Handwriting Movement Abnormalities in Older Adults with Silent Cerebral Small Vessel Disease—A Preliminary Study

Abstract

Background: The features of cerebral small vessel disease (CSVD) range from occurrence of asymptomatic radiological markers to symptomatic characteristics that include cognitive deficits and gait decline. The aim of the present study was to examine whether handwriting movement is abnormal in older people with CSVD through handwriting and drawing tasks using digitized handwriting kinematic assessment technology. Methods: Older subjects (n = 60) were grouped according to Fazekas score, with 16 in the Severe CSVD group, 12 in the Non-severe group and 32 in the Healthy group. Kinematic data were recorded and analyzed during handwriting and drawing tasks: signature; writing of Chinese characters (“正” and “永”); and Archimedes’ spiral drawing. Results: The Severe CSVD group showed lower velocity and higher tortuosity during signature writing, lower velocity of stroke #4 of “正” and vertical size of “永” than did the Non-severe and Healthy groups. Both Severe CSVD and Non-severe CSVD subjects displayed higher average normalized jerk than did the Healthy group. Partial correlation analysis adjusting for age, gender, education, and mini-mental state evaluation (MMSE) showed that CSVD burden was positively associated with tortuosity of signature and average normalized jerk of Archimedes’ spiral, and was negatively associated with velocity of strokes #3 and #4 of “正”, as well as vertical size of “永”. Conclusions: Older adults with CSVD showed abnormal handwriting movement. And the handwriting abnormalities captured by digitized handwriting analysis were correlated with CSVD severity in users of simplified Chinese characters.

Keywords

• aging
• cerebral small vessel disease
• handwriting analysis
• kinematics
• magnetic resonance imaging (mri)
• white matter hyperintensities