Handwriting as an objective tool to support the identification of people with Alzheimer’s disease: suitability of an assessment protocol (Preprint)

Abstract

Alzheimer’s disease (AD) is the most common of dementia, and has associated cognitive and motor disorders, with consequences on daily activities, including handwriting. Handwriting has been used to study fine motor control or executive functioning in healthy and unhealthy populations. Changes in this skill are present at different stages of the clinical course of Alzheimer’s Disease. Sensorimotor deterioration is observed in handwriting tasks (motion kinematics, such as movement time, speed, and profiles) and brain activity rhythms.

We aim to study the suitability of a handwriting assessment protocol to differentiate handwriting characteristics and the associated brain activity in older people with AD and cognitively healthy.

Subjects from three organizations (one hospital and two Residential Centers for the Elderly) were recruited. Participants were either cognitively healthy or had clinical diagnoses of minor cognitive impairment or dementia, suggestive of AD. When a direct assessment by a neurologist was not feasible, as in the two nursing homes, participants undertook a comprehensive neuropsychological evaluation that supported the existing diagnoses by clinicians in charge. All participants performed a handwriting assessment with the following instruments: Beery Buktenica Visual-Motor Integration Development Test – 6 and Adult Writing Assessment Battery (HAB). The handwriting tasks were carried out on a Wacom digitizing platform, and the data extraction was done through the MovAlyzeR software. Participants wore an EPOC X helmet during handwriting tasks to assess brain activity.

The study received funding in May 2023. Data collection was initiated in January 2024. As of April 2024, 21 participants had been enrolled (female: n=17; male, n=3; cognitively healthy: n=9, dementia: n=11). Data collection finished on July 2024. Data analysis and dissemination of findings will be submitted at the beginning of 2025.

The findings from this research can contribute to a more in-depth knowledge of this subject and potentially support early identification and treatment.

ClinicalTrials.gov Protocol Identifier: NCT06483438