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Title of Journal: J Neurol

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Abbravation: Journal of Neurology

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Springer-Verlag

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10.1007/978-0-387-45524-2_36

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1432-1459

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Accuracy of subjective and objective handwriting a

Authors: N P S Bajaj L Wang V Gontu D G Grosset P G Bain
Publish Date: 2012/04/25
Volume: 259, Issue: 11, Pages: 2335-2340
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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 akineticrigid PD from 39 movementdisorder 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 = 00352 and in akineticrigid than tremulous PD p = 00259 Macrographia was predominantly seen in patients with dystonic tremor and not other diagnoses p = 0007 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 akineticrigid 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 akineticrigid than tremulous PD In addition macrographia strongly suggests a diagnosis of dystonic tremorDG 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 medicallyrelated 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 PG Bain none

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