Severity of Parkinson’s disease determined by spiral sketch

A test that involves drawing a spiral on a sheet of paper could reveal how serious a patient’s Parkinson’s disease is, according to a study published in Frontiers In Neurology. The writing pace and pen pressure while sketching was lower among Parkinson’s patients, especially those with a threatening form of the disease.

Parkinson’s is a disease of the nervous system that impacts movement. It progresses slowly, sometimes beginning with a barely evident tremor in one hand. Symptoms frequently start on one side of the body and remain harmful on that side, even after symptoms begin to impact both sides. People with Parkinson’s disease may experience shaking in their hands or fingers, slowed movement, rigid muscles and slurred speech. Parkinson’s disease is triggered by certain gene variations, exposure to toxins and a protein called alpha-synuclein found within Lewy bodies. Men are at a higher risk for the disease than women. Depression, fatigue and sleep disorders co-occur with Parkinson’s disease.

Many of the treatment choices for Parkinson’s disease are only successful if the patient is diagnosed early. It may be too late when signs of the disease are visible.

One method that can indicate the severity of Parkinson’s disease is giving a patient a pen to use. Stiffness in their muscles can hinder the ability to write. A person’s degree of education and language expertise can impact their handwriting, so the stronger option would be sketching a shape such as a spiral.

Earlier investigations found that Parkinson’s patients were inclined to move their pen slowly when they sketched and they put less pressure on the page. These results were helpful for determining whether the participants had Parkinson’s.

However, there are no investigations that have further calculated how serious the patient’s condition is by using pen speed or pressure.

Researchers in Australia created a computerized system to pinpoint Parkinson’s disease and to analyze its intensity.

“Our aim was to develop an affordable and automated electronic system for early-stage diagnosis of Parkinson’s disease, which could be easily used by a community doctor or nursing staff,” said Poonam Zham, a researcher at Royal Melbourne Institute of Technology University.

Researchers recruited 55 people for this study. Of those studied, 27 had Parkinson’s disease and 28 did not. The participants were recruited from a clinic at Dandenong Neurology in Melbourne, Australia. All participants were right- hand dominant.

Researchers used their computerized system and a tablet computer that assessed writing speed. A pen that assessed pressure on a page was also used. A patient’s spiral sketch was documented using the tablet, and the pen was used to sketch the spiral using piloting dots. The pen detected the position of contact, x and y, and the pressure, pr, between the tip and the paper. The center of the sheet was the (0,0) point. The spiral was created using Adobe Illustrator Software. Its characteristics included a maximum radius of 75 millimeters and 4.5 revolutions, a complete turn. The spiral was drawn clock-wise by participants and the length between two dots in the spiral was 12 millimeters.

The researchers’ method integrated pen speed and pressure into one measurement, which they called the Composite Index of Speed and Pen-pressure, or CISP, score.

The method analyzed slower pen speeds, pen pressures and CISP scores in Parkinson’s disease participants. Researchers then compared their scores to healthy participants’ scores.

Pen speed and pressure were not distinct enough to pinpoint the intensity of Parkinson’s in participants. Nonetheless, the CISP score could reveal whether the patients had Level 1 or Level 3 Parkinson’s.

David Dexter, deputy research director at Parkinson’s U.K, said that these results can pave the road to developing improved clinical trials for Parkinson’s. Current tests fail to determine the severity of a patient’s Parkinson’s.

“This can impact on the ability to select the right people for clinical research, which is essential to develop new and better treatments for Parkinson’s,” he said.