Parkinson’s Progression Caught in Your Handwriting

writing wall grafitti

By the time a patient notices the symptoms, treatment options against the progression of Parkinson’s is limited. While some of us might rather live on in ignorant bliss until the disease hits us in the face in older age, a new tool from the University of Haifa finds that with Parkinson’s, the writing is on the wall: the disease can be detected much earlier, through a person’s handwriting.

Some scientists already figure that the high incidence of Parkinson’s in some Middle East communities is due to pesticides, and that artificial sweeteners may hold promise for a treatment. But earlier diagnoses for earlier intervention?

The University and nearby Rambam Hospital in Haifa, Israel compared the writing process of 40 sick and healthy subjects and now suggests their method as “an innovative and noninvasive method of diagnosing Parkinson’s at a fairly early stage,” they write.

Today Parkinson’s disease is determined by the diagnostic ability of the physician, who can generally identify the clinical symptoms only when the disease is at a relatively advanced stage.

They use a physical evaluation or a test called SPECT, which uses radioactive material to image the brain. The latter, however, is no more effective in diagnosing the illness than an expert doctor and it exposes the patient to unnecessary radiation exposure. We don’t want that!

Studies from recent years show that there are unique and distinctive differences between the handwriting of patients with Parkinson’s disease and that of healthy people. However, most studies that were conducted to date have focused on handwriting focused on motor skills, such as the drawing of spirals, and not on writing that involves cognitive abilities, such as signing a check.

According to Prof. Sara Rosenblum from Haifa University, Parkinson’s patients report feeling a change in their cognitive abilities before detecting a change in their motor abilities and therefore a test of cognitive impairment like the one performed in this study could attest to the presence of the disease and offer a way to diagnose it earlier.

In the study, the researchers asked the subjects to write their names and gave them addresses to copy, two everyday tasks that require cognitive abilities. Participants were 40 adults with at least 12 years of schooling, half healthy and half known to be in the early stages of Parkinson’s disease (before obvious motor signs are visible).

The writing was done on a regular piece of paper that was placed on electronic tablet, using a special pen with pressure-sensitive sensors operated by the pen when it hit the writing surface. A computerized analysis of the results compared a number of parameters: writing form (length, width and height of the letters), time required, and the pressure exerted on the surface while performing the assignment.

Analysis of the results showed significant differences between the patients and the healthy group, and all subjects, except one, had their status correctly diagnosed (97.5% accuracy). The Parkinson’s disease patients wrote smaller letters (“micrograph”), exerted less pressure on the writing surface, and took more time to complete the task.

According to Prof. Rosenblum a particularly noticeable difference was the length of time the pen was in the air between the writing of each letter and each word.

“This finding is particularly important because while the patient holds the pen in the air, his mind is planning his next action in the writing process, and the need for more time reflects the subject’s reduced cognitive ability. Changes in handwriting can occur years before a clinical diagnosis and therefore can be an early signal of the approaching disease,” Prof. Sara Rosenblum, one of the researchers said.

This new advance is one more reason to keep cursive in school, even as more and more schoolchildren use the tablet or computer to write. And linked with a tablet is another way of providing remote medicine to people in disadvantaged and remote communities. We see a new Kickstarter campaign for someone to start. Anyone?

Image of grafiti on wall, by Shutterstock

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