Accuracy of subjective and objective handwriting assessment for differentiating Parkinson%26apos;s disease from tremulous subjects without evidence of dopaminergic deficits (SWEDDs): an FP-CIT-validated study

作者：Bajaj N P S^*; Wang L; Gontu V; Grosset D G; Bain P G

来源：Journal of Neurology, 2012, 259(11): 2335-2340.

DOI：10.1007/s00415-012-6495-5

• Parkinson%26apos
• s disease
• Macrographia
• Micrographia
• Handwriting
• SWEDDs (subjects without evidence of dopaminergic deficit)

Handwriting examinations are commonly performed in the analysis of tremor and Parkinson%26apos;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.

• 出版日期2012-11