Kinematic and Pressure Features of Handwriting and Drawing: Preliminary Results Between Patients with Mild Cognitive Impairment, Alzheimer Disease and Healthy Controls

Background: Alzheimer’s disease (AD) is the most common neurodegenerative dementia of old age, and the leading chronic disease contributor to disability and dependence among older people worldwide. Clinically, AD is characterized by a progressive cognitive decline that interferes with the abil-ity to perform the activities of daily living. Handwriting and drawing are complex human activities that entail an intricate blend of cognitive, kinesthetic, and perceptual-motor features. Objective: To compare the kinematic characteristics of handwriting and drawing between patients with AD, patients with mild cognitive impairment (MCI) and healthy controls. Methods: We used a cross-sectional and observational design to assess the kinematic and pressure fea-tures of handwriting and drawing using a computerized system. Participants were asked to copy one sen-tence, write a dictated sentence and an own sentence, copy two and-three dimensions drawings, and to execute the clock drawing test. By means of discriminant analyses, we explored the value of several kin-ematic features in order to classify participants depending on their degree of cognitive functioning. Results: The sample consisted of 52 participants (23 AD, 12 MCI, and 17 healthy controls) with a mean age of 69.7 years (SD=8.11). The degree of correct classification was largely dependent on the nature of the groups to be classified and the specific task, and ranged between 63.5% and 100%. Diagnostic accu-racy based on kinematic measures showed higher specificity values for distinguishing between normal and impaired cognition (MCI and AD), and higher sensitivity was obtained when distinguishing between impaired cognition levels (MCI vs. AD). Conclusion: The kinematic features of writing and drawing procedures, rather than the final product, may be a useful and objective complement to the clinical assessment of patients with cognitive impairment.

[1]  R. Reitan.  The relation of the trail making test to organic brain damage. , 1955, Journal of consulting psychology.

[2]  F. Fazio,et al.  Visual feedback has differential effects on reaching movements in Parkinson’s and Alzheimer’s disease , 2000, Brain Research.

[3]  K. Langa,et al.  The diagnosis and management of mild cognitive impairment: a clinical review. , 2014, JAMA.

[4]  H. Möller,et al.  Kinematic Analysis of Handwriting Movements in Patients with Alzheimer’s Disease, Mild Cognitive Impairment, Depression and Healthy Subjects , 2003, Dementia and Geriatric Cognitive Disorders.

[5]  S. Sahrmann,et al.  Motor dysfunction in mildly demented AD individuals without extrapyramidal signs , 1999, Neurology.

[6]  T. Bak,et al.  A cognitive bedside assessment beyond the MMSE: the Addenbrooke's Cognitive Examination. , 2007, Practical neurology.

[7]  E. Tangalos,et al.  Mild Cognitive Impairment Clinical Characterization and Outcome , 1999 .

[8]  M. Samuel,et al.  Handwriting as an objective tool for Parkinson’s disease diagnosis , 2013, Journal of Neurology.

[9]  H. Buschke,et al.  Cued recall in amnesia. , 1984, Journal of clinical neuropsychology.

[10]  H. Arrighi,et al.  Mild cognitive impairment: Disparity of incidence and prevalence estimates , 2012, Alzheimer's & Dementia.

[11]  Sara Rosenblum,et al.  Handwriting process variables among elderly people with mild Major Depressive Disorder: a preliminary study , 2010, Aging clinical and experimental research.

[12]  A. Korczyn,et al.  Handwriting process variables discriminating mild Alzheimer's disease and mild cognitive impairment. , 2006, The journals of gerontology. Series B, Psychological sciences and social sciences.

[13]  F. Huppert,et al.  CAMDEX: A Standardised Instrument for the Diagnosis of Mental Disorder in the Elderly with Special Reference to the Early Detection of Dementia , 1986, British Journal of Psychiatry.

[14]  Gerard P. van Galen,et al.  Handwriting: Issues for a psychomotor theory ☆ , 1991 .

[15]  J. Jolles,et al.  Cross-national comparisons of the Cambridge Cognitive Examination-revised: the CAMCOG-R: results from the European Harmonization Project for Instruments in Dementia. , 2003, Age and ageing.

[16]  Jun Soo Kwon,et al.  Clinical and empirical applications of the Rey–Osterrieth Complex Figure Test , 2006, Nature Protocols.

[17]  A. Cheema,et al.  The critical need for defining preclinical biomarkers in Alzheimer's disease , 2014, Alzheimer's & Dementia.

[18]  M. Gangitano,et al.  Movements Execution in Amnestic Mild Cognitive Impairment and Alzheimer’s Disease , 2007, Behavioural neurology.

[19]  Sara Rosenblum,et al.  Computerized kinematic analysis of the clock drawing task in elderly people with mild Major Depressive Disorder: an exploratory study , 2009, International Psychogeriatrics.

[20]  Marcos Faúndez-Zanuy,et al.  An Information Analysis of In-Air and On-Surface Trajectories in Online Handwriting , 2011, Cognitive Computation.

[21]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[22]  S. Gauthier,et al.  Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. , 1999, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[23]  J. Vilalta-Franch,et al.  Grouping and trajectories of neuropsychiatric symptoms in patients with Alzheimer's disease. Part II: two-year patient trajectories. , 2011, Journal of Alzheimer's disease : JAD.

[24]  C. Sadowsky,et al.  Practical Guidelines for the Recognition and Diagnosis of Dementia , 2012, The Journal of the American Board of Family Medicine.

[25]  M. Folstein,et al.  Clinical diagnosis of Alzheimer's disease , 1984, Neurology.

[26]  Claude Ghez,et al.  Impaired movement control in Alzheimer's disease , 1999, Neuroscience Letters.