DIFFICOLTÀ NELLA SCRITTURA IN PAZIENTI CON MALATTIA DI PARKINSON: VALUTAZION TECNOLOGICA E CORRELATI DI RM FUNZIONALE A RIPOSO

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HANDWRITING DIFFICULTIES IN PARKINSON’S DISEASE: TECHNOLOGICAL ASSESSMENT AND RESTING-STATE FMRI CORRELATES

Autori

Gardoni Andrea (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy)

Elisabetta Sarasso (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy)

Lucia Zenere (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy). Roberta Balestrino (Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy)

Marco Forghieri (Vita-Salute San Raffaele University, Milan, Italy). Elisa Sibilla (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy)

Elisa Canu (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy). Andrea Grassi (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy)

Silvia Basaia (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy)

Veronica Castelnovo (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy). Massimo Malcangi (Neurology Unit and Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy)

Maria Antonietta Volontè (Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy). Davide Corbetta (Department of Rehabilitation and Functional Recovery, IRCCS Ospedale San Raffaele, Milan, Italy)

Massimo Filippi (Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy and Neurotech Hub, Milan Italy)

Federica Agosta (Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy)

Background and aims

Handwriting is a complex activity requiring cognitive and motor abilities, often impaired in people with Parkinson’s Disease (pwPD). Proper handwriting assessment is essential to develop and evaluate the effect of rehabilitation protocols [1]. The aims of the study were to assess handwriting alterations in pwPD compared to healthy controls (HC) and to identify the functional neural correlates of handwriting changes using resting-state functional connectivity (RS-FC) analysis.

Methods

Forty pwPD and 30 age- and sex-matched HC underwent handwriting and hand dexterity assessments, neuropsychological evaluation, and RS-functional MRI (fMRI). A tablet-based handwriting assessment included four tasks: Systematic Screening for Handwriting Difficulties-SOS test (copying a text), funnel test (coloring a shape), closed loop task (drawing specific symbols), and repetitive cursive loop task (writing repeated symbols). SOS test was executed also on paper. RS-fMRI analysis used MELODIC to identify RS-FC differences, and correlations with clinical variables significantly differing between groups were assessed.

Results

Compared to HC, pwPD showed smaller word size, slower drawing speed, and poorer performance in the handwriting tasks on tablet. SOS test on paper confirmed slower writing speed, smaller size, and lower writing quality in pwPD. RS-FC analysis revealed decreased connectivity in the basal ganglia, cerebellum, ventral default mode, and visual networks, alongside increased RS-FC in the salience and executive control networks. Smaller writing amplitude and poorer handwriting quality were associated with altered RS-FC in motor and cognitive networks.

Conclusion

PwPD exhibited handwriting impairments that were correlated with RS-FC changes in motor and cognitive networks, highlighting the neurological basis of handwriting difficulties in pwPD. These findings underscore the multifaceted nature of handwriting deficits in pwPD, emphasizing the need for future studies investigating the effects of specific handwriting rehabilitation strategies on clinical, kinematic and MRI parameters.
Fundings: Italian Ministry of Health, grant number GR-2018-12366005

REFERENCES

[1] Gardoni A, Sarasso E, Basaia S, Corbetta D, Zenere L, Grassi A, Canu E, Castelnovo V, Sibilla E, Malcangi M, Balestrino R, Emedoli D, Volontè MA, Filippi M, Agosta F. Handwriting, touchscreen dexterity and bradykinesia measures in Parkinson’s disease: a feature selection study. J Neurol. 2025 May 11;272(6):389. doi: 10.1007/s00415-025-13121-0. PMID: 40349278.

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