Copying and handwriting ability in the screening of cognitive dysfunction in old age

A Study of Assisted Screening for Alzheimer's Disease Based on Handwriting and Gait Analysis

Background

Alzheimer's disease (AD) is a progressive neurodegenerative disease that is not easily detected in the early stage. Handwriting and walking have been shown to be potential indicators of cognitive decline and are often affected by AD.

Objective

This study proposes an assisted screening framework for AD based on multimodal analysis of handwriting and gait and explores whether using a combination of multiple modalities can improve the accuracy of single modality classification.

Methods

We recruited 90 participants (38 AD patients and 52 healthy controls). The handwriting data was collected under four handwriting tasks using dot-matrix digital pens, and the gait data was collected using an electronic trail. The two kinds of features were fused as inputs for several different machine learning models (Logistic Regression, SVM, XGBoost, Adaboost, LightGBM), and the model performance was compared.

Results

The accuracy of each model ranged from 71.95% to 96.17%. Among them, the model constructed by LightGBM had the best performance, with an accuracy of 96.17%, sensitivity of 95.32%, specificity of 96.78%, PPV of 95.94%, NPV of 96.74%, and AUC of 0.991. However, the highest accuracy of a single modality was 93.53%, which was achieved by XGBoost in gait features.

Conclusions

The research results show that the combination of handwriting features and gait features can achieve better classification results than a single modality. In addition, the assisted screening model proposed in this study can achieve effective classification of AD, which has development and application prospects.

The Tree Drawing Test in Evolution: An Explorative Longitudinal Study in Alzheimer's Disease

OBJECTIVE

To study the evolution of the Tree Drawing Test (TDT) in a group of Alzheimer's disease (AD) patients.

METHODS

A total of 33 AD patients were consecutively evaluated by Mini Mental State Evaluation (MMSE) and TDT. The evolution of the TDT parameters, trunk-to-crown (TC) and space occupation (SO) index, were analyzed.

RESULTS

The median age at first visit was 79 years. Globally, trees drawn by patients showed an evolution characterized by a progressive reduction of the crown compared to the trunk. TC index showed a significant linear growth change (2.52 points per year) while SO index did not significantly increase. No significant associations were found examining the relations between MMSE and TC and SO index.

CONCLUSIONS

TDT could represent a complementary technique to the main neuropsychological screening tests for orienting cognitive impairment diagnosis and an aid in following the evolution of cognitive impairment over time in AD patients.

Distinct brain dysfunctions underlying visuo-constructive deficit in DLB and AD

Visuo-constructive abilities are a multicomponential process that can be impaired in several neurodegenerative dementias. Among visuo-constructive tasks, the Rey-Osterrieth Complex Figure-copy (ROCF-c) is the most commonly used and it seems influenced by different skills mediated by specific brain regions. This task complexity allows exploring differential mechanisms of impairment in different neurodegenerative disorders. In this study we examined the neuroanatomical substrates of ROCF-c performance in patients with Dementia with Lewy Bodies (DLB) and patients with Alzheimer's disease (AD). We included forty-five patients with probable DLB, and thirty-four patients with probable typical-AD. To identify the ROCF-c scores neural correlates we performed a regression analysis with brain hypometabolism using the ROCF-c scores as independent variable. Then we evaluated the correlation between regional hypometabolism and ROCF-c scores in each group separately, throughout offline Pearson correlation analysis. The DLB and AD groups differed only in visuo-constructive and memory performances. DLB patients performed worse at the visuo-constructive test, while typical-AD patients performed worse at the verbal memory task. In DLB, worse performance at ROCF-c scores (more severe visuo-constructive impairment) correlated with occipital and temporo-parietal hypometabolism. In AD, worse performance at ROCF-c score was associated with brain hypometabolism in the temporo-parietal regions. The inability to correctly perform the ROCF-c derives from distinct brain dysfunctions in DLB and AD. The present results suggest alterations in visuoperceptual processes due to the severe occipital hypometabolism in DLB, and in visuospatial processes related to temporo-parietal hypometabolism in AD.

Parietal Involvement in Constructional Apraxia as Measured Using the Pentagon Copying Task

Deficits in copying ("constructional apraxia") is generally defined as a multifaceted deficit. The exact neural correlates of the different types of copying errors are unknown. To assess whether the different categories of errors on the pentagon drawing relate to different neural correlates, we examined the pentagon drawings of the MMSE in persons with subjective cognitive complaints, mild cognitive impairment, or early dementia due to Alzheimer's disease. We adopted a qualitative scoring method for the pentagon copy test (QSPT) which categorizes different possible errors in copying rather than the dichotomous categories "correct" or "incorrect." We correlated (regional) gray matter volumes with performance on the different categories of the QSPT. Results showed that the total score of the QSPT was specifically associated with parietal gray matter volume and not with frontal, temporal, and occipital gray matter volume. A more fine-grained analysis of the errors reveals that the intersection score and the number of angles share their underlying neural correlates and are associated with specific subregions of the parietal cortex. These results are in line with the idea that constructional apraxia can be attributed to the failure to integrate visual information correctly from one fixation to the next, a process called spatial remapping.

Factors associated with cognitive function that cause a decline in the level of activities of daily living in Alzheimer's disease

AIM

The principal aim of the present study was to clarify what type of cognitive decline results in a decrease in the ability to carry out activities of daily living (ADL) in patients with Alzheimer's disease (AD).

METHODS

The participants comprised 1384 outpatients with mild AD. We used the Mini-Mental State Examination (MMSE) and Barthel Index (BI) as indicators of basic ADL, and the Lawton Index (LI) as an indicator of instrumental ADL (IADL). We then analyzed the relationships between MMSE and BI, as well as between MMSE and LI. We also carried out a logistic regression analysis with BI and LI subitems as dependent variables, and MMSE subitems as independent variables.

RESULTS

For almost all BI and LI subitems, significantly high odds ratios (OR) were noted in MMSE "Copy the design shown" (e.g. dressing OR 3.66, toilet use OR 3.60 and transfers OR 2.80) and "Write a sentence" (e.g. ability to use telephone OR 5.24, laundry OR 2.60, grooming OR 2.50; P < 0.05).

CONCLUSIONS

Visuospatial cognition had an important effect on the decrease in basic ADL and IADL. Furthermore, the subitems with minimal effect on the decrease of basic ADL and IADL differed. Therefore, it appears that specific activities have little effect on the maintenance of ADL and IADL, and that determining residual cognitive function and utilizing this as a means of compensating for decreased ADL is a useful strategy. Geriatr Gerontol Int 2018; 18: 50-56.

Signing below the dotted line: signature position as a marker of vulnerability for visuospatial processing difficulties

Almost one-third of the participants in a neuropsychological study signed the consent form below the given line. The relationship between a signature position on or below the line and participants' cognitive function was investigated. Fifty drug-dependent individuals, 50 of their siblings, and 50 unrelated control participants completed a battery of neuropsychological tests using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Individuals signing below, rather than on, the line performed more poorly on tests of visuospatial memory, but no differently on other cognitive tests. Signature positioning may be a soft sign for impairment of the mechanisms involved in visuospatial memory.

A retrospective analysis of the sentence writing component of the Mini Mental State Examination: cognitive and affective aspects

BACKGROUND

One of the components of the Mini Mental State Examination (MMSE) is the request to write a sentence. We investigated the relationship between the characteristics of the written sentence of the MMSE and the cognitive and affective status of elderly patients.

METHODS

The characteristics of the sentence were compared to the total MMSE score, sociodemographic characteristics, tests evaluating cognition and affective status, and diagnoses.

RESULTS

The number of words was significantly associated with the degree of cognitive impairment, whereas the emotional polarity of sentences and concerns about health were associated with depression.

CONCLUSIONS

Characteristics of the MMSE sentence may provide important additional information regarding both cognition and affect when assessing older people.

The usefulness of cube copying for evaluating treatment of Alzheimer's disease

AIMS

Cube copying measures visuospatial ability, which is often impaired in Alzheimer's disease (AD). Cube copying was examined as an evaluation of cholinesterase inhibitor (ChEI) treatment in AD.

METHODS

Eighty-five ChEI-treated AD patients were included. Cube drawings made at prebaseline, baseline, 6 months, and 12 months were assessed. Cube drawings from 56 healthy individuals were also examined.

RESULTS

The healthy individuals remained stable in cube copying, whereas untreated AD patients deteriorated during a median period of 6 months. When treatment was given, the deterioration was interrupted. After 12 months, Mini-Mental State Examination (MMSE) had deteriorated compared with baseline whereas cube copying was unchanged.

CONCLUSIONS

The results indicate that cube copying can be used to evaluate ChEI treatment. It might also show a more long-lasting response to treatment than MMSE. Cube copying only measures a narrow cognitive function and can preferably be used with MMSE, which evaluates visuospatial ability poorly.

Age-related psychomotor slowing as an important component of verbal fluency

Generalized psychomotor slowing is a characteristic of normal aging, and there is evidence suggesting that this feature is also central in dementia. The present article aims to evaluate the importance of psychomotor slowing as a factor underlying changes in the performance of verbal fluency tasks in normal and pathological aging. In study 1 reading and handwriting speed were used to predict performance on written and oral verbal fluency tasks (VFTs) in healthy elderly subjects (n = 20) and in patients of the Alzheimer type disease (n = 20). In study 2, spectrographic techniques were used to obtain reaction times, average of voice intensity and duration of single word production in young individuals (n = 20), healthy elderly subjects (n = 20), and in patients of the Alzheimer type disease (n = 7). Additionally, duration of single word production were also obtained. The results suggest that age-related psychomotor decline in word production speed is an important determinant of VFT.

Cube drawing performances in normal ageing and Alzheimer's disease: data from the PAQUID elderly population-based cohort

To assess the influence of age and other sociodemographical variables, depressive symptomatology and the occurrence of Alzheimer's disease (AD) on cube drawing, we examined the performance of 858 normal subjects and 17 incident AD patients in the PAQUID population-based study. Cube drawing was first performed on verbal command and, in case of failure, a model of a cube was given to the subjects to copy. Normal subjects had some difficulties in drawing a cube on verbal command, evidenced by 40% failure in the drawing-to-command condition, while only 17% still failed in the drawing-to-copy condition. Multivariate logistic regressions showed that age, gender, and educational level were associated with cube drawing failure in both conditions, but depressive symptomatology was only associated with persistent failure in the drawing-to-copy condition. Seventy-six point five percent of incident AD subjects failed in the drawing-to-command condition and 64.7% did not benefit from the presentation of the model. Analysis showed that persistent failure in the copy condition was the best level of differentiation between normal and AD subjects.

Human-figure drawing and memory functioning across the adult life span

The main objective was to evaluate changes in the ability to draw the human figure (HFD) across adult life span and to relate these changes to those known to exist in memory function. Healthy adults (1000) from each of 10 five-year cohorts between 35 and 80 years were recruited randomly from a population in northern Sweden. Each participant was administered a health examination including cognitive testing and a drawing test, and an extensive examination of memory functions. For the drawing variables HFDarch and HFDtot, there is a steady decrease in episodic memory with poor drawers performing at a lower level. For semantic memory up to 65 years of age, there is no difference in performance, but thereafter a decrease. Good drawers show a better memory performance than poor drawers. For priming data for both HFDarch and HFDtot, there seems to be an interaction between age and drawing, such that poor drawers perform at a lower level for the two oldest groups but not for the youngest group. The HFDess is a valuable instrument and can support clinical evaluation as a screening for cognitive decline. The reduction of essential body details was strongly related to dementia progression, and thus as good a predictor of cognitive decline as episodic memory performance. The reduced capacity to perform a complex HFD declines with age and is most pronounced in the oldest age groups.

Dental management of Alzheimer patients. A predictive test of dental cooperation in individualized treatment planning

The aim of the study was to investigate a possible relationship in Alzheimer patients between the stage of dementia, cognitive and functional capacity, and behavior as a dental patient. A special index for assessing behavior in the dental setting was used. The 40 participants were inmates of a nursing home and fulfilled the criteria for Alzheimer's disease in accordance with DSM-III-R. A deficiency in the dental behavior index (DBI) of 50% or less did not correlate with cognitive, functional, or graphic capacity. These subjects were generally aware of earlier regular dental treatment and behaved as if dental visits were familiar to them, although their cognitive, functional, and graphic capacities were more impaired than disclosed by the dental behavior index. A deficiency in the dental behavior index of 50% or more was more correlated with the other capacity assessments. Finding a proper treatment level for an Alzheimer patient is a delicate task in which it is essential to balance awareness of various aspects of impairment and realistic anticipation of benefit. The dental behavior index can be an appropriate instrument in this complex process.