“Micrographia” or small handwriting has been a signal symptom of Parkinson’s disease (PD) for many years. Why the handwriting gets smaller and smaller is not well understood. But now a group of occupational therapists working at University of Haifa and the Rambam Hospital have studied this phenomenon and found what is perhaps and early way to predict and diagnose Parkinson’s disease based on handwriting.
Professor Sara Rosenblum noted that many people who have Parkinson’s disease have often felt there were cognitive changes happening in their brains well before any motor symptoms were seen and they were aware of changes in their handwriting, sometimes years before there were motor symptoms. Most studies have focused on the motor skills of hand writing and not on the cognitive changes. Professor Rosenblum decided to look at the cognitive changes by asking the participants to sign their name and write several addresses, as if addressing an envelope, tasks that require cognitive skills. She chose 40 subjects: 20 healthy and 20 with early stage PD that had no motor symptoms.
Using a plain piece of paper placed on an electronic tablet and a special, pressure sensitive pen, they were able to analyze the writing from several perspectives. They could see how the subjects formed the letters, the length, height and width as well as how much pressure was applied and the time it took to write them. They found some interesting differences.
The people with Parkinson’s disease wrote smaller letters, used less pressure and took longer to write them than the healthy group. Of special note was the longer time the people with PD held the pen in the air before writing, which shows the amount of time their brain was contemplating the next writing action. This suggests that there is a reduced or slower cognitive ability.
Further development of this research could lead to earlier detection of Parkinson’s disease . It has the advantage that it could be done my a technologist other than the physician and if the changes are noted, the patient can then be referred to a physician for further evaluation and treatment.
Professor Rosenblum is presently collaborating with Dr. Ilana Schlessinger, the head of the Movement Disorders and Parkinson’s Disease at Rambam Hospital in Haifa, Israel.. They are using handwriting analysis to measure the degree of Parkinson’s patients improved functioning after undergoing deep brain stimulation.
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Sara Rosenblum, Margalit Samuel, Sharon Zlotnik, Ilana Erikh, Ilana Schlesinger. Handwriting as an objective tool for Parkinson’s disease diagnosis. Journal of Neurology, 2013; DOI: 10.1007/s00415-013-6996-x.