from healthy control participants.

AB - Objective: To assess whether standardized handwriting can provide quantitative measures to distinguish patients diagnosed with Parkinson's disease from age- and gender-matched healthy control participants. Design: Exploratory study. Pen tip trajectories were recorded during circle, spiral and line drawing and repeated character ‘elelelel’ and sentence writing, performed by Parkinson patients and healthy control participants. Parkinson patients were tested after overnight withdrawal of anti-Parkinsonian medication. Setting: University Medical Center Groningen, tertiary care, the Netherlands. Participants: Patients with Parkinson's disease (n = 10; mean age 69.0 years; 6 male) and healthy controls (n = 10; mean age 68.1 years; 6 male). Interventions: Not applicable. Main Outcome Measures: Movement time and velocity to detect bradykinesia and the size of writing to detect micrographia. A rest recording to investigate the presence of a rest-tremor, by frequency analysis. Results: Mean disease duration in the Parkinson group was 4.4 years and the patients were in modified Hoehn-Yahr stages 1–2.5. In general, Parkinson patients were slower than healthy control participants. Median time per repetition, median velocity and median acceleration of the sentence task and median velocity of the elel task differed significantly between Parkinson patients and healthy control participants (all p<0.0014). Parkinson patients also wrote smaller than healthy control participants and the width of the ‘e’ in the elel task was significantly smaller in Parkinson patients compared to healthy control participants (p<0.0014). A rest-tremor was detected in the three patients who were clinically assessed as having rest-tremor. Conclusions: This study shows that standardized handwriting can provide objective measures for bradykinesia, tremor and micrographia to distinguish Parkinson patients from healthy control participants.

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