Advertisement

Journal of Neurology

, Volume 259, Issue 11, pp 2335–2340 | Cite as

Accuracy of subjective and objective handwriting assessment for differentiating Parkinson’s disease from tremulous subjects without evidence of dopaminergic deficits (SWEDDs): an FP-CIT-validated study

  • N. P. S. BajajEmail author
  • L. Wang
  • V. Gontu
  • D. G. Grosset
  • P. G. Bain
Original Communication

Abstract

Handwriting examinations are commonly performed in the analysis of tremor and Parkinson’s disease (PD). We analyzed the accuracy of subjective and objective assessment of handwriting samples for distinguishing 27 PD cases, 22 with tremulous PD, and five with akinetic-rigid PD, from 39 movement-disorder patients with normal presynaptic dopamine imaging (subjects without evidence of dopamine deficiency or SWEDDs; 31 with dystonic tremor (DT), six indeterminate tremor syndrome, one essential tremor, one vascular parkinsonism). All handwriting analysis was performed blind to clinical details. Subjective classification was made as: (1) micrographia, (2) normal, or (3) macrographia. In addition, a range of objective metrices were measured on standardized handwriting specimens. Subjective assessments found micrographia more frequently in PD than SWEDDs (p = 0.0352) and in akinetic-rigid than tremulous PD (p = 0.0259). Macrographia was predominantly seen in patients with dystonic tremor and not other diagnoses (p = 0.007). Micrographia had a mean sensitivity of 55 % and specificity of 84 % for distinguishing PD from SWEDDs and mean sensitivity of 90 % and specificity of 55 % for distinguishing akinetic-rigid PD from tremulous PD. Macrographia had a sensitivity of 26 % and specificity of 96 % for distinguishing DT from all other diagnoses. The best of the objective metrices increased sensitivity for the distinction of SWEDDs from PD with a reduction in specificity. We conclude that micrographia is more indicative of PD than SWEDDs and more characteristic of akinetic-rigid than tremulous PD. In addition, macrographia strongly suggests a diagnosis of dystonic tremor.

Keywords

Parkinson’s disease Macrographia Micrographia Handwriting SWEDDs (subjects without evidence of dopaminergic deficit) 

Notes

Conflicts of interest

DG has received consultancy fees from Civitas Therapeutics Inc, Vectura Group plc, and honoraria from Teva/Lundbeck, UCB Pharma, GSK, Pharmacia, and Abbott. Nin Bajaj—Stock Ownership in medically-related fields: none; Consultancies: none; Advisory Boards: UCB Pharma, GE Healthcare; Partnerships: none; Honoraria: UCB, Teva, GE Healthcare, Genus; Grants: MRC, Parkinson’s UK; Intellectual Property Rights: none; Expert Testimony: none; Employment: NHS; Contracts: none; Royalties: none. P.G. Bain: none.

References

  1. 1.
    Marek K, Jennings D, Seibyl J (2003) Imaging the dopamine system to assess disease-modifying drugs: studies comparing dopamine agonists and levodopa. Neurology 61(6 Suppl 3):S43–S48PubMedCrossRefGoogle Scholar
  2. 2.
    Whone AL, Watts RL, Stoessl AJ, Poewe WH, Hauser RA et al (2003) REAL-PET Study Group. Slower progression of Parkinson’s disease with ropinirole versus levodopa: The REAL-PET study. Ann Neurol 54:93–101PubMedCrossRefGoogle Scholar
  3. 3.
    Parkinson Study Group (2000) Pramipexole vs levodopa as initial treatment for Parkinson disease: a randomized controlled trial. JAMA 284:1931–1938CrossRefGoogle Scholar
  4. 4.
    Fahn S (2005) Does levodopa slow or hasten the rate of progression of Parkinson’s disease? J Neurol 252(Suppl 4):VI37–VI42Google Scholar
  5. 5.
    Marek K, Jennings D, Seibyl J (2005) Long-term follow-up of patients with scans without evidence of dopaminergic deficit (SWEDD) in the ELLDOPA study. Neurology 64:A274 AbstractGoogle Scholar
  6. 6.
    Marshall VL, Patterson J, Hadley DM, Grosset KA, Grosset DG (2006) Successful antiparkinsonian medication withdrawal in patients with parkinsonism and normal FP-CIT SPECT. Mov Disord 21:2247–2250PubMedCrossRefGoogle Scholar
  7. 7.
    Silveira-Moriyama L, Schwingenschuh P, O’Donnell A et al (2009) Olfaction in patients with suspected parkinsonism and scans without evidence of dopaminergic deficit (SWEDDs). J Neurol Neurosurg Psychiatry 80(7):744–748PubMedCrossRefGoogle Scholar
  8. 8.
    Soane T, Grosset D, Lees A, Bajaj N (2009) Scans without evidence of dopaminergic deficit: diagnosis, etiology, and management. Curr Med Lit 25(4):93–103Google Scholar
  9. 9.
    Schneider SA, Edwards MJ, Mir P et al (2007) Patients with adult-onset dystonic tremor resembling parkinsonian tremor have scans without evidence of dopaminergic deficit (SWEDDs). Mov Disord 22:2210–2215PubMedCrossRefGoogle Scholar
  10. 10.
    Bain PG (2009) Dystonic tremor presenting as Parkinsonism—long-term follow-up of a SWEDDS patient. Neurology 72(16):1443–1445PubMedCrossRefGoogle Scholar
  11. 11.
    McLennan JE, Nakano K, Tyler HR, Schwab RS (1972) Micrographia in Parkinson’s disease. J Neurol Sci 15(2):141–152PubMedCrossRefGoogle Scholar
  12. 12.
    Stewart DA (2007) NICE guideline for Parkinson’s disease. Age Ageing 36:240–242PubMedCrossRefGoogle Scholar
  13. 13.
    Bajaj NP, Gontu V, Birchall J, Patterson J, Grosset DG, Lees AJ (2010) Accuracy of clinical diagnosis in tremulous parkinsonian patients: a blinded video study. J Neurol Neurosurg Psychiatry 81(11):1223–1228PubMedCrossRefGoogle Scholar
  14. 14.
    Bajaj NP, Knöbel M, Gontu V, Bain PG (2011) Can spiral analysis predict the FP-CIT SPECT scan result in tremulous patients? Mov Disord 26(4):699–704. doi: 10.1002/mds.23507 Google Scholar
  15. 15.
    Phillips JG, Bradshaw JL, Chiu E, Bradshaw JA (1994) Characteristics of handwriting of patients with Huntington’s disease. Mov Disord 9(5):521–530PubMedCrossRefGoogle Scholar
  16. 16.
    Beversdorf DQ, Anderson JM, Manning SE, Anderson SL, Nordgren RE, Felopulos GJ, Bauman ML (2001) Brief report: macrographia in high-functioning adults with autism spectrum disorder. J Autism Dev Disord 31(1):97–101PubMedCrossRefGoogle Scholar
  17. 17.
    Louis ED, Faust PH, Vonsattel J-P et al (2007) Neuropathological changes in essential tremor: 33 cases compared with 21 controls. Brain 130(12):3297–3307PubMedCrossRefGoogle Scholar
  18. 18.
    Tucha O, Mecklinger L, Thome J et al (2006) Kinematic analysis of dopaminergic effects on skilled handwriting movements in Parkinson’s disease. J Neural Transm 113(5):609–623PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • N. P. S. Bajaj
    • 1
    • 2
    Email author
  • L. Wang
    • 3
  • V. Gontu
    • 1
    • 2
  • D. G. Grosset
    • 4
  • P. G. Bain
    • 3
  1. 1.Department of Clinical NeurologyNottingham University Hospitals NHS TrustNottinghamUK
  2. 2.Department of Clinical NeurologyDerby Hospitals NHS Foundation TrustDerbyUK
  3. 3.Department of NeurosciencesCharing Cross Hospital, Imperial CollegeLondonUK
  4. 4.Institute of Neurological SciencesSouthern General HospitalGlasgowScotland, UK

Personalised recommendations