A survey on computer-assisted Parkinson's Disease diagnosis

Artificial intelligence in Parkinson's disease: Early detection and diagnostic advancements

Parkinson's disease (PD) is the second most common neurodegenerative disorder, globally affecting men and women at an exponentially growing rate, with currently no cure. Disease progression starts when dopaminergic neurons begin to die. In PD, the loss of neurotransmitter, dopamine is responsible for the overall communication of neural cells throughout the body. Clinical symptoms of PD are slowness of movement, involuntary muscular contractions, speech & writing changes, lessened automatic movement, and chronic tremors in the body. PD occurs in both familial and sporadic forms and modifiable and non-modifiable risk factors and socioeconomic conditions cause PD. Early detectable diagnostics and treatments have been developed in the last several decades. However, we still do not have precise early detectable biomarkers and therapeutic agents/drugs that prevent and/or delay the disease process. Recently, artificial intelligence (AI) science and machine learning tools have been promising in identifying early detectable markers with a greater rate of accuracy compared to past forms of treatment and diagnostic processes. Artificial intelligence refers to the intelligence exhibited by machines or software, distinct from the intelligence observed in humans that is based on neural networks in a form and can be used to diagnose the longevity and disease severity of disease. The term Machine Learning or Neural Networks is a blanket term used to identify an emerging technology that is created to work in the way of a "human brain" using many intertwined neurons to achieve the same level of raw intelligence as that of a brain. These processes have been used for neurodegenerative diseases such as Parkinson's disease and Alzheimer's disease, to assess the severity of the patient's condition. In the current article, we discuss the prevalence and incidence of PD, and currently available diagnostic biomarkers and therapeutic strategies. We also highlighted currently available artificial intelligence science and machine learning tools and their applications to detect disease and develop therapeutic interventions.

Assessing gait dysfunction severity in Parkinson's Disease using 2-Stream Spatial-Temporal Neural Network

Parkinson's Disease (PD), a neurodegenerative disorder, significantly impacts the quality of life for millions of people worldwide. PD primarily impacts dopaminergic neurons in the brain's substantia nigra, resulting in dopamine deficiency and gait impairments such as bradykinesia and rigidity. Currently, several well-established tools, such as the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Hoehn and Yahr (H&Y) Scale, are used for evaluating gait dysfunction in PD. While insightful, these methods are subjective, time-consuming, and often ineffective in early-stage diagnosis. Other methods using specialized sensors and equipment to measure movement disorders are cumbersome and expensive, limiting their accessibility. This study introduces a hierarchical approach to evaluating gait dysfunction in PD through videos. The novel 2-Stream Spatial-Temporal Neural Network (2S-STNN) leverages the spatial-temporal features from the skeleton and silhouette streams for PD classification. This approach achieves an accuracy rate of 89% and outperforms other state-of-the-art models. The study also employs saliency values to highlight critical body regions that significantly influence model decisions and are severely affected by the disease. For a more detailed analysis, the study investigates 21 specific gait attributes for a more nuanced quantification of gait disorders. Parameters such as walking pace, step length, and neck forward angle are found to be strongly correlated with PD gait severity categories. This approach offers a comprehensive and convenient solution for PD management in clinical settings, enabling patients to receive a more precise evaluation and monitoring of their gait impairments.

Parkinson's Disease Detection from Voice Recordings Using Associative Memories

Parkinson's disease (PD) is a neurological condition that is chronic and worsens over time, which presents a challenging diagnosis. An accurate diagnosis is required to recognize PD patients from healthy individuals. Diagnosing PD at early stages can reduce the severity of this disorder and improve the patient's living conditions. Algorithms based on associative memory (AM) have been applied in PD diagnosis using voice samples of patients with this health condition. Even though AM models have achieved competitive results in PD classification, they do not have any embedded component in the AM model that can identify and remove irrelevant features, which would consequently improve the classification performance. In this paper, we present an improvement to the smallest normalized difference associative memory (SNDAM) algorithm by means of a learning reinforcement phase that improves classification performance of SNDAM when it is applied to PD diagnosis. For the experimental phase, two datasets that have been widely applied for PD diagnosis were used. Both datasets were gathered from voice samples from healthy people and from patients who suffer from this condition at an early stage of PD. These datasets are publicly accessible in the UCI Machine Learning Repository. The efficiency of the ISNDAM model was contrasted with that of seventy other models implemented in the WEKA workbench and was compared to the performance of previous studies. A statistical significance analysis was performed to verify that the performance differences between the compared models were statistically significant. The experimental findings allow us to affirm that the proposed improvement in the SNDAM algorithm, called ISNDAM, effectively increases the classification performance compared against well-known algorithms. ISNDAM achieves a classification accuracy of 99.48%, followed by ANN Levenberg-Marquardt with 95.89% and SVM RBF kernel with 88.21%, using Dataset 1. ISNDAM achieves a classification accuracy of 99.66%, followed by SVM IMF1 with 96.54% and RF IMF1 with 94.89%, using Dataset 2. The experimental findings show that ISNDAM achieves competitive performance on both datasets and that statistical significance tests confirm that ISNDAM delivers classification performance equivalent to that of models published in previous studies.

Computer-assisted approaches for measuring, segmenting, and analyzing functional upper extremity movement: a narrative review of the current state, limitations, and future directions

The analysis of functional upper extremity (UE) movement kinematics has implications across domains such as rehabilitation and evaluating job-related skills. Using movement kinematics to quantify movement quality and skill is a promising area of research but is currently not being used widely due to issues associated with cost and the need for further methodological validation. Recent developments by computationally-oriented research communities have resulted in potentially useful methods for evaluating UE function that may make kinematic analyses easier to perform, generally more accessible, and provide more objective information about movement quality, the importance of which has been highlighted during the COVID-19 pandemic. This narrative review provides an interdisciplinary perspective on the current state of computer-assisted methods for analyzing UE kinematics with a specific focus on how to make kinematic analyses more accessible to domain experts. We find that a variety of methods exist to more easily measure and segment functional UE movement, with a subset of those methods being validated for specific applications. Future directions include developing more robust methods for measurement and segmentation, validating these methods in conjunction with proposed kinematic outcome measures, and studying how to integrate kinematic analyses into domain expert workflows in a way that improves outcomes.

Quick computer aided differential diagnostics based on repetitive finger tapping in Parkinson’s disease and atypical parkinsonisms

Background

Parkinson's disease (PD) is the second most common neurodegenerative disorder whose prevalence rises with age, yet clinical diagnosis is still a challenging task due to similar manifestations of other neurodegenerative movement disorders. In untreated patients or those with unclear responses to medication, correct percentages of early diagnoses go as low as 26%. Technology has been used in various forms to facilitate discerning between persons with PD and healthy individuals, but much less work has been dedicated to separating PD and atypical parkinsonisms.

Methods

A wearable system was developed based on inertial sensors that capture the movements of fingers during repetitive finger tapping. A k-nearest-neighbor classifier was used on features extracted from gyroscope recordings for quick aid in differential diagnostics, discerning patients with PD, progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and healthy controls (HC).

Results

The overall classification accuracy achieved was 85.18% in the multiclass setup. MSA and HC groups were the easiest to discern (100%), while PSP was the most elusive diagnosis, as some patients were incorrectly assigned to MSA and HC groups.

Conclusions

The system shows potential for use as a tool for quick diagnostic aid, and in the era of big data, offers a means of standardization of data collection that could allow scientists to aggregate multi-center data for further research.

Has machine learning over-promised in healthcare? A critical analysis and a proposal for improved evaluation, with evidence from Parkinson’s disease

Adoption of artificial intelligence (AI) by the medical community has long been anticipated, endorsed by a stream of machine learning literature showcasing AI systems that yield extraordinary performance. However, many of these systems are likely over-promising and will under-deliver in practice. One key reason is the community's failure to acknowledge and address the presence of inflationary effects in the data. These simultaneously inflate evaluation performance and prevent a model from learning the underlying task, thus severely misrepresenting how that model would perform in the real world. This paper investigated the impact of these inflationary effects on healthcare tasks, as well as how these effects can be addressed. Specifically, we defined three inflationary effects that occur in medical data sets and allow models to easily reach small training losses and prevent skillful learning. We investigated two data sets of sustained vowel phonation from participants with and without Parkinson's disease, and revealed that published models which have achieved high classification performances on these were artificially enhanced due to the inflationary effects. Our experiments showed that removing each inflationary effect corresponded with a decrease in classification accuracy, and that removing all inflationary effects reduced the evaluated performance by up to 30%. Additionally, the performance on a more realistic test set increased, suggesting that the removal of these inflationary effects enabled the model to better learn the underlying task and generalize. Source code is available at https://github.com/Wenbo-G/pd-phonation-analysis under the MIT license.

Computerized analysis of speech and voice for Parkinson's disease: A systematic review

BACKGROUND AND OBJECTIVE

Speech impairment is an early symptom of Parkinson's disease (PD). This study has summarized the literature related to speech and voice in detecting PD and assessing its severity.

METHODS

A systematic review of the literature from 2010 to 2021 to investigate analysis methods and signal features. The keywords "Automatic analysis" in conjunction with "PD speech" or "PD voice" were used, and the PubMed and ScienceDirect databases were searched. A total of 838 papers were found on the first run, of which 189 were selected. One hundred and forty-seven were found to be suitable for the review. The different datasets, recording protocols, signal analysis methods and features that were reported are listed. Values of the features that separate PD patients from healthy controls were tabulated. Finally, the barriers that limit the wide use of computerized speech analysis are discussed.

RESULTS

Speech and voice may be valuable markers for PD. However, large differences between the datasets make it difficult to compare different studies. In addition, speech analytic methods that are not informed by physiological understanding may alienate clinicians.

CONCLUSIONS

The potential usefulness of speech and voice for the detection and assessment of PD is confirmed by evidence from the classification and correlation results.

An Efficient Rotation Forest-Based Ensemble Approach for Predicting Severity of Parkinson’s Disease

Parkinson's disease (PD) is a neurodegenerative nervous system disorder that mainly affects body movement, and it is one of the most common diseases, particularly in elderly individuals. This paper proposes a new machine learning approach to predict Parkinson's disease severity using UCI's Parkinson's telemonitoring voice dataset. The proposed method analyses the patient's voice data and classifies them into “severe” and “nonsevere” classes. At first, a subset of features was selected, then a novel approach with a combination of Rotation Forest and Random Forest was applied on selected features to determine each patient's disease severity. Analysis of the experimental results shows that the proposed approach can detect the severity of PD patients in the early stages. Moreover, the proposed model is compared with several algorithms, and the results indicate that the model is highly successful in classifying records and outperformed the other methods concerning classification accuracy and F1-measure rate.

A survey of visual and procedural handwriting analysis for neuropsychological assessment

To date, Artificial Intelligence systems for handwriting and drawing analysis have primarily targeted domains such as writer identification and sketch recognition. Conversely, the automatic characterization of graphomotor patterns as biomarkers of brain health is a relatively less explored research area. Despite its importance, the work done in this direction is limited and sporadic. This paper aims to provide a survey of related work to provide guidance to novice researchers and highlight relevant study contributions. The literature has been grouped into “visual analysis techniques” and “procedural analysis techniques”. Visual analysis techniques evaluate offline samples of a graphomotor response after completion. On the other hand, procedural analysis techniques focus on the dynamic processes involved in producing a graphomotor reaction. Since the primary goal of both families of strategies is to represent domain knowledge effectively, the paper also outlines the commonly employed handwriting representation and estimation methods presented in the literature and discusses their strengths and weaknesses. It also highlights the limitations of existing processes and the challenges commonly faced when designing such systems. High-level directions for further research conclude the paper.

Echinocystic Acid Inhibits Inflammation and Exerts Neuroprotective Effects in MPTP-Induced Parkinson’s Disease Model Mice

Parkinson’s disease (PD), the second primary neurodegenerative disease affecting human health, is mainly characterized by dopaminergic neuron damage in the midbrain and the clinical manifestation of movement disorders. Studies have shown that neuroinflammation plays an important role in the progression of PD. Excessively activated microglia produce several pro-inflammatory mediators, leading to damage to the surrounding neurons and finally inducing neurodegeneration. Echinocystic acid (EA) exhibits an anti-inflammatory effect in peripheral tissues. However, whether it inhibited neuroinflammation remains unclear. Therefore, the current study investigates the effect of EA on neuroinflammation and whether it can improve PD symptoms through inhibiting neuroinflammation. In our experiments, we discovered that EA inhibited the production of pro-inflammatory mediators in LPS-exposed BV2 cells. Further mechanism-related studies revealed that EA inhibited inflammation by activating PI3K/Akt and inhibiting NF-κB and MAPK signal pathways in LPS-induced BV2 cells. Research revealed that EA eases microglia-mediated neuron death in SN4741 and SHSY5Y cells. In in vivo studies, the results demonstrated that EA improves weight loss and behavioral impairment in MPTP-induced mice. Further studies have revealed that EA inhibited dopaminergic neuron damage and inflammation in the mice midbrain. In conclusion, our study demonstrated that EA inhibits neuroinflammation and exerts neuroprotective effects by activating PI3K/Akt and inhibiting NF-κB and MAPK signal pathways in vivo and in vitro.

A robust framework for shoulder implant X-ray image classification

Purpose

Medical images are increasingly popular; therefore, the analysis of these images based on deep learning helps diagnose diseases become more and more essential and necessary. Recently, the shoulder implant X-ray image classification (SIXIC) dataset that includes X-ray images of implanted shoulder prostheses produced by four manufacturers was released. The implant's model detection helps to select the correct equipment and procedures in the upcoming surgery.

Design/methodology/approach

This study proposes a robust model named X-Net to improve the predictability for shoulder implants X-ray image classification in the SIXIC dataset. The X-Net model utilizes the Squeeze and Excitation (SE) block integrated into Residual Network (ResNet) module. The SE module aims to weigh each feature map extracted from ResNet, which aids in improving the performance. The feature extraction process of X-Net model is performed by both modules: ResNet and SE modules. The final feature is obtained by incorporating the extracted features from the above steps, which brings more important characteristics of X-ray images in the input dataset. Next, X-Net uses this fine-grained feature to classify the input images into four classes (Cofield, Depuy, Zimmer and Tornier) in the SIXIC dataset.

Findings

Experiments are conducted to show the proposed approach's effectiveness compared with other state-of-the-art methods for SIXIC. The experimental results indicate that the approach outperforms the various experimental methods in terms of several performance metrics. In addition, the proposed approach provides the new state of the art results in all performance metrics, such as accuracy, precision, recall, F1-score and area under the curve (AUC), for the experimental dataset.

Originality/value

The proposed method with high predictive performance can be used to assist in the treatment of injured shoulder joints.

A convolutional-recurrent neural network approach to resting-state EEG classification in Parkinson's disease

BACKGROUND

Parkinson's disease (PD) is expected to become more common, particularly with an aging population. Diagnosis and monitoring of the disease typically rely on the laborious examination of physical symptoms by medical experts, which is necessarily limited and may not detect the prodromal stages of the disease.

NEW METHOD

We propose a lightweight (~20 K parameters) deep learning model to classify resting-state EEG recorded from people with PD and healthy controls (HC). The proposed CRNN model consists of convolutional neural networks (CNN) and a recurrent neural network (RNN) with gated recurrent units (GRUs). The 1D CNN layers are designed to extract spatiotemporal features across EEG channels, which are subsequently supplied to the GRUs to discover temporal features pertinent to the classification.

RESULTS

The CRNN model achieved 99.2% accuracy, 98.9% precision, and 99.4% recall in classifying PD from HC. Interrogating the model, we further demonstrate that the model is sensitive to dopaminergic medication effects and predominantly uses phase information in the EEG signals.

COMPARISON WITH EXISTING METHODS

The CRNN model achieves superior performance compared to baseline machine learning methods and other recently proposed deep learning model.

CONCLUSION

The approach proposed in this study adequately extracts spatial and temporal features in multi-channel EEG signals that enable accurate differentiation between PD and HC. The CRNN model has excellent potential for use as an oscillatory biomarker for assisting in the diagnosis and monitoring of people with PD. Future studies to further improve and validate the model's performance in clinical practice are warranted.

Multimodal Classification of Parkinson's Disease in Home Environments with Resiliency to Missing Modalities

Parkinson’s disease (PD) is a chronic neurodegenerative condition that affects a patient’s everyday life. Authors have proposed that a machine learning and sensor-based approach that continuously monitors patients in naturalistic settings can provide constant evaluation of PD and objectively analyse its progression. In this paper, we make progress toward such PD evaluation by presenting a multimodal deep learning approach for discriminating between people with PD and without PD. Specifically, our proposed architecture, named MCPD-Net, uses two data modalities, acquired from vision and accelerometer sensors in a home environment to train variational autoencoder (VAE) models. These are modality-specific VAEs that predict effective representations of human movements to be fused and given to a classification module. During our end-to-end training, we minimise the difference between the latent spaces corresponding to the two data modalities. This makes our method capable of dealing with missing modalities during inference. We show that our proposed multimodal method outperforms unimodal and other multimodal approaches by an average increase in F1-score of 0.25 and 0.09, respectively, on a data set with real patients. We also show that our method still outperforms other approaches by an average increase in F1-score of 0.17 when a modality is missing during inference, demonstrating the benefit of training on multiple modalities.

Machine Learning for the Diagnosis of Parkinson's Disease: A Review of Literature

Diagnosis of Parkinson's disease (PD) is commonly based on medical observations and assessment of clinical signs, including the characterization of a variety of motor symptoms. However, traditional diagnostic approaches may suffer from subjectivity as they rely on the evaluation of movements that are sometimes subtle to human eyes and therefore difficult to classify, leading to possible misclassification. In the meantime, early non-motor symptoms of PD may be mild and can be caused by many other conditions. Therefore, these symptoms are often overlooked, making diagnosis of PD at an early stage challenging. To address these difficulties and to refine the diagnosis and assessment procedures of PD, machine learning methods have been implemented for the classification of PD and healthy controls or patients with similar clinical presentations (e.g., movement disorders or other Parkinsonian syndromes). To provide a comprehensive overview of data modalities and machine learning methods that have been used in the diagnosis and differential diagnosis of PD, in this study, we conducted a literature review of studies published until February 14, 2020, using the PubMed and IEEE Xplore databases. A total of 209 studies were included, extracted for relevant information and presented in this review, with an investigation of their aims, sources of data, types of data, machine learning methods and associated outcomes. These studies demonstrate a high potential for adaptation of machine learning methods and novel biomarkers in clinical decision making, leading to increasingly systematic, informed diagnosis of PD.

Data-driven gait analysis for diagnosis and severity rating of Parkinson's disease

Parkinsons disease (PD) is the second most neurodegenerative disease, which results in gradual loss of movements. To diagnose PD in a clinical setting, clinicians generally use clinical manifestations like motor and non-motor symptoms and rate the severity based on unified Parkinsons disease rating scale (UPDRS). Such clinical assessment largely depends on the expertise and experience of the clinicians and it is subjective leading to variation in assessment between clinicians. As the gait of people with Parkinson's generally differs from gait of healthy age-matched adults, the assessment of gait abnormalities can lead to not only the diagnosis of PD but also the rating of severity level based on motor symptoms. Hence, in this paper, a data-driven gait classification framework using the supervised machine learning algorithms is presented. Using the publicly available gait datasets acquired using vertical ground reaction force (VGRF) sensors, we present a correlation based feature extraction technique for improved stage classification of PD. Significant biomarkers from spatiotemporal gait features are obtained based on the correlation, and the normal distribution of the gait dataset is assessed using the Shapiro-Wilk test. Subsequently, four supervised machine learning algorithms, namely, K-nearest neighbours (KNN), Naive Bayes (NB), Ensemble classifier (EC) and Support vector machine (SVM) are used to rate the severity level of PD according to the Hoehn and Yahr (H&Y) scale. The performance of the classifiers, assessed using the confusion matrix and parallel coordinate plots, highlights that SVM can result in a classification accuracy of 98.4%. Moreover, with minimal gait feature set acquired based on the rank correlation, the proposed approach outperforms several other state-of-the-art methods that have used the same dataset for PD stage classification.

Human Posture Detection Method Based on Wearable Devices

The dynamic detection of human motion is important, which is widely applied in the fields of motion state capture and rehabilitation engineering. In this study, based on multimodal information of surface electromyography (sEMG) signals of upper limb and triaxial acceleration and plantar pressure signals of lower limb, the effective virtual driving control and gait recognition methods were proposed. The effective way of wearable human posture detection was also constructed. Firstly, the moving average window and threshold comparison were used to segment the sEMG signals of the upper limb. The standard deviation and singular values of wavelet coefficients were extracted as the features. After the training and classification by optimized support vector machine (SVM) algorithm, the real-time detection and analysis of three virtual driving actions were performed. The average identification accuracy was 90.90%. Secondly, the mean, standard deviation, variance, and wavelet energy spectrum of triaxial acceleration were extracted, and these parameters were combined with plantar pressure as the gait features. The optimized SVM was selected for the gait identification, and the average accuracy was 90.48%. The experimental results showed that, through different combinations of wearable sensors on the upper and lower limbs, the motion posture information could be dynamically detected, which could be used in the design of virtual rehabilitation system and walking auxiliary system.

Deep convolutional neural network for the automated detection of Subthalamic nucleus using MER signals

BACKGROUND

Deep brain stimulation (DBS) surgery has been extensively conducted for treating advanced Parkinson's disease (PD) patient's symptoms. DBS hinges on the localization of the subthalamic nucleus (STN) in which a permanent electrode should be accurately placed to produce electrical current. Microelectrode recording (MER) signals are routinely recorded in the procedure of DBS surgery to validate the planned trajectories. However, manual MER signals interpretation with the goal of detecting STN borders requires expertise and prone to inter-observer variability. Therefore, a computerized aided system would be beneficial to automatic detection of the dorsal and ventral borders of the STN in MER.

NEW METHOD

In this study, a new deep learning model based on convolutional neural system for automatic delineation of the neurophysiological borders of the STN along the electrode trajectory was developed.

COMPARISON WITH EXISTING METHODS

The proposed model does not involve any conventional standardization, feature extraction or selection steps.

RESULTS

Promising results of 98.67% accuracy, 99.03% sensitivity, 98.11% specificity, 98.79% precision and 98.91% F1-score for subject based testing were achieved using the proposed convolutional neural network (CNN) model.

CONCLUSIONS

This is the first study on the analysis of MER signals to detect STN using deep CNN. Traditional machine learning (ML) algorithms are often cumbersome and suffer from subjective evaluation. Though, the developed 10-layered CNN model has the capability of extracting substantial features at the convolution stage. Hence, the proposed model has the potential to deliver high performance on STN region detection which shows perspective in aiding the neurosurgeon intraoperatively.

Computer-assisted Parkinson's disease diagnosis using fuzzy optimum- path forest and Restricted Boltzmann Machines

Parkinson's disease (PD) is a progressive neurodegenerative illness associated with motor skill disorders, affecting thousands of people, mainly elderly, worldwide. Since its symptoms are not clear and commonly confused with other diseases, providing early diagnosis is a challenging task for traditional methods. In this context, computer-aided assistance is an alternative method for a fast and automatic diagnosis, accelerating the treatment and alleviating an excessive effort from professionals. Moreover, the most recent studies proposing a solution to this problem lack in computational efficiency, prediction power, reliability among other factors. Therefore, this work proposes a Fuzzy Optimum Path Forest for automated PD identification, which is based on fuzzy logic and graph-based framework theory. Experiments consider a dataset composed of features extracted from hand-drawn images using Restricted Boltzmann Machines, and results are compared with baseline models such as Support Vector Machines, KNN, and the standard OPF classifier. Results show that the proposed model outperforms the baselines in most cases, suggesting the Fuzzy OPF as a viable alternative to deal with PD detection problems.

Classification of PPMI MRI scans with voxel-based morphometry and machine learning to assist in the diagnosis of Parkinson's disease

BACKGROUND AND OBJECTIVES

Qualitative and quantitative analyses of Magnetic Resonance Imaging (MRI) scans are carried out to study and understand Parkinson's Disease, the second most common neurodegenerative disorder in people at their 60's. Some quantitative analyses are based on the application of voxel-based morphometry (VBM) on magnetic resonance images to determine the regions of interest, within gray matter, where there is a loss of the nerve cells that generate dopamine. This loss of dopamine is indicative of Parkinson's disease. The purpose of this research is the introduction of a new method to classify the 3-D magnetic resonance scans of an individual, as an assisting tool for diagnosis of Parkinson's disease by using the largest MRI dataset (Parkinson's Progression Markers Initiative) from a population of patients with Parkinson's disease and control individuals. A contribution is that separate studies are conducted for men and women since gender plays a significant role within Neurobiology, which is demonstrated by the fact that men are more prone to Parkinson's disease than women are.

METHODS

Previous to classification, VBM is conducted on magnetic resonance images to detect the regions where features are extracted by using first- and second-order statistics methods. Furthermore, the number of features is considerably reduced by using feature selection techniques. Seven classifiers are used and we are conducting separate experiments for men and women.

RESULTS

The best detection performance achieved in men is 99.01% of accuracy, 99.35% of sensitivity, 100% of specificity, and 100% of precision. The best detection performance achieved in women is 96.97% of accuracy, 100% of sensitivity, 96.15% of specificity, and 97.22% of precision. During classification of magnetic resonance images, the corresponding computational complexity is reduced since few features are selected.

CONCLUSIONS

The proposed method provides high performance as an assisting tool in the diagnosis of Parkinson's disease, by conducting separate experiments in men and women. While previous works have focused their analysis to the striatum region of the brain (the largest nuclear complex of the basal ganglia), the proposed approach is based on analysis over the whole brain by looking for decreases of tissue thickness, with the consequence of finding other regions of interest such as the cortex.

Cartesian genetic programming for diagnosis of Parkinson disease through handwriting analysis: Performance vs. interpretability issues

In the last decades, early disease identification through non-invasive and automatic methodologies has gathered increasing interest from the scientific community. Among others, Parkinson's disease (PD) has received special attention in that it is a severe and progressive neuro-degenerative disease. As a consequence, early diagnosis would provide more effective and prompt care strategies, that cloud successfully influence patients' life expectancy. However, the most performing systems implement the so called black-box approach, which do not provide explicit rules to reach a decision. This lack of interpretability, has hampered the acceptance of those systems by clinicians and their deployment on the field. In this context, we perform a thorough comparison of different machine learning (ML) techniques, whose classification results are characterized by different levels of interpretability. Such techniques were applied for automatically identify PD patients through the analysis of handwriting and drawing samples. Results analysis shows that white-box approaches, such as Cartesian Genetic Programming and Decision Tree, allow to reach a twofold goal: support the diagnosis of PD and obtain explicit classification models, on which only a subset of features (related to specific tasks) were identified and exploited for classification. Obtained classification models provide important insights for the design of non-invasive, inexpensive and easy to administer diagnostic protocols. Comparison of different ML approaches (in terms of both accuracy and interpretability) has been performed on the features extracted from the handwriting and drawing samples included in the publicly available PaHaW and NewHandPD datasets. The experimental findings show that the Cartesian Genetic Programming outperforms the white-box methods in accuracy and the black-box ones in interpretability.

Intelligent Sensory Pen for Aiding in the Diagnosis of Parkinson's Disease from Dynamic Handwriting Analysis

In this paper, we propose a pen device capable of detecting specific features from dynamic handwriting tests for aiding on automatic Parkinson’s disease identification. The method used in this work uses machine learning to compare the raw signals from different sensors in the device coupled to a pen and extract relevant information such as tremors and hand acceleration to diagnose the patient clinically. Additionally, the datasets composed of raw signals from healthy and Parkinson’s disease patients acquired here are made available to further contribute to research related to this topic.

A novel ensemble of random forest for assisting diagnosis of Parkinson's disease on small handwritten dynamics dataset

BACKGROUND

Parkinson's disease (PD) is a neurodegenerative disease of the elderly, which leads to patients' motor and non-motor disabilities and affects patients' quality of daily life. Timely and effective detection of PD is a key step to medical intervention. Recently, computer aided methods for PD detection have gained lots of attention in artificial intelligence domain.

METHODS

This paper proposed a novel ensemble learning model fusing Random Forest (RF) classifiers and Principal Component Analysis (PCA) technique to differentiate PD patients from healthy controls (HC). Six different RF models were separately constructed to generate the corresponding class probability vectors which represent an individual's category predictions on 6 different handwritten exams, and the final prediction result for an individual was obtained through voting strategy of all RF models. Stratified k-fold cross validation was performed to split the exam datasets and evaluate the classification performances.

RESULTS

Experimental results prove that our proposed ensemble model on six handwritten exams has achieved better classification performances than a single RF based method on a single handwritten exam. Our ensemble of RF model based on multiple handwritten exams has promising accuracy (89.4 %), specificity (93.7 %), sensitivity (84.5 %) and F1-score (87.7 %). Compared with Logistic Regression (LR) and Support Vector Machines (SVM), the ensemble model based on RF can achieve better classification results.

CONCLUSION

A computer-assisted PD diagnosis model on small handwritten dynamics dataset is proposed, and it provides a potential way for assisting diagnosis of PD in clinical setting.

How People with Parkinson's Disease and Health Care Professionals Wish to Partner in Care Using eHealth: Co-Design Study

Background

Worldwide, the number of people with Parkinson’s disease (PD) is predicted to double between the years 2005 and 2030. Chronic care management requires active collaboration and knowledge exchange between patients and health care professionals (HCPs) for best possible health outcomes, which we describe as co-care. eHealth services have the potential to support the realization of co-care between people with PD (PwP) and HCPs.

Objective

This study aimed to explore how co-care could be operationalized in PD care, supported by eHealth. More specifically, this study explores PwP's and HCPs' expectations and desired eHealth functionalities to achieve co-care.

Methods

Principles of participatory design were used to enable the identification of co-care needs and design ideas, in a series of 4 half-day co-design workshops. The sample included 7 (4 women) PwP and 9 (4 women) HCPs, including 4 neurologists, 3 nurses, and 2 physiotherapists. The co-design process resulted in a functional prototype that was evaluated by the co-design participants in the last workshop. Data were collected through note cards produced by the participants during the first 3 workshops and focus group discussions during the 3rd and 4th workshops. The data were analyzed using qualitative thematic analysis. After the workshop series, the prototype was demonstrated at a Mini Fair for ongoing PD research and evaluated using a self-developed questionnaire with 37 respondents: 31 PwP (14 women) and 6 informal caregivers (3 women). Descriptive statistics are reported.

Results

The qualitative analysis of data resulted in 2 main themes. The first theme, core eHealth functionalities and their expected values, describes 6 desired eHealth functionalities for supporting PD co-care between PwP and HCPs: (1) self-tracking, (2) previsit forms, (3) graphical visualization, (4) clinical decision support, (5) self-care recommendations, and (6) asynchronous communication. The second theme, individual and organizational constraints, describes constraints that need to be addressed to succeed with an eHealth service for co-care. Individual constraints include eHealth literacy and acceptance; organizational constraints include teamwork and administrative workload. The majority of the questionnaire respondents (31/37, 84%) perceived that they would benefit from an eHealth service similar to the demonstrated prototype. All prototype functionalities were rated as very important or important by the majority of respondents (ranging from 86% to 97% per functionality).

Conclusions

This study adds to our knowledge on how PD co-care could be operationalized. Co-care implies a shift from episodic routine-driven care to more flexible care management that is driven by the mutual needs of patients and HCPs and supported by active information exchange between them, as well as automated information processing to generate patient-specific advice. More research is needed to further explore the concept of co-care in chronic care management and what it means for self-care and health care.

International Registered Report Identifier (IRRID)

RR2-10.2196/11278

Effect of Parkinson's disease and two therapeutic interventions on muscle activity during walking: a systematic review

Gait deficits are a common feature of Parkinson’s disease (PD) and predictors of future motor and cognitive impairment. Understanding how muscle activity contributes to gait impairment and effects of therapeutic interventions on motor behaviour is crucial for identifying potential biomarkers and developing rehabilitation strategies. This article reviews sixteen studies that investigate the electromyographic (EMG) activity of lower limb muscles in people with PD during walking and reports on their quality. The weight of evidence establishing differences in motor activity between people with PD and healthy older adults (HOAs) is considered. Additionally, the effect of dopaminergic medication and deep brain stimulation (DBS) on modifying motor activity is assessed. Results indicated greater proximal and decreased distal activity of lower limb muscles during walking in individuals with PD compared to HOA. Dopaminergic medication was associated with increased distal lower limb muscle activity whereas subthalamic nucleus DBS increased activity of both proximal and distal lower limb muscles. Tibialis anterior was impacted most by the interventions. Quality of the studies was not strong, with a median score of 61%. Most studies investigated only distal muscles, involved small sample sizes, extracted limited EMG features and lacked rigorous signal processing. Few studies related changes in motor activity with functional gait measures. Understanding mechanisms underpinning gait impairment in PD is essential for development of personalised rehabilitative interventions. Recommendations for future studies include greater participant numbers, recording more functionally diverse muscles, applying multi-muscle analyses, and relating EMG to functional gait measures.

A Mobile Application for Smart Computer-Aided Self-Administered Testing of Cognition, Speech, and Motor Impairment

We present a model for digital neural impairment screening and self-assessment, which can evaluate cognitive and motor deficits for patients with symptoms of central nervous system (CNS) disorders, such as mild cognitive impairment (MCI), Parkinson's disease (PD), Huntington's disease (HD), or dementia. The data was collected with an Android mobile application that can track cognitive, hand tremor, energy expenditure, and speech features of subjects. We extracted 238 features as the model inputs using 16 tasks, 12 of them were based on a self-administered cognitive testing (SAGE) methodology and others used finger tapping and voice features acquired from the sensors of a smart mobile device (smartphone or tablet). Fifteen subjects were involved in the investigation: 7 patients with neurological disorders (1 with Parkinson's disease, 3 with Huntington's disease, 1 with early dementia, 1 with cerebral palsy, 1 post-stroke) and 8 healthy subjects. The finger tapping, SAGE, energy expenditure, and speech analysis features were used for neural impairment evaluations. The best results were achieved using a fusion of 13 classifiers for combined finger tapping and SAGE features (96.12% accuracy), and using bidirectional long short-term memory (BiLSTM) (94.29% accuracy) for speech analysis features.

Parkinson's disease and wearable devices, new perspectives for a public health issue: an integrative literature review

Parkinson's disease is the second most common neurodegenerative disease, with an estimated prevalence of 41/100,000 individuals affected aged between 40 and 49 years old and 1,900/100,000 aged 80 and over. Based on the essentiality of ascertaining which wearable devices have clinical literary evidence and with the purpose of analyzing the information revealed by such technologies, we conducted this scientific article of integrative review. It is an integrative review, whose main objective is to carry out a summary of the state of the art of wearable devices used in patients with Parkinson's disease. After the review, we retrieved 8 papers. Of the selected articles, only 3 were not systematic reviews; one was a series of cases and two prospective longitudinal studies. These technologies have a very rich field of application; however, research is still necessary to make such evaluations reliable and crucial to the well-being of these patients.

Systematic Review Looking at the Use of Technology to Measure Free-Living Symptom and Activity Outcomes in Parkinson's Disease in the Home or a Home-like Environment

BACKGROUND

The emergence of new technologies measuring outcomes in Parkinson's disease (PD) to complement the existing clinical rating scales has introduced the possibility of measurement occurring in patients' own homes whilst they freely live and carry out normal day-to-day activities.

OBJECTIVE

This systematic review seeks to provide an overview of what technology is being used to test which outcomes in PD from free-living participant activity in the setting of the home environment. Additionally, this review seeks to form an impression of the nature of validation and clinimetric testing carried out on the technological device(s) being used.

METHODS

Five databases (Medline, Embase, PsycInfo, Cochrane and Web of Science) were systematically searched for papers dating from 2000. Study eligibility criteria included: adults with a PD diagnosis; the use of technology; the setting of a home or home-like environment; outcomes measuring any motor and non-motor aspect relevant to PD, as well as activities of daily living; unrestricted/unscripted activities undertaken by participants.

RESULTS

65 studies were selected for data extraction. There were wide varieties of participant sample sizes (<10 up to hundreds) and study durations (<2 weeks up to a year). The metrics evaluated by technology, largely using inertial measurement units in wearable devices, included gait, tremor, physical activity, bradykinesia, dyskinesia and motor fluctuations, posture, falls, typing, sleep and activities of daily living.

CONCLUSIONS

Home-based free-living testing in PD is being conducted by multiple groups with diverse approaches, focussing mainly on motor symptoms and sleep.

A hybrid machine learning approach to cerebral stroke prediction based on imbalanced medical dataset

BACKGROUND AND OBJECTIVE

Cerebral stroke has become a significant global public health issue in recent years. The ideal solution to this concern is to prevent in advance by controlling related metabolic factors. However, it is difficult for medical staff to decide whether special precautions are needed for a potential patient only based on the monitoring of physiological indicators unless they are obviously abnormal. This paper will develop a hybrid machine learning approach to predict cerebral stroke for clinical diagnosis based on the physiological data with incompleteness and class imbalance.

METHODS

Two steps are involved in the whole process. Firstly, random forest regression is adopted to impute missing values before classification. Secondly, an automated hyperparameter optimization(AutoHPO) based on deep neural network(DNN) is applied to stroke prediction on an imbalanced dataset.

RESULTS

The medical dataset contains 43,400 records of potential patients which includes 783 occurrences of stroke. The false negative rate from our prediction approach is only 19.1%, which has reduced by an average of 51.5% in comparison to other traditional approaches. The false positive rate, accuracy and sensitivity predicted by the proposed approach are respectively 33.1, 71.6, and 67.4%.

CONCLUSION

The approach proposed in this paper has effectively reduced the false negative rate with a relatively high overall accuracy, which means a successful decrease in the misdiagnosis rate for stroke prediction. The results are more reliable and valid as the reference in stroke prognosis, and also can be acquired conveniently at a low cost.

A Smartphone Application for Automated Decision Support in Cognitive Task Based Evaluation of Central Nervous System Motor Disorders

BACKGROUND AND OBJECTIVE

New technology enables constant boost to the powers of mobile devices, which in the previous years have transformed from simple mobile phones to smart phones. Computational powers of these electronics enable actions that previously were possible only for computers. By the use of special applications, we may benefit from sensors and multimedia capabilities of operating systems. Therefore, a new era for devoted implementations opens, in which a smart application can take a role of computing system to estimate the symptoms of diseases by evaluating signals coming from a human body.

METHODS

We propose a model of an application implemented for mobile android systems, which can be used for examination of central nervous system motor disorders occurring in patients suffering from Huntington (HD), Alzheimer, or Parkinson diseases. In particular, the model tracks tremors (involuntary movements), and cognitive (memory loss or dementia) impairments using touch and visual stimulus modalities. The proposed model interprets the symptoms from human bodies that indicate one of the diseases of the nervous system. Pre-processing of collected data for feature extraction is executed on a mobile device by using core functionality and methods provided in android's application programming interface. The information is evaluated by a back-propagation neural network classifier and the result is presented to the end user. The system is able to contact medical supervision and provide an assistance from the clinic.

RESULTS

The system uses a collected dataset of 1928 records, taken from 11 HD patients and 11 healthy persons in Lithuania, to gather statistics about examinations and presents the results as medical evaluation with prediction on the state of health. The accuracy of recognition of early, prodromal symptoms for central nervous system motor disorders is 86.4% (F-measure 0.859). The app (available on Google Play) is easy to use and is efficient tool for decision support in medical examinations.

CONCLUSIONS

The use of intelligent apps which can help to evaluate neurodegenerative disorders is an important enhancement to medical diagnosis. The developed smartphone app supports the doctor with additional results that are easy to compare with other examinations. This kind of examination is a nice change from classic stereotypes, especially for younger age patients, who are used to various aspects of information technology.