1
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Frank B, Bandyopadhyay S, Dion C, Formanski E, Matusz E, Penney D, Davis R, O'Connor MK, Au R, Amini S, Rashidi P, Tighe P, Libon DJ, Price CC. A Network Analysis of Digital Clock Drawing for Command and Copy Conditions. Assessment 2024:10731911241236336. [PMID: 38494894 DOI: 10.1177/10731911241236336] [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] [Indexed: 03/19/2024]
Abstract
Graphomotor and time-based variables from the digital Clock Drawing Test (dCDT) characterize cognitive functions. However, no prior publications have quantified the strength of the associations between digital clock variables as they are produced. We hypothesized that analysis of the production of clock features and their interrelationships, as suggested, will differ between the command and copy test conditions. Older adults aged 65+ completed a digital clock drawing to command and copy conditions. Using a Bayesian hill-climbing algorithm and bootstrapping (10,000 samples), we derived directed acyclic graphs (DAGs) to examine network structure for command and copy dCDT variables. Although the command condition showed moderate associations between variables (μ | β z | = 0.34) relative to the copy condition (μ | β z | = 0.25), the copy condition network had more connections (18/18 versus 15/18 command). Network connectivity across command and copy was most influenced by five of the 18 variables. The direction of dependencies followed the order of instructions better in the command condition network. Digitally acquired clock variables relate to one another but differ in network structure when derived from command or copy conditions. Continued analyses of clock drawing production should improve understanding of quintessential normal features to aid in early neurodegenerative disease detection.
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Affiliation(s)
- Brandon Frank
- University of Florida, Gainesville, USA
- Boston University, MA, USA
| | | | | | | | | | - Dana Penney
- Lahey Clinic Medical Center, Burlington, MA, USA
| | - Randall Davis
- Massachusetts Institute of Technology, Cambridge, USA
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2
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Reinshagen A. Grid cells: the missing link in understanding Parkinson's disease? Front Neurosci 2024; 18:1276714. [PMID: 38389787 PMCID: PMC10881698 DOI: 10.3389/fnins.2024.1276714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
The mechanisms underlying Parkinson's disease (PD) are complex and not fully understood, and the box-and-arrow model among other current models present significant challenges. This paper explores the potential role of the allocentric brain and especially its grid cells in several PD motor symptoms, including bradykinesia, kinesia paradoxa, freezing of gait, the bottleneck phenomenon, and their dependency on cueing. It is argued that central hubs, like the locus coeruleus and the pedunculopontine nucleus, often narrowly interpreted in the context of PD, play an equally important role in governing the allocentric brain as the basal ganglia. Consequently, the motor and secondary motor (e.g., spatially related) symptoms of PD linked with dopamine depletion may be more closely tied to erroneous computation by grid cells than to the basal ganglia alone. Because grid cells and their associated central hubs introduce both spatial and temporal information to the brain influencing velocity perception they may cause bradykinesia or hyperkinesia as well. In summary, PD motor symptoms may primarily be an allocentric disturbance resulting from virtual faulty computation by grid cells revealed by dopamine depletion in PD.
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3
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Tasaki S, Kim N, Truty T, Zhang A, Buchman AS, Lamar M, Bennett DA. Explainable deep learning approach for extracting cognitive features from hand-drawn images of intersecting pentagons. NPJ Digit Med 2023; 6:157. [PMID: 37612472 PMCID: PMC10447434 DOI: 10.1038/s41746-023-00904-w] [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: 03/20/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
Hand drawing, which requires multiple neural systems for planning and controlling sequential movements, is a useful cognitive test for older adults. However, the conventional visual assessment of these drawings only captures limited attributes and overlooks subtle details that could help track cognitive states. Here, we utilized a deep-learning model, PentaMind, to examine cognition-related features from hand-drawn images of intersecting pentagons. PentaMind, trained on 13,777 images from 3111 participants in three aging cohorts, explained 23.3% of the variance in the global cognitive scores, 1.92 times more than the conventional rating. This accuracy improvement was due to capturing additional drawing features associated with motor impairments and cerebrovascular pathologies. By systematically modifying the input images, we discovered several important drawing attributes for cognition, including line waviness. Our results demonstrate that deep learning models can extract novel drawing metrics to improve the assessment and monitoring of cognitive decline and dementia in older adults.
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Affiliation(s)
- Shinya Tasaki
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Namhee Kim
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Tim Truty
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Ada Zhang
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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4
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Arakaki Y, Yoshimoto T, Ishiyama H, Tanaka T, Hattori Y, Ihara M. Preservation of Dopamine Transporters in a Patient With Micrographia Due to Cerebral Infarction: A Case Report. J Mov Disord 2023; 16:221-223. [PMID: 37258282 DOI: 10.14802/jmd.23033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/17/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Yoshito Arakaki
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Ishiyama
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yorito Hattori
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
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5
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Tasaki S, Kim N, Truty T, Zhang A, Buchman AS, Lamar M, Bennett DA. Interpretable deep learning approach for extracting cognitive features from hand-drawn images of intersecting pentagons in older adults. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.18.537358. [PMID: 37131841 PMCID: PMC10153174 DOI: 10.1101/2023.04.18.537358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Hand drawing involves multiple neural systems for planning and precise control of sequential movements, making it a valuable cognitive test for older adults. However, conventional visual assessment of drawings may not capture intricate nuances that could help track cognitive states. To address this issue, we utilized a deep-learning model, PentaMind, to examine cognition-related features from hand-drawn images of intersecting pentagons. PentaMind, trained on 13,777 images from 3,111 participants in three aging cohorts, explained 23.3% of the variance in global cognitive scores, a comprehensive hour-long cognitive battery. The model’s performance, which was 1.92 times more accurate than conventional visual assessment, significantly improved the detection of cognitive decline. The improvement in accuracy was due to capturing additional drawing features that we found to be associated with motor impairments and cerebrovascular pathologies. By systematically modifying the input images, we discovered several important drawing attributes for cognition, including line waviness. Our results demonstrate that hand-drawn images can provide rich cognitive information, enabling rapid assessment of cognitive decline and suggesting potential clinical implications in dementia.
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6
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The significance of micrographia as a clinical feature of Parkinson's disease and underlying pathophysiology. Neurol Sci 2023; 44:1791-1793. [PMID: 36593420 DOI: 10.1007/s10072-022-06590-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
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7
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Lo Monaco MR, Di Tella S, Anzuino I, Ciccarelli N, Silveri MC. Writing errors in primary progressive aphasia. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:802-809. [PMID: 32905710 DOI: 10.1080/23279095.2020.1811707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Peripheral errors in writing, that is errors produced download the spelling, have been occasionally described in primary progressive aphasia (PPA), but the possibility that these errors might be a marker of parkinsonism associated to some subtypes of PPA has not been explored. We investigated whether errors of peripheral nature characterize the writing disorder in PPA when associated with parkinsonian signs (PSs). Subgroups of PPA without PSs and with PSs were studied. The proportion of the central and peripheral errors in writing words and pseudowords was calculated in each group. In writing words, central errors significantly exceeded peripheral errors in subgroups without PSs. The higher the number of peripheral errors, the higher the probability of presenting PSs. No relation emerged between any error and the Unified Parkinson's Disease Rating Scale, but both types of errors correlated with measures of cognitive ability. Peripheral errors emerge when PSs are associated with PPA and may be linked to a decay of the cognitive control on movement, possibly involving the right hemisphere. Peripheral errors have clinical relevance in PPA, to the extent that they may assume the significance of a marker of specific subtypes and can help to outline the specific clinical picture of individual patients.
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Affiliation(s)
| | | | - Isabella Anzuino
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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8
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Eklund M, Nuuttila S, Joutsa J, Jaakkola E, Mäkinen E, Honkanen EA, Lindholm K, Vahlberg T, Noponen T, Ihalainen T, Murtomäki K, Nojonen T, Levo R, Mertsalmi T, Scheperjans F, Kaasinen V. Diagnostic value of micrographia in Parkinson's disease: a study with [ 123I]FP-CIT SPECT. J Neural Transm (Vienna) 2022; 129:895-904. [PMID: 35624405 PMCID: PMC9217822 DOI: 10.1007/s00702-022-02517-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022]
Abstract
Micrographia is a common symptom of Parkinson’s disease (PD), and it may precede other motor symptoms. Despite the high prevalence of micrographia in PD, its neurobiological mechanisms are not known. Given that levodopa may alleviate consistent micrographia and that nondopaminergic essential tremor (ET) is not associated with micrographia, micrographia could possibly be used as an ancillary diagnostic method that reflects nigrostriatal dopamine function. We evaluated the usefulness of micrographia as a simple one-sentence writing test in differentiating PD from ET. A total of 146 PD patients, 42 ET patients and 38 healthy controls provided writing samples and were scanned with brain [123I]FP-CIT dopamine transporter (DAT) SPECT imaging with ROI-based and voxelwise analyses. The diagnostic accuracy of micrographia was evaluated and compared to that of DAT binding. Compared to ET and healthy controls, PD patients showed micrographia (consistent, 25.6% smaller area of handwriting sample in PD compared to ET, p = 0.002, and 27.2% smaller area of handwriting compared to healthy controls, p = 0.004). PD patients showed 133% more severe progressive micrographia compared with ET patients (median b = − 0.14 in PD, b = − 0.06 in ET, p = 0.021). In early unmedicated cognitively normal patients, consistent micrographia showed 71.2% specificity and 87.5% sensitivity in PD versus ET differentiation, but micrographia had no correlation with striatal or extrastriatal [123I]FP-CIT binding in patients with PD. The one-sentence micrographia test shows moderately good accuracy in PD versus ET differentiation. The severity of micrographia has no relationship with DAT binding, suggesting nondopaminergic mechanism of micrographia in PD. ClinicalTrials.gov identifier: NCT02650843 (NMDAT study).
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Affiliation(s)
- Mikael Eklund
- Clinical Neurosciences, University of Turku, FI-20014, Turku, Finland. .,Neurocenter, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland. .,Turku PET Centre, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland.
| | - Simo Nuuttila
- Clinical Neurosciences, University of Turku, FI-20014, Turku, Finland.,Neurocenter, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland
| | - Juho Joutsa
- Clinical Neurosciences, University of Turku, FI-20014, Turku, Finland.,Neurocenter, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland.,Turku PET Centre, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland.,Turku Brain and Mind Center, University of Turku, FI-20014, Turku, Finland
| | - Elina Jaakkola
- Clinical Neurosciences, University of Turku, FI-20014, Turku, Finland.,Neurocenter, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland
| | - Elina Mäkinen
- Clinical Neurosciences, University of Turku, FI-20014, Turku, Finland.,Department of Neurology, Helsinki University Hospital HUS, Helsinki, Finland.,Department of Clinical Neurosciences, University of Helsinki HUS, PO Box 800, FI-00029, Helsinki, Finland
| | - Emma A Honkanen
- Clinical Neurosciences, University of Turku, FI-20014, Turku, Finland.,Neurocenter, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland.,Turku PET Centre, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland
| | - Kari Lindholm
- Clinical Neurosciences, University of Turku, FI-20014, Turku, Finland.,Neurocenter, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland
| | - Tero Vahlberg
- Clinical Medicine, Biostatistics, University of Turku and Turku University Hospital, PO Box 52, FI-20521, Turku, Finland
| | - Tommi Noponen
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland.,Department of Medical Physics, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland
| | - Toni Ihalainen
- HUS Medical Imaging Center, Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital HUS, PO Box 800, FI-00029, Helsinki, Finland
| | - Kirsi Murtomäki
- Department of Neurology, Helsinki University Hospital HUS, Helsinki, Finland.,Department of Clinical Neurosciences, University of Helsinki HUS, PO Box 800, FI-00029, Helsinki, Finland
| | - Tanja Nojonen
- Department of Neurology, Helsinki University Hospital HUS, Helsinki, Finland.,Department of Clinical Neurosciences, University of Helsinki HUS, PO Box 800, FI-00029, Helsinki, Finland
| | - Reeta Levo
- Department of Neurology, Helsinki University Hospital HUS, Helsinki, Finland.,Department of Clinical Neurosciences, University of Helsinki HUS, PO Box 800, FI-00029, Helsinki, Finland
| | - Tuomas Mertsalmi
- Department of Neurology, Helsinki University Hospital HUS, Helsinki, Finland.,Department of Clinical Neurosciences, University of Helsinki HUS, PO Box 800, FI-00029, Helsinki, Finland
| | - Filip Scheperjans
- Department of Neurology, Helsinki University Hospital HUS, Helsinki, Finland.,Department of Clinical Neurosciences, University of Helsinki HUS, PO Box 800, FI-00029, Helsinki, Finland
| | - Valtteri Kaasinen
- Clinical Neurosciences, University of Turku, FI-20014, Turku, Finland.,Neurocenter, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland.,Turku Brain and Mind Center, University of Turku, FI-20014, Turku, Finland
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9
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Tsai MC, Sung YF. Handwriting impairment in a case of adult-onset leukoencephalopathy with axonal spheroids and pigmented glia caused by a novel mutation in the CSF1R gene. Neurol Sci 2022; 43:2109-2110. [DOI: 10.1007/s10072-021-05819-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
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10
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Kaur M, Saini K. Forensic examination of effects of Parkinsonism on various handwriting characteristics. Sci Justice 2022; 62:10-20. [PMID: 35033322 DOI: 10.1016/j.scijus.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 10/07/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
Parkinsonism is a neurodegenerative syndrome that causes impairment of motor skills in affected persons. Thus, adverse effects may be produced in the handwriting of persons suffering from Parkinsonism. Medication used for the treatment of Parkinsonism is known to subside certain motor defects for specific time intervals, showing slight differences or improvement in certain handwriting characteristics during those intervals on the same day as compared to the ones executed before medication. Certain handwriting characteristics affected due to Parkinsonism may be mistaken as forged features due to poor line quality, which can cause suspicion upon the authenticity of important legal documents. The present research work has been carried out to determine the effects of Parkinsonism and medication used for its treatment on handwriting. Handwriting/signature samples executed before and after the onset of Parkinsonism (both pre- and post-medication) have been randomly collected from 70 participants. These handwritings have been evaluated separately and compared inter-se for various handwriting characteristics with qualitative and statistical approach. The results have demonstrated significant changes in most of the characteristics in both affected writings of majority of participants as compared to their corresponding earlier writings. Thus, forensic document experts should be aware of the detrimental effects of Parkinsonism on handwriting in pre- and post-medication conditions of this ailment.
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Affiliation(s)
- Manpreet Kaur
- Department of Forensic Science, Punjabi University, Patiala, Punjab, India
| | - Komal Saini
- Department of Forensic Science, Punjabi University, Patiala, Punjab, India.
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11
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Cilia ND, D'Alessandro T, De Stefano C, Fontanella F, Molinara M. From online handwriting to synthetic images for Alzheimer's disease detection using a deep transfer learning approach. IEEE J Biomed Health Inform 2021; 25:4243-4254. [PMID: 34347614 DOI: 10.1109/jbhi.2021.3101982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Early diagnosis of neurodegenerative disorders, such as Alzheimer's Disease (AD), is very important to reduce their effects and to improve both quality and life expectancy of patients. In this context, it is generally agreed that handwriting is one of the first skills altered by the onset of such diseases. For this reason, the analysis of handwriting and the study of its alterations have become of great interest in order to formulate the diagnosis as soon as possible. A fundamental aspect for the use of these techniques is the definition of effective features, which allows the system to distinguish the natural alterations of handwriting due to age, from those caused by neurodegenerative disorders. Starting from these considerations, the aim of our study is to verify whether the combined use of both shape and dynamic features allows a decision support system to improve performance for AD diagnosis. To this purpose, starting from a database of on-line handwriting samples, we generated for each of them an off-line synthetic color image, where the color of each elementary trait encodes, in the three RGB channels, the dynamic information associated with that trait. In order to verify the importance and the specific role played by shape information, we also generated an off-line synthetic binary image for each handwriting sample, where background pixels have white color, while those corresponding to the traits have black color. Finally, we exploited the ability of Convolutional Neural Network (CNN) to automatically extract features on both color and binary images. We carried out a large set of experiments for comparing the results obtained by using on-line features with those obtained by using the off-line features provided by CNN on both color and binary images.
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12
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Hanyu R, Hatakeyama M, Namekawa M, Otsu Y, Sukegawa M, Hashida H, Kawachi I, Kanazawa M, Onodera O. Progressive micrographia without parkinsonism caused by autoimmune brainstem encephalitis: A case report. Clin Neurol Neurosurg 2021; 202:106496. [PMID: 33476883 DOI: 10.1016/j.clineuro.2021.106496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/30/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Ryutaro Hanyu
- Department of Neurology, Brain Research Institute, Niigata University, Japan
| | - Masahiro Hatakeyama
- Department of Neurology, Brain Research Institute, Niigata University, Japan.
| | - Masaki Namekawa
- Department of Neurology, Brain Research Institute, Niigata University, Japan
| | - Yutaka Otsu
- Department of Neurology, Brain Research Institute, Niigata University, Japan
| | - Mayura Sukegawa
- Department of Neurology, Brain Research Institute, Niigata University, Japan
| | - Hiromi Hashida
- Rehabilitation Center, Niigata University Medical & Dental Hospital, Japan
| | - Izumi Kawachi
- Department of Neurology, Brain Research Institute, Niigata University, Japan
| | - Masato Kanazawa
- Department of Neurology, Brain Research Institute, Niigata University, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Japan
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13
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Dion C, Frank BE, Crowley SJ, Hizel LP, Rodriguez K, Tanner JJ, Libon DJ, Price CC. Parkinson's Disease Cognitive Phenotypes Show Unique Clock Drawing Features when Measured with Digital Technology. JOURNAL OF PARKINSON'S DISEASE 2021; 11:779-791. [PMID: 33682726 PMCID: PMC8108094 DOI: 10.3233/jpd-202399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A companion paper (Crowley et al., 2020) reports on the neuroimaging and neuropsychological profiles of statistically determined idiopathic non-dementia Parkinson's disease (PD). OBJECTIVE The current investigation sought to further examine subtle behavioral clock drawing differences within the same PD cohort by comparing 1) PD to non-PD peers on digitally acquired clock drawing latency and graphomotor metrics, and 2) PD memory, executive, and cognitively well phenotypes on the same variables. METHODS 230 matched participants (115 PD, 115 non-PD) completed neuropsychological tests and dCDT. Statistically-derived PD cognitive phenotypes characterized PD participants as PD low executive (PDExe; n = 25), PD low memory (PDMem; n = 34), PD cognitively well (PDWell; n = 56). Using a Bayesian framework and based on apriori hypotheses, we compared groups on: total completion time (TCT), pre-first hand latency (PFHL), post-clock face latency (PCFL), total clock face area (TCFA), and total number of pen strokes. RESULTS Fewer strokes and slower performance to command were associated with higher odds of PD diagnosis, while a larger clock face in the copy condition was associated with lower odds of PD diagnosis. Within PD cognitive phenotypes, slower performance (TCT, PCFL) and smaller clock face to command were associated with higher odds of being PDExe than PDWell, whereas larger clock faces associated with higher odds of being PDMem than PDWell. Longer disease duration, more pen strokes (command) and smaller clocks (command) associated with higher odds of being PDExe than PDWell. CONCLUSION Digitally-acquired clock drawing profiles differ between PD and non-PD peers, and distinguish PD cognitive phenotypes.
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Affiliation(s)
- Catherine Dion
- Department of Clinical and Health Psychology, Gainesville, FL, USA
| | - Brandon E Frank
- Department of Clinical and Health Psychology, Gainesville, FL, USA
| | - Samuel J Crowley
- Department of Clinical and Health Psychology, Gainesville, FL, USA
| | - Loren P Hizel
- Department of Clinical and Health Psychology, Gainesville, FL, USA
| | - Katie Rodriguez
- Department of Clinical and Health Psychology, Gainesville, FL, USA
| | - Jared J Tanner
- Department of Clinical and Health Psychology, Gainesville, FL, USA
| | - David J Libon
- Departments of Geriatrics and Gerontology and Psychology, School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
| | - Catherine C Price
- Department of Clinical and Health Psychology, Gainesville, FL, USA
- Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, FL, USA
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14
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Oliveira DLD, Freitas SMSFD, Alouche SR, Gimenez R, Gonzalez Alonso CC, Gutierrez RMS, Martins CE, Pires RS. Handwriting with different effectors in individuals with Parkinson's disease. Parkinsonism Relat Disord 2020; 78:91-93. [PMID: 32769033 DOI: 10.1016/j.parkreldis.2020.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/15/2020] [Accepted: 06/27/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Dalton Lustosa de Oliveira
- Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, 448 Cesário Galeno, São Paulo, SP, 03071-000, Brazil.
| | | | - Sandra Regina Alouche
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, 448 Cesário Galeno, São Paulo, SP, 03071-000, Brazil.
| | - Roberto Gimenez
- Master's and Doctoral Programs in Education, Universidade Cidade de São Paulo, 448 Cesário Galeno, São Paulo, SP, 03071-000, Brazil.
| | - Cintia Cabral Gonzalez Alonso
- Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, 448 Cesário Galeno, São Paulo, SP, 03071-000, Brazil.
| | - Rita Mara Soares Gutierrez
- Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, 448 Cesário Galeno, São Paulo, SP, 03071-000, Brazil.
| | - Carlos Eduardo Martins
- Master Program in Education, Universidade Cidade de São Paulo, 448 Cesário Galeno, São Paulo, SP, 03071-000, Brazil.
| | - Raquel Simoni Pires
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, 448 Cesário Galeno, São Paulo, SP, 03071-000, Brazil.
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15
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Kanno S, Shinohara M, Kanno K, Gomi Y, Uchiyama M, Nishio Y, Baba T, Hosokai Y, Takeda A, Fukuda H, Mori E, Suzuki K. Neural substrates underlying progressive micrographia in Parkinson's disease. Brain Behav 2020; 10:e01669. [PMID: 32558361 PMCID: PMC7428504 DOI: 10.1002/brb3.1669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/18/2020] [Accepted: 05/04/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The neural substrates associated with the development of micrographia remain unknown. We aimed to elucidate the neural substrates underlying micrographia in Parkinson's disease (PD) patients. METHODS Forty PD patients and 20 healthy controls underwent handwriting tests that involved free writing and copying. We measured the size of each letter and the resting cerebral glucose metabolic rate of the PD patients and another group of age- and sex-matched 14 healthy controls (HCs), who had not participated in the writing tests, using resting-state 18F-fluorodeoxyglucose positron emission tomography. RESULTS In the PD patients, the prevalence of consistent micrographia (CM) associated with free writing was 2.5% for both tasks. Alternatively, the prevalence of progressive micrographia (PM) was 15% for free writing and 17.5% for copying. In the PD patients, there was no significant difference in the letter sizes between these tasks, whereas the variability of the letter sizes for copying was significantly different from that for free writing. The means and decrements in letter sizes in either task were not significantly correlated with the severity of brady/hypokinesia in the PD patients. For free writing, the PD patients with PM showed glucose hypometabolism in the anterior part of the right middle cingulate cortex, including the rostral cingulate motor area, compared with those without PM. For copying, the PD patients with PM showed glucose hypometabolism in the right superior occipital gyrus, including V3A, compared with those without PM. CONCLUSIONS These findings suggest that PM in free writing in PD patients is caused by the difficulty of monitoring whether the actual handwriting movements are desirable for maintaining letter size during self-paced handwriting. By contrast, PM in copying in PD patients is evoked by a lack of visual information about the personal handwriting and hand motions that are used as cues for maintaining letter sizes.
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Affiliation(s)
- Shigenori Kanno
- Department of Behavioural Neurology and Cognitive NeuroscienceTohoku University Graduate School of MedicineSendaiJapan
| | - Mayumi Shinohara
- Department of Behavioural Neurology and Cognitive NeuroscienceTohoku University Graduate School of MedicineSendaiJapan
| | - Kasumi Kanno
- Department of Behavioural Neurology and Cognitive NeuroscienceTohoku University Graduate School of MedicineSendaiJapan
| | - Yukihiro Gomi
- Department of Behavioural Neurology and Cognitive NeuroscienceTohoku University Graduate School of MedicineSendaiJapan
- Department of Occupational TherapyInternational University of Health and WelfareNaritaJapan
| | - Makoto Uchiyama
- Department of Behavioural Neurology and Cognitive NeuroscienceTohoku University Graduate School of MedicineSendaiJapan
- Department of Speech, Language, and Hearing SciencesNiigata University of Health and WelfareNiigataJapan
| | - Yoshiyuki Nishio
- Department of Behavioural Neurology and Cognitive NeuroscienceTohoku University Graduate School of MedicineSendaiJapan
- Department of General PsychiatryTokyo Metropolitan Matsuzawa HospitalSetagayaJapan
| | - Toru Baba
- Department of Behavioural Neurology and Cognitive NeuroscienceTohoku University Graduate School of MedicineSendaiJapan
- Department of NeurologySendai Nishitaga HospitalSendaiJapan
| | - Yoshiyuki Hosokai
- Department of Behavioural Neurology and Cognitive NeuroscienceTohoku University Graduate School of MedicineSendaiJapan
- Department of Radiological ScienceInternational University of Health and WelfareOtawaraJapan
| | - Atsushi Takeda
- Department of NeurologySendai Nishitaga HospitalSendaiJapan
| | - Hiroshi Fukuda
- Department of Nuclear Medicine and RadiologyInstitute of Development, Aging and CancerTohoku UniversitySendaiJapan
- Division of RadiologyTohoku Medical and Pharmaceutical UniversitySendaiJapan
| | - Etsuro Mori
- Department of Behavioural Neurology and Cognitive NeuroscienceTohoku University Graduate School of MedicineSendaiJapan
- Department of Behavioural Neurology and Cognitive NeuropsychiatryOsaka University United Graduate School of Child DevelopmentSuitaJapan
| | - Kyoko Suzuki
- Department of Behavioural Neurology and Cognitive NeuroscienceTohoku University Graduate School of MedicineSendaiJapan
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16
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Dion C, Arias F, Amini S, Davis R, Penney D, Libon DJ, Price CC. Cognitive Correlates of Digital Clock Drawing Metrics in Older Adults with and without Mild Cognitive Impairment. J Alzheimers Dis 2020; 75:73-83. [PMID: 32250300 PMCID: PMC7217723 DOI: 10.3233/jad-191089] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND A digital version of the clock drawing test (dCDT) provides new latency and graphomotor behavioral measurements. These variables have yet to be validated with external neuropsychological domains in non-demented adults. OBJECTIVE The current investigation reports on cognitive constructs associated with selected dCDT latency and graphomotor variables and compares performances between individuals with mild cognitive impairment (MCI) and non-MCI peers. METHODS 202 non-demented older adults (age 68.79 ± 6.18, 46% female, education years 16.02 ± 2.70) completed the dCDT and a comprehensive neuropsychological protocol. dCDT variables of interest included: total completion time (TCT), pre-first hand latency (PFHL), post-clock face latency (PCFL), and clock face area (CFA). We also explored variables of percent time drawing (i.e., 'ink time') versus percent time not drawing (i.e., 'think time'). Neuropsychological domains of interest included processing speed, working memory, language, and declarative memory. RESULTS Adjusting for age and premorbid cognitive reserve metrics, command TCT positively correlated with multiple cognitive domains; PFHL and PCFL negatively associated with worse performance on working memory and processing speed tests. For Copy, TCT, PCFL, and PFHL negatively correlated with processing speed, and CFA negatively correlated with language. Between-group analyses show MCI participants generated slower command TCT, produced smaller CFA, and required more command 'think' (% Think) than 'ink' (% Ink) time. CONCLUSION Command dCDT variables of interest were primarily processing speed and working memory dependent. MCI participants showed dCDT differences relative to non-MCI peers, suggesting the dCDT may assist with classification. Results document cognitive construct validation to digital metrics of clock drawing.
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Affiliation(s)
- Catherine Dion
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Franchesca Arias
- Aging Brain Center at Hebrew Senior Life, Harvard University, Boston, MA, USA
| | - Shawna Amini
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Randall Davis
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Dana Penney
- Department of Neurology, Lahey Clinic Medical Center, Burlington, MA, USA
| | - David J. Libon
- Department of Geriatrics, Gerontology, and Psychology, Rowan University, Glassboro, NJ, USA
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
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17
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Persad AR, Mehta V. Permanent isolated micrographia from traumatic basal ganglia injury. Childs Nerv Syst 2019; 35:1415-1418. [PMID: 31127339 DOI: 10.1007/s00381-019-04196-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
Micrographia is a rare neurological finding in isolation. Most cases of isolated micrographia have been found in association with focal ischemia of the left basal ganglia. Here, we present a case of post-traumatic micrographia stemming from contusion to the left basal ganglia.
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Affiliation(s)
- A R Persad
- Division of Neurosurgery, Department of Surgery, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - V Mehta
- Division of Neurosurgery, Department of Surgery, Stollery Childrens' Hospital, University of Alberta, 8215 112 Street Northwest, Edmonton, AB, T6G 2B7, Canada.
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18
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Saini K, Kaur M. Forensic study on the effect of age and illness (Parkinsonism) on handwriting characteristics. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2019. [DOI: 10.1186/s41935-019-0131-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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19
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Abraham A, Wright GN, Morrison MW, Hart A, Dickstein R, Hackney ME. Psychometric properties of clock and pelvic drawings in Parkinson's disease: A validity and cross-sectional study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1781. [PMID: 31090203 DOI: 10.1002/pri.1781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) is characterized by visuospatial and body schema deficits. People with PD often exhibit hypometric movements and graphic hypometria (i.e., small drawing dimensions). The goal of the current study was to explore graphic-metric representation in people with PD by assessing pelvic and clock drawing dimensions (i.e., height and width) and by investigating associations between pelvic drawing dimensions and participant characteristics. METHODS Twenty people (16 males, 4 females; M age: 65.75 ± 10.13 years) with idiopathic PD (Hoehn &Yahr Stages I-III) volunteered to participate in this study. Draw Your Pelvis and Clock Drawing tests were used for assessing drawing dimensions, which were then correlated with PD severity, stage and duration, cognitive level, side of symptoms onset, and pelvic schema score. Bivariate and multiple linear regression analyses were also used. RESULTS Excellent (.844-.999) interrater reliability was shown for measuring pelvic and clock drawing dimensions. Pelvic drawing dimensions did not significantly (P > .05) differ in magnitude, whereas clock drawing height was significantly (p < .01) greater than width, both suggesting graphic dysmetria (i.e., distorted graphic dimensions). Pelvic drawing width was negatively associated with PD severity and stage, was positively associated with pelvic schema score, and predicted all three parameters. CONCLUSION Measuring pelvic drawing dimensions, and specifically pelvic drawing width, holds potential as an adjunct diagnostic measure in PD assessments and for detecting pelvic schema deficits or misperceptions. This test can be used by physical therapists in the clinic for assessing disease severity, stage, and pelvic schema in people with PD. The knowledge gained from this study contributes to a greater understanding of graphic-metric representation and associated deficits in people with PD. Future studies should explore the relationship between pelvic drawing dimensions and pelvic mentally imaged estimates, and their role in motor planning, control, and execution in people with PD.
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Affiliation(s)
- Amit Abraham
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Gene N Wright
- Science Illustration Program, Lamar Dodd School of Art, University of Georgia, Athens, GA, USA
| | - Margaret W Morrison
- Drawing and Painting Program, Lamar Dodd School of Art, University of Georgia, Athens, GA, USA
| | - Ariel Hart
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Ruth Dickstein
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Madeleine E Hackney
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA.,Center for Visual and Neurocognitive Rehabilitation, Atlanta Department of Veterans Affairs, Atlanta, GA, USA
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20
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Abraham A, Hart A, Dickstein R, Hackney ME. "Will you draw me a pelvis?ˮ Dynamic neuro-cognitive imagery improves pelvic schema and graphic-metric representation in people with Parkinson's Disease: A randomized controlled trial. Complement Ther Med 2019; 43:28-35. [PMID: 30935544 DOI: 10.1016/j.ctim.2018.11.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/29/2018] [Accepted: 11/21/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Body schema (i.e., the mental representations of the body), vital for motor and cognitive functions, is often distorted in people with Parkinson's disease (PD). Deficits in body, and especially pelvic, schema can further exacerbate motor and cognitive deficits associated with PD. Such deficits, including those in graphic and metric misjudgments, can manifest in drawing tasks. Mental imagery is a recommended approach for PD rehabilitation with potential for ameliorating body schema. OBJECTIVE To investigate the effect of a two-week dynamic neuro-cognitive imagery (DNI) training versus in-home learning and exercise control (learning/exercise) on pelvic schema and graphic representation (i.e., drawing height and width). DESIGN Twenty participants with idiopathic PD (Hoehn&Yahr I-III; M age: 65.75 ± 10.13) were randomly allocated into either a DNI or a learning/exercise group. Participants were asked to complete the "Draw Your Pelvisˮ test in which they drew their pelvis at pre- and post-intervention. Drawings were assessed for pelvic schema score and drawing dimensions (i.e., height and weight). INTERVENTION DNI anatomical and metaphorical imagery focusing on pelvic anatomy and biomechanics. RESULTS No difference (p > .05) was detected at baseline between drawn pelvis height and width. Following intervention, improvements were greater in the DNI group for pelvic schema (p < .01), drawn pelvic width (p < .05) and width-height difference (p < .05). CONCLUSIONS This study suggests that DNI could serve as a rehabilitation path for improving body schema in people with PD. Future studies should explore DNI mechanisms of effect and the effect of enhanced pelvic schema on motor and non-motor deficits in this population.
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Affiliation(s)
- Amit Abraham
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Kinesiology, University of Georgia, Athens, Georgia, USA.
| | - Ariel Hart
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ruth Dickstein
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Madeleine E Hackney
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA; Atlanta Department of Veterans Affairs Center for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia, USA
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21
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Vijiaratnam N, Lees AJ, Morris HR. Small spiral, big mass. J Neurol Neurosurg Psychiatry 2018; 89:1189-1190. [PMID: 30076268 DOI: 10.1136/jnnp-2018-319019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 11/04/2022]
Affiliation(s)
| | - Andrew John Lees
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Huw R Morris
- Department of Neurology, Royal Free Hospital, London, UK.,Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK.,Department of Clinical Neurosciences, Royal Free Campus Institute of Neurology, University College London, London, UK
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22
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Thomas M, Lenka A, Kumar Pal P. Handwriting Analysis in Parkinson's Disease: Current Status and Future Directions. Mov Disord Clin Pract 2017; 4:806-818. [PMID: 30363367 PMCID: PMC6174397 DOI: 10.1002/mdc3.12552] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The majority of patients with Parkinson's disease (PD) have handwriting abnormalities. Micrographia (abnormally small letter size) is the most commonly reported and easily detectable handwriting abnormality in patients with PD. However, micrographia is perhaps the tip of the iceberg representing the handwriting abnormalities in PD. Digitizing tablet technology, which has evolved over the last 2 decades, has made it possible to study the pressure and kinematic features of handwriting. This has resulted in a surge of studies investigating graphomotor impairment in patients with PD. METHODS The objectives of this study were to review the evolution of the kinematic analysis of handwriting in PD and to provide an overview of handwriting abnormalities observed in PD along with future directions for research in this field. Articles for review were searched from the PubMed and SCOPUS databases. RESULTS Digitizing tablet technologies have resulted in a shift of focus from the analysis of only letter size to the analysis of several kinematic features of handwriting. Studies based on the kinematic analysis of handwriting have revealed that patients with PD may have abnormalities in velocity, fluency, and acceleration in addition to micrographia. The recognition of abnormalities in several kinematic parameters of handwriting has given rise to the term PD dysgraphia. In addition, certain kinematic properties potentially may be helpful in distinguishing PD from other parkinsonian disorders. CONCLUSION The journey from micrographia to PD dysgraphia is indeed a paradigm shift. Further research is warranted to gain better insight into the graphomotor impairments in PD and their clinical implications.
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Affiliation(s)
- Mathew Thomas
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
| | - Abhishek Lenka
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
- Department of Clinical NeurosciencesNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
| | - Pramod Kumar Pal
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
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23
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Elkouzi A, Bit-Ivan EN, Elble RJ. Pure akinesia with gait freezing: a clinicopathologic study. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2017; 4:15. [PMID: 29051824 PMCID: PMC5644075 DOI: 10.1186/s40734-017-0063-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/04/2017] [Indexed: 12/05/2022]
Abstract
Background Pure akinesia with gait freezing is a rare syndrome with few autopsied cases. Severe freezing of gait occurs in the absence of bradykinesia and rigidity. Most autopsies have revealed progressive supranuclear palsy. We report the clinical and postmortem findings of two patients with pure akinesia with gait freezing, provide video recordings of these patients, and review the literature describing similar cases. We also discuss bradykinesia, hypokinesia and akinesia in the context of this clinical syndrome. Case presentation Two patients with the syndrome of pure akinesia with gait freezing were examined by the same movement disorder specialist at least annually for 9 and 18 years. Both patients initially exhibited freezing, tachyphemia, micrographia and festination without bradykinesia and rigidity. Both autopsies revealed characteristic tau pathology of progressive supranuclear palsy, with nearly total neuronal loss and gliosis in the subthalamus and severe neuronal loss and gliosis in the globus pallidus and substantia nigra. Previously published postmortem studies revealed that most patients with this syndrome had progressive supranuclear palsy or pallidonigroluysian atrophy. Conclusions Pallidonigroluysian degeneration produces freezing and festination in the absence of generalized slowing (bradykinesia). Freezing and festination are commonly regarded as features of akinesia. Akinesia literally means absence of movement, and akinesia is commonly viewed as an extreme of bradykinesia. The pure akinesia with gait freezing phenotype illustrates that bradykinesia and akinesia should be viewed as separate phenomena. Electronic supplementary material The online version of this article (doi:10.1186/s40734-017-0063-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ahmad Elkouzi
- Department of Neurology, Southern Illinois University School of Medicine, PO Box 19645, Springfield, IL 62794-9645 USA
| | - Esther N Bit-Ivan
- Department of Neurology, Southern Illinois University School of Medicine, PO Box 19645, Springfield, IL 62794-9645 USA.,Department of Pathology, Southern Illinois University School of Medicine and Memorial Medical Center, Springfield, IL USA
| | - Rodger J Elble
- Department of Neurology, Southern Illinois University School of Medicine, PO Box 19645, Springfield, IL 62794-9645 USA
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