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A new computer method for assessing drawing impairment in Parkinson's disease
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
Dalarna University.
Dalarna University.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology. (Neurologi)
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2010 (English)In: Journal of Neuroscience Methods, ISSN 0165-0270, E-ISSN 1872-678X, Vol. 190, no 1, 143-148 p.Article in journal (Refereed) Published
Abstract [en]

A test battery, consisting of self-assessments and motor tests (tapping and spiral drawing tasks) was used on 9482 test occasions by 62 patients with advanced Parkinson's disease (PD) in a telemedicine setting. On each test occasion, three Archimedes spirals were traced. A new computer method, using wavelet transforms and principal component analysis processed the spiral drawings to generate a spiral score. In a web interface, two PD specialists rated drawing impairment in spiral drawings from three random test occasions per patient, using a modification of the Bain & Findley 10-category scale. A standardised manual rating was defined as the mean of the two raters' assessments. Bland-Altman analysis was used to evaluate agreement between the spiral score and the standardised manual rating. Another selection of spiral drawings was used to estimate the Spearman rank correlations between the raters (r=0.87), and between the mean rating and the spiral score (r=0.89). The 95% confidence interval for the method's prediction errors was +/-1.5 scale units, which was similar to the differences between the human raters. In conclusion, the method could assess PD-related drawing impairments well comparable to trained raters.

Place, publisher, year, edition, pages
2010. Vol. 190, no 1, 143-148 p.
National Category
Neurology Biomedical Laboratory Science/Technology
Research subject
Neurology; Medical Informatics
URN: urn:nbn:se:uu:diva-128958DOI: 10.1016/j.jneumeth.2010.04.027ISI: 000279888800019PubMedID: 20438759OAI: oai:DiVA.org:uu-128958DiVA: diva2:332315
Available from: 2010-08-04 Created: 2010-08-04 Last updated: 2014-01-29Bibliographically approved
In thesis
1. Decision Support for Treatment of Patients with Advanced Parkinson’s Disease
Open this publication in new window or tab >>Decision Support for Treatment of Patients with Advanced Parkinson’s Disease
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Beslutsstöd för behandling av patienter med avancerad Parkinsons sjukdom
Abstract [en]

The overall aim of this thesis was to develop, deploy and evaluate new IT-based methods for supporting treatment and assessment of treatment of advanced Parkinson’s disease. In this condition a number of different motor and non-motor symptoms occur in episodes of varying frequency, duration and severity. In order to determine outcome of treatment changes, repeated assessments are necessary. Hospitalization for observation is expensive and may not be representative for the situation at home. Paper home diaries have questionable reliability and storage and retrieval of results are problematic. Approaches for monitoring using wearable sensors are unable to address important non-motor symptoms.

A test battery system consisting of both self-assessments of symptoms and motor function tests was constructed for a touch screen mobile phone. Tests are performed on several occasions per day during test periods of one week. Data is transmitted over the mobile net to a central server where summaries in different symptom dimensions and an overall test score per patient and test period are calculated. There is a web application that graphically presents the results to treating clinical staff. As part of this work, a novel method for assessment of spiral drawing impairment useful during event-driven sampling was developed. To date, the system has been used by over 100 patients in 10 clinics in Sweden and Italy. Evidence is growing that the test battery is useful, reliable and valid for assessment of symptoms during advanced Parkinson’s disease.

Infusion of a levodopa/carbidopa gel into the small intestine has been shown to reduce variation in plasma drug levels and improve clinical response in this patient category. A pharmacokinetic-pharmacodynamic model of this intestinal gel infusion was constructed. Possibly this model can assist the process of individualization of dosage for this treatment through in numero simulations. Results from an exploratory data analysis indicate that severity measures during oral levodopa treatment may be factors to consider when deciding candidates for infusion treatment.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 76 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 621
Parkinson’s disease, telemedicine, motor test, tapping, spiral, self-assessment, home-assessment, outcome measure, electronic diary, patient-reported outcome, remote patient monitoring, levodopa, infusion, pharmacokinetic, pharmacodynamic
National Category
Biomedical Laboratory Science/Technology
Research subject
Medical Informatics
urn:nbn:se:uu:diva-132635 (URN)978-91-554-7947-3 (ISBN)
Public defence
2010-12-18, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 13:00 (Swedish)
Available from: 2010-11-26 Created: 2010-10-23 Last updated: 2011-01-13Bibliographically approved

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