Parkinson’s Disease Identification using KNN and

ANN Algorithms based on Voice Disorder

Ouhmida Asmae Raihani Abdelhadi Cherradi Bouchaib
SSDIA Laboratory, ENSET SSDIA Laboratory, ENSET SSDIA Laboratory, ENSET
Mohammedia Mohammedia Mohammedia
Hassan II Univiversity Hassan II Univiversity Hassan II Univiversity
Casablanca, Morocco Casablanca, Morocco Casablanca, Morocco
asmaeouhmida1995@gmail.com raihani@enset-media.ac.ma bouchaib.cherradi@gmail.com

Sandabad Sara Khalili Tajeddine

SSDIA Laboratory, ENSET SSDIA Laboratory, ENSET
Mohammedia Mohammedia
Hassan II Univiversity Hassan II Univiversity
Casablanca, Morocco Casablanca, Morocco

Abstract—In recent years, speech signal processing has
benefited from a lot of attention, because of its widespread
application. In this study, we have led a comparative analysis for
efficient detection of Parkinson’s disease applied to machine
learning classifiers from voice disorder known as dysphonia. To
prove robust detection process, we used Artificial Neural
Networks (ANN) and K Nearest Neighbors (KNN) algorithms,
in the purpose of distinguishing between PD patient and healthy
individual. Experimental results show that the ANN classifier
achieved higher average performance than the KNN classifier
in term of accuracy. The UCI Experiment consists of 31 subjects
of which 23 were diagnosed with Parkinson's disease. The
established system is able to distinguish healthy people from an
acceptable range of people with PD with an accuracy rate of
96.7% by using ANN.
Keywords—Parkinson’s disease; ANN; KNN; dysphonia
I. INTRODUCTION
Neurodegenerative disease has human, social and
financial impacts, on a personal, professional and social level.
It is a progressive pathology that affects the brain and the
nervous system, leading to the death of nerve cells. The most
known and frequent ones are Alzheimer's and Parkinson's
diseases. Parkinson’s disease, is particularly linked to the loss
of dopamine-producing neurons in the basic ganglia. In fact,
medication fees for Parkinson's disease are very expensive. At
the moment, no cure has been found. Medication is limited to
treatments, at an early stage, to improve the patient's quality
of life.
Several methods have been used to detect the symptoms
of Parkinson's disease, but most of them require motor actions
that appear only in an advanced state of the disease.
Most used traditional methods for the determination of the
disease, are costly invasive methods namely SPECT and CT
tomography’s which are effective, essentially, in the mature
stage of the disease. Besides classic methods, practitioners
adopt several diagnostic paths. Some of them were based on
handwriting by considering the relationship between
handwriting and nervous system problems. Others have relied
on peripheral biomarkers for early detection of PD.
The current study focuses on voice analysis based
diagnostic paths. In fact, voice-based systems are the focal
point of recent PD telemedicine studies. Thus, several speech
signal processing algorithms have been used to extract the
necessary information for the assessment of PD. The extracted
characteristics are transmitted to learning algorithms for the
creation of reliable decision support systems.
Currently, the commonly used acoustic parameters in
acoustic analysis applications as well as the most cited in the
literature are fundamental frequency, jitter, shimmer and
HNR.
The fundamental frequency (F0), measured in hertz, is
defined as the number of times the vocal cords repeat a
produced sound wave during a given period. It is also the
number of opening / closing cycles of the glottis. There is a
typical range of values for this frequency for different genders
and ages. But these values are not stationary since F0 is also
used to transmit prosody [1].
Jitter is defined as the parameter of frequency variation
from one cycle to the next. It is mainly affected by the lack of
control over the vibration of the vocal cords; the voices of
patients with pathologies often have a higher percentage of
jitter. Most researchers have estimated that sustained
phonation for adults range from 0.5 to 1.0%.
Shimmer refers to the variation in amplitude of the sound
wave [2]. It changes according to reduced glottal resistance
and massive damage of the vocal cords and is correlated with
the presence of noise and breathing. It is considered as
pathological voice for values below 3% for adults and between
0.4 and 1% for children [3].
The detection of Parkinson's disease is based on the use of
different classifiers. The distinction between them is based on
measurement criteria, namely classification accuracy,
Matthews’s correlation coefficient (MCC), Spearman
correlation coefficient, specificity, sensitivity, F-score (F-
measure) ... etc. Each of these measurement criteria has
formulas to calculate it and conclude which is the most
qualitatively adequate classifier for the study.
Before defining these criteria, we must focus on the
confusion matrix. Called a contingency table, it is a tool for
measuring the performance of a learning model, checking how
far its predictions are correct, compared to reality in
classification problems.
Table I shows the confusion matrix for a two-class
classifier.

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 TABLE I. CONFUSION MATRIX 𝑇𝑁
𝑆𝑝𝑒𝑐𝑖𝑓𝑖𝑐𝑖𝑡𝑦 = (6)
Predicted Class 𝑇𝑁 + 𝐹𝑃
Positive Negative F1-score:
Actual Positive (TP) (FN)
Class It represents the harmonic average of the recall and the
Negative (FP) (TN)
precision:
𝑝𝑟𝑒𝑐𝑖𝑠𝑖𝑜𝑛 ∗ 𝑠𝑒𝑛𝑠𝑖𝑡𝑖𝑣𝑖𝑡𝑦
TP (True Positive): the prediction is positive while the 𝐹𝑠𝑐𝑜𝑟𝑒 = 2 ∗ (7)
𝑝𝑟𝑒𝑐𝑖𝑠𝑖𝑜𝑛 + 𝑠𝑒𝑛𝑠𝑖𝑡𝑖𝑣𝑖𝑡𝑦
actual real value is positive.
In general, the evaluation of a classifier is based on the
TN (True Negative): the prediction is negative while the confusion matrix. And it is from the measurement criteria
actual real value is negative. extracted from this matrix that we quantify the performance of
FP (False Positive): the prediction is positive while the a classifier.
actual real value is negative. In order to accomplish the evaluation, several authors
FN (False Negative): the prediction is negative while the based their work on the overall accuracy, which is an index of
actual real value is positive. overall performance, since, among all the reference sites, it
indicates what proportion has been correctly mapped and
a) Matthews’s correlation coefficient (MCC): measures performance regardless of the size of the classes.
The overall accuracy is generally expressed as a percentage,
𝑇𝑃. 𝑇𝑁 − 𝐹𝑃. 𝐹𝑁 and at a value of 100%, it constitutes a perfect classification
𝑀𝐶𝐶 = (1)
√(𝑇𝑃 + 𝐹𝑃). (𝑇𝑃 + 𝐹𝑁). (𝑇𝑁 + 𝐹𝑃). (𝑇𝑁 + 𝐹𝑁) in which all the reference sites have been classified correctly.
In this study, two classifiers were applied for
distinguishing healthy people from people with Parkinson’s
This coefficient is used as a quality measurement of binary Disease (PD), which are the ANN and the KNN. According to
and multi-class classification. It’s based on the true and false the precision classifier, the ANN gives a classification rate of
positive and negative. It returns a value ranging from -1 to 1. 96.7% and the KNN gives 79.3% of accuracy.

(1): Perfect classifier (perfect prediction). II. MATERIALS AND METHODS:

(0): No better than random prediction.
(-1): Contradiction between prediction and observation.
b) Spearman correlation coefficient:
This coefficient analyzes monotonic non-linear relations (if
one of the variables increases, the other does the same, and
vice versa).
6 ∑ di 2
rs = 1 −
n(n2 − 1)
n: number of observations.
𝑑𝑖 = 𝑔(𝑋𝑖 ) − 𝑟𝑔(𝑌𝑖 ): The difference between the two rows of
each observation
c) Classification accuracy, specificity, sensitivity:
The classification model can be evaluated based on the
confusion matrix. According to the evaluation results the
performance measures are then extracted.
Precision: Represents the proportion of correct predictions
among the points that have been predicted positives.
𝑇𝑃
𝑃𝑟𝑒𝑐𝑖𝑠𝑖𝑜𝑛 =
𝑇𝑃 + 𝐹𝑃
Accuracy: the number of correct predictions made by the
model over all kinds predictions made.
𝑇𝑃 + 𝑇𝑁
𝐴𝑐𝑐𝑢𝑟𝑎𝑐𝑦 =
𝑇𝑃 + 𝑇𝑁 + 𝐹𝑃 + 𝐹𝑁
Sensitivity: It represents the rate of true positives.
𝑇𝑃
𝑆𝑒𝑛𝑠𝑖𝑡𝑖𝑣𝑖𝑡𝑦 =
𝑇𝑃 + 𝐹𝑁
Specificity: It represents the rate of true negatives.
The current study is based on Parkinson's UI Machine
Learning [4] database, having acoustic characteristics.
A. Data set:
The database consists of 195 sustained vocal phonations
of 31 male and female subjects, of which 23 were diagnosed
with Parkinson's disease. The age of the patients varies
between 46 and 85 years (average of 65.8, standard deviation
of 9.8). For each patient, averages of six phonations were
recorded, with a length ranging from 1 to 36 s.
(2)
According to this database, the main goal is to distinguish
healthy people from those suffering from Parkinson's disease.
It is done based on the "status" column, which is defined by 0
for healthy people and 1 for patients with PD. Each column in
the table represents a measure of voice and each line
represents one of the 195 recordings of the voice of these
individuals (the column ‘name’).
B. Speech recordings:
The subjects had ages ranging from 46 years to 85 years
(average of 65.8 and standard deviation of 9.8). For each of
the subjects, averages of six phonations, lasting from 1 to 36
s, were recorded. See Table I for subject details. Figure 3
(3) illustrates plots of two of these voice signals [5].
(4)
(5)

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 Table Head Table Column Head
MDVP: RAP Relative Amplitude Perturbation

MDVP: PPQ Five-point Period Perturbation Quotient

Jitter: DDP Average absolute difference of differences between

cycles, divided by the average period
MDVP: Shimmer Shimmer Local amplitude perturbation

MDVP: Shimmer Local amplitude perturbation (decibels)

(db)
Shimmer: APQ3 3-point Amplitude Perturbation Quotient

Shimmer: APQ5 5-point Amplitude Perturbation Quotient

MDVP: APQ 11-point Amplitude Perturbation Quotient

Fig. 1. Example of speech signal of a healthy individual
Shimmer: DDA Average absolute difference between the
amplitudes of consecutive periods
NHR Noise-to-Harmonics Ratio

HNR Harmonics-to-Noise Ratio

RPDE Recurrence Period Density Entropy

D2 Correlation Dimension

DFA Detrended Fluctuation Analysis

Spread1 Fundamental frequency variation

Spread2 Fundamental frequency variation

PPE Pitch period entropy

Fig. 2. Example of speech signal of a subject with PD

The phonations were recorded in an Industrial Acoustics
Company (IAC) sound-treated booth using a head-mounted
microphone (AKG C420) positioned at 8 cm from the lips.
The microphone was calibrated using a class 1 sound-level
meter (B&K 2238) placed 30 cm from the speaker.
Computerized Speech Laboratory (CSL) 4300B hardware
(KAY Elemetrics) was used to record the voice signals
directly on computer, sampled at 44.1 kHz, with 16-bit
resolution [5].
C. Feature Extraction / Selection :
To calculate the characteristics, it is necessary to base the
selection on traditional as well as non-standard measurement
methods for all voice signals. Each method produces a unique
number for each of the 195 signals. Table II shows a list of the
measures used as characteristics of this study.
1) Calculation of traditional measures
This calculation was made using Praat software [6].
Traditional measurements are based on the application of
short-term autocorrelation to successive segments of the
signal, with peak peaking to determine the frequency of
vibration of the vocal cords (F0 or pitch period), and location
in time of the beginning of each cycle of vibration of the vocal
cords (pitch marks) [7].
TABLE II. ATTRIBUTE DETAILS FOR DIAGNOSIS OF PD PATIENT
Table Head Table Column Head
MDVP: F0 (Hz) Average vocal fundamental frequency
MDVP: Fhi (Hz) Maximum vocal fundamental frequency
MDVP: Flo (Hz) Minimum vocal fundamental frequency
MDVP: Jitter (%) Fundamental frequency perturbation (%)
MDVP:Jitter Absolute jitter in microseconds
(Abs)
To calculate the jitter and period disturbance measurements, it
is necessary to use the sequence of frequencies for each vocal
cycle, by taking the successive absolute differences between
the frequencies of each cycle and calculating the average over
a varying number of cycles, eventually normalizing by the
overall average.
The shimmer and amplitude perturbation measures are
obtained from the sequence of the maximum extent of the
amplitude of the signal within each vocal cycle. The average
difference of this sequence is taken as a measure of the
variation between cycle amplitudes. The noise-to-harmonics
(and harmonics-to-noise) ratios are obtained from the signal-
to-noise estimates of the autocorrelation of each cycle. To
know more about how to calculate the traditional measures
refer back to [6], [8] and [7].
2) Calculation of Nonstandard measures:
The calculation of the correlation dimension (D2) is based
on time-delay embedding the signal to reconstruct the phase
space of the nonlinear dynamical system in order to generate
the speech signal [10]. In this recreation phase space, complex
dynamics which are implicated in dysphonia, were indicated
by a geometrically self-similar (fractal) object [9]. We employ
the Time Series Analysis (TISEAN) implementation [11]. The
recurrence period density entropy (RPDE) quantifies the
extent to which dynamics in the reconstructed phase space
after time-delay embedding can be regarded as strictly
periodic, i.e., repeating exactly [13]. The recurrence period T
represent a recurrent signal that, after a certain length of time,
returns to the same point in the phase space. It has been shown
that the diversion from periodicity estimated by the entropy H
of the distribution of these recurrence periods 𝑃(𝑇) is a
convenient indicator of general voice disorders, as general
voice pathologies guide to impairment in the capability to
sustain regular vibration of the vocal folds [13]. The RPDE

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values ( 𝐻𝑛𝑜𝑟𝑚 ) is normalized by dividing through by the
entropy of the uniform distribution, to the range [0,1].
Finally, DFA represents a measure of the extent of the
stochastic self-similarity of the noise in the speech signal.
Mostly, turbulent airflow generates the noise in speech
through the vocal folds [13]. It is noticed that for general voice
disorders, the scaling exponent is larger for dysphonic than
healthy subjects [8]. The extent of amplitude variation 𝐹(𝐿)
of the speech signal over a range of times scales is calculated
by the DFA algorithm. And the self-similarity of the speech
signal is measured by the slope 𝛼 of a straight line on a log-
log plot of 𝐿 versus 𝐹(𝐿). These slope values (𝛼𝑛𝑜𝑟𝑚 ) are then
normalized by a simple nonlinear transformation to the range
[0,1][8].
D. Classifiers baselines:
In our study, the machine learning algorithms used are
Artificial Neural Networks (ANN) and K-nearest neighbors
(KNN). They are some of the most popular classifiers in
literature. Each one of them, has his own techniques and
methods of tuning that will be used to classify PD patients
from healthy ones.
1) ANN Classification:
The biological neural networks were behind the
appearance of the artificial neural networks. It comprises a
large network of interconnected neurons which exchange
signals between each other. These links are weighted based on
past experiences. Thus; it’s an adaptive network capable of
learning [14].
The Artificial neural networks are widely used to model
complex patterns, prediction and classification problems.
Fig.3 shows the general structure of artificial neural network.
During the training of the ANN, there are many different
optimization algorithms. They, all, have different
characteristics and performance regarding requirements,
speed and precision. Therefore, we should be very accurate to
choose the correct algorithm in accordance with the correct
conclusion of the problem. The main optimization algorithms
used in the training phase of multilayer networks are Gradient
Descent (GD), Batch Back Propagation (BBP), conjugate
gradient descent (CGD) and Levenberg-Marquardt (LM)
training algorithms. In our study, it was preferred to use LM
algorithm for the classification process, which is a nonlinear
optimization algorithm. Developed by Kenneth Levenberg
and Donald Marquardt, the LM algorithm represent a
combination of Newton’s method in back propagation and
gradient descent characteristics [15]. It has been designed to
work specifically with loss functions which take the form of a
sum of squared errors. It works with the gradient vector and
the Jacobian matrix.
m data were divided into 3 parts of artificial neural networks:
f = ∑ e2i
i=1
Where m is the number of instances in the data set.
The weight calculation equation used in LM algorithm is
shown in (9).
W = (JT J + μU)−1 JT e
Where J is Jacobian matrix, which is composed of
derivatives of errors at each weight, μ is a scalar, U unit matrix
and e represents the error vector of the network.
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Fig. 3. General Structure of Artificial Neural Network
2) K-NN Classification:
The K-Nearest Neighbors or KNN is one of the supervised
machine learning algorithms most used and one of the
simplest classification algorithms. It’s a method to data
classification, that determines what group a data point is in by
looking at the data points around it. A case is classified based
on the majority vote of its neighbors, with the case being
assigned to the class most common amongst its K nearest
neighbors measured by a distance function. In summary, the
formal k-NN classifier algorithm is as follows:
arg min(𝑑𝑒 (𝑡, 𝑜, 𝑘))  Identify P (10)
Where 𝑡 is the training data, 𝑜 is the object to be
classified, 𝑃 is the assigned class of the new object, 𝑘 is the
number of closest neighbors to be considered, and 𝑑𝑒 is the
Euclidean distance given by:
L
de (t, o, k) = √∑( t i,k − oi,k )2 (11)
i=1
Where 𝐿 is the length of each of data vector.
To have the optimal results, we should choose the optimal
value for K and the appropriate method to calculate distance.
Historically, the optimal value of k for most datasets has been
between 3 and 10. There are different ways of calculating
distance, but one way might be the preferable one according
to the problem we are solving. However, the Euclidean
Distance is the popular choice.
III. RESULTS AND DISCUSSION
The present study is based on 22 acoustic features,
extracted from dysphonia measurements of people. It is used
to identify PD patients. The 22 features are provided in table
II.
A. ANN Classification:
To perform the classification process, Neural Network
Pattern Recognition tool (nprtool) was used in MATLAB. Our
(8) Training: the network is trained according to 70% from the
data set (137) which is given to the network during the
training.
Validation: when the development of the network stopped,
we use 5% from the data set to terminate the training.
Test: to measure the performance parameters of the
(9) network during training and validation steps, we use 25%
from the data set. Figure 4 shows the view of ANN.
 The regression graphs of the training, validation and test
data set are shown in figure 5, 6 and 7 respectively. The figure
8 shows the entire regression of the data set.

Fig. 4. The view of ANN

Fig. 8. All Dataset regression

B. K-NN Classification:
The data were divided into training (70%) and test (30%)
data. The KNN classifier method, was used here, to store all
the training data. We used ten-fold cross validation method,
which is a reliable technique widely used to assess the
accuracy of the predictive system and for avoiding the over
fitting. The number of neighbors was used to classify the new
example and the distance function was used to determinate the
nearest neighbors. The best accuracy of 79% was obtained
Fig. 5. Training regression when the number of neighbors taken was k=1, by using the
cosine distance.
By using ANN, 96.7% correct classification rate was
obtained. And for the KNN, the accuracy achieved was
79.31%. Thus, the classifier result that was produced by the
ANN is the best score to our knowledges.
Our results show that the ANN is better that the KNN for
classifying PD patients, according to the higher accuracy
obtained results.
IV. CONCLUSION:
In this study, we aimed to compare between machine
learning classifiers, Artificial Neural Networks (ANN) and K
nearest neighbors (KNN). We used them to detect PD patients
from healthy ones. The ANN algorithm yielded the best score.
The experiments results gained 96.7% classification accuracy
Fig. 6. Validation regression for ANN, depending on the data set and the number of
acoustic features used. MATLAB is one of the widely used
software for this purpose. Nowadays, in the medical imaging
domain, many classification techniques are applied in order to
achieve a highest accuracy.
This work can be extended to other machine learning
algorithms and diverse datasets in order to increase the
performance of classifiers to achieve the highest score of
accuracy. As a perspective we intend to work on hybrid
classification methods which can gather ANN and KNN with
other machine learning classifiers.

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