Effect of levodopa on handwriting tasks of different complexity in Parkinson’s disease: a kinematic study
Levodopa treatment does improve Parkinson’s disease (PD) dysgraphia, but previous research is not in agreement about which aspects are most responsive. This study investigated the effect of levodopa on the kinematics of writing. Twenty-four patients with PD of less than 10 years duration and 25 age-matched controls were recruited. A practically defined off state method was used to assess the levodopa motor response, measured on the Unified Parkinson’s Disease Rating Scale Part III. The kinematic features for six handwriting tasks involving different levels of complexity were recorded from PD patients in off and on states and from the control group. Levodopa is effective for simple writing activities involving repetition of letters, denoting improved fine motor control. But the same benefit was not seen for copying a sentence and a written category fluency test, tasks that carry memory and cognitive loads. We also found significant differences in kinematic features between control participants and PD patients, for all tasks and in both on and off states. Serial testing of handwriting in patients known to be at risk for developing PD might prove to be an effective biomarker for cell loss in the substantia nigra and the associated dopamine deficiency. We recommend using a panel of writing tasks including sentence copying and memory dependence. Dual-task effects may make these activities more sensitive to early motor deficits, while their weaker levodopa responsiveness would cause them to be more stable indicators of motor progression once symptomatic treatment has been commenced.
KeywordsParkinson’s disease Levodopa Kinematic Dysgraphia
We acknowledge the funding supported by RMIT University scholarship and clinical support from Monash Medical Centre, Melbourne, Australia.
Compliance with ethical standards
Conflicts of Interest
The authors declare that they have no conflict of interest.
- 1.Kinnier Wilson S (1925) The Croonian Lecutures on some disorders of mortility and of muscle tone, with special reference to the corpus striatum. Lancet ii:1–10Google Scholar
- 5.Pereira CR, Pereira DR, da Silva FA, Hook C, Weber SA, Pereira LA, Papa JP (2015) A step towards the automated diagnosis of Parkinson’s disease: analyzing handwriting movements. In: 2015 IEEE 28th international symposium on computer-based medical systems. pp 171–176Google Scholar
- 8.Cobbah W, Fairhurst MC (2000) Computer analysis of handwriting dynamics during dopamimetic tests in Parkinson’s disease. In: Euromicro Conference, 2000. Proceedings of the 26th IEEE, pp 414–418Google Scholar
- 12.Broeder S, Nackaerts E, Nieuwboer A, Smits-Engelsman BC, Swinnen SP, Heremans E (2014) The effects of dual tasking on handwriting in patients with Parkinson’s disease. Neuroscience 263:193–202. https://doi.org/10.1016/j.neuroscience.2014.01.019 CrossRefGoogle Scholar
- 15.Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R (2008) Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): Scale presentation and clinimetric testing results. Mov Disord 23(15):2129–2170CrossRefGoogle Scholar
- 20.Thomassen AJ, Teulings H-L (1983) Constancy in stationary and progressive handwriting. Acta Physiol (Oxf) 54(1–3):179–196Google Scholar
- 22.du Prel J-B, Röhrig B, Hommel G, Blettner M (2010) Choosing statistical tests: part 12 of a series on evaluation of scientific publications. Dtsch Ärztebl Int 107(19):343Google Scholar