Kinematic analysis of dopaminergic effects on skilled handwriting movements in Parkinson’s disease

Abstract

Patients with Parkinson's disease (PD) exhibit impairments in the execution of highly practiced and skilled motor actions such as handwriting. The analysis of kinematic aspects of handwriting movements has demonstrated that size, speed, acceleration and stroke duration are affected in PD. Although beneficial effects of dopaminergic therapy in regard to execution of movements have been reported, the effects of pharmacological therapy on these measures have not been examined in detail. The present study has compared kinematic aspects of handwriting movements of 27 healthy subjects and 27 patients with PD both on their usual dopaminergic treatment and following withdrawal of dopaminergic medication. Healthy subjects were matched with PD patients according to age, sex, handedness and education level. A digitising tablet was used for the assessment of handwriting movements. Subjects were asked to perform a simple writing task. Movement time, distance, velocity, acceleration and measures of fluency of handwriting movements were measured. Compared with healthy subjects, the kinematics of handwriting movements in PD patients were markedly disturbed following withdrawal of dopaminergic medication. Although dopaminergic treatment in PD patients resulted in marked improvements in the kinematics of handwriting movements, PD patients did not reach an undisturbed level of performance. The results suggest that dopamine medication results in partial restoration of automatic movement execution.

Handwriting speed and size in individuals with Parkinson’s disease compared to healthy controls: the possible effect of cueing

“…The results are in accordance with previous studies [6,9,11,13]. However, former studies have merely compared handwriting of PD patients and healthy controls and have not looked into different types of paper as possible cues for improving handwriting.…”

“…In addition, our study confirmed that individuals with PD write slower than healthy controls [4,6,13]. The writing speed was not affected by writing on different types of paper in neither of groups.…”

“…Writing a sentence is a more complex activity with higher cognitive demands compared to drawing lines or circles. Tucha and colleagues [13] came to the same conclusion.…”

“…Changes in handwriting are one of the clinical symptoms of PD [7]. According to previous studies [6,8,13] the handwriting speed of people with PD is slower compared to age-and gender-matched healthy individuals and. Changes in handwriting occur prior PD is diagnosed, being one of the first symptoms of the illness [11].…”

Evaluation of Graphic Gesture in Parkinson’s Disease

“…In the graphical deficits due to motor difficulties it can be found the presence of diseases such as Parkinson's Disease (PD) (Lange, 2006;Tucha, 2006;Longstaff, 2003); PD symptoms include bradykinesia, tremor, rigidity, reduced manual ability and loss of accuracy, which cause typical phenomena that can be classified using graphic gesture analysis and then related to the specific pathology (Tucha, 2006). In literature there are several studies finalized to the quantification of kinematic alterations in the graphic gesture in patients with PD.…”