title: Automatic Spiral Analysis for Objective Assessment of Motor Symptoms in Parkinson's Disease.
abstract: A challenge for the clinical management of advanced Parkinson's disease (PD) patients is the emergence of fluctuations in motor performance, which represents a significant source of disability during activities of daily living of the patients. There is a lack of objective measurement of treatment effects for in-clinic and at-home use that can provide an overview of the treatment response. The objective of this paper was to develop a method for objective quantification of advanced PD motor symptoms related to off episodes and peak dose dyskinesia, using spiral data gathered by a touch screen telemetry device. More specifically, the aim was to objectively characterize motor symptoms (bradykinesia and dyskinesia), to help in automating the process of visual interpretation of movement anomalies in spirals as rated by movement disorder specialists. Digitized upper limb movement data of 65 advanced PD patients and 10 healthy (HE) subjects were recorded as they performed spiral drawing tasks on a touch screen device in their home environment settings. Several spatiotemporal features were extracted from the time series and used as inputs to machine learning methods. The methods were validated against ratings on animated spirals scored by four movement disorder specialists who visually assessed a set of kinematic features and the motor symptom. The ability of the method to discriminate between PD patients and HE subjects and the test-retest reliability of the computed scores were also evaluated. Computed scores correlated well with mean visual ratings of individual kinematic features. The best performing classifier (Multilayer Perceptron) classified the motor symptom (bradykinesia or dyskinesia) with an accuracy of 84% and area under the receiver operating characteristics curve of 0.86 in relation to visual classifications of the raters. In addition, the method provided high discriminating power when distinguishing between PD patients and HE subjects as well as had good test-retest reliability. This study demonstrated the potential of using digital spiral analysis for objective quantification of PD-specific and/or treatment-induced motor symptoms.
authors.affiliation: School of Technology and Business Studies, Computer Engineering, Dalarna University, Falun SE-791-88, Sweden. mmi@du.se.
authors.forename: Mevludin
authors.initials: M
authors.lastname: Memedi
authors.affiliation: Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana 1000, Slovenia. aleksander.sadikov@fri.uni-lj.si.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Sadikov
authors.affiliation: Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana 1000, Slovenia. vida.groznik@fri.uni-lj.si.
authors.forename: Vida
authors.initials: V
authors.lastname: Groznik
authors.affiliation: Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana 1000, Slovenia. jure.zabkar@fri.uni-lj.si.
authors.forename: Jure
authors.initials: J
authors.lastname: Žabkar
authors.affiliation: Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana 1000, Slovenia. martin.mozina@fri.uni-lj.si.
authors.forename: Martin
authors.initials: M
authors.lastname: Možina
authors.affiliation: Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden. filip.bergquist@pharm.gu.se.
authors.forename: Filip
authors.initials: F
authors.lastname: Bergquist
authors.affiliation: Department of Clinical Neuroscience, Neurology, Karolinska Institutet, Stockholm 171 76, Sweden. anders.johansson@ki.se.
authors.forename: Anders
authors.initials: A
authors.lastname: Johansson
authors.affiliation: Clinical Trials Unit, Office of the Clinical Director, NINDS Intramural Research Program, National Institutes of Health, 10 Center Drive, Rm 6C-5700, Bethesda, MD 20892, USA. haubenbergerd@ninds.nih.gov.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Haubenberger
authors.affiliation: Department of Neuroscience, Neurology, Uppsala University, Uppsala 751 85, Sweden. dag.nyholm@neuro.uu.se.
authors.forename: Dag
authors.initials: D
authors.lastname: Nyholm
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001331:Automation; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D018476:Hypokinesia / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D025341:Principal Component Analysis; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric
keywords: Parkinson’s disease; bradykinesia; digital spiral analysis; dyskinesia; machine learning; motor fluctuations; objective measures; remote monitoring; time series analysis; visualization