Pattern Recognition Letters 125 (2019) 78–84

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Pattern Recognition Letters

journal homepage: www.elsevier.com/locate/patrec

Handwritten pattern recognition for early Parkinson’s disease

diagnosis ✩
Lucas S. Bernardo a, Angeles Quezada b, Roberto Munoz c, Fernanda Martins Maia d,
Clayton R. Pereira e, Wanqing Wu f,∗, Victor Hugo C. de Albuquerque a,∗
a
Graduate Program in Applied Informatics, University of Fortaleza, Fortaleza-CE, Brazil
b
Instituto Tecnológico de Tijuana, Tijuana, B.C, México
c
Escuela de Ingeniería Civil Informática, Centro de Investigación y Desarrollo en Ingeniería en Salud, Universidad de Valparaíso, Valparaíso, Chile
d
Medical Sciences Post-Graduation Program, University of Fortaleza. Neurology Department, Hospital Geral de Fortaleza, Fortaleza-CE, Brazil
e
UNESP - São Paulo State University, School of Sciences, Bauru, Brazil
f
School of Biomedical Engineering, Sun Yat-Sen University, Guanzhou, 510275, PR China

a r t i c l e i n f o a b s t r a c t

Article history: Parkinson’s disease is a neurodegenerative disorder that affects around 10 million people in the world
Available online 8 April 2019 and is slightly more prevalent in males. It is characterized by the loss of neurons in a region of the
brain known as substantia nigra. The neurons of this region are responsible for synthesizing the neuro-
MSC:
transmitter dopamine, and a decrease in the production of this substance may cause motor symptoms,
41A05
41A10 a characteristic of the disease. To obtain a definitive diagnosis, the patient’s medical history is analyzed
65D05 and the subject submitted to a series of clinical exams. One of these exams that can take place in the
65D17 clinical environment comprises asking the patient to create a series of specific drawings. Our work is
based on asking the patients to draw using a software developed for this specific purpose. The drawings
Keywords: will then be passed through a series of image methods to reduce noises and extract the characteristics
Parkinson’s disease
of 11 metrics of each drawing; finally, these 11 metrics will be stored. Machine learning techniques such
machine learning
as Optimum-Path Forest, Support Vector Machine remove, and Naive Bayes use the dataset to search and
image processing
learn of the characteristics for the process of classifying individuals distributed into two classes: sick and
healthy.
© 2019 Elsevier B.V. All rights reserved.

1. Introduction tional progress and medical care precautions, no diagnostic treat-

Parkinson’s disease (PD) is the second most prevalent neurode-
generative disease in the world affecting approximately 10 million
people worldwide [10]. It consists of a neurodegenerative dysfunc-
tion that is present in around 50–150 cases per 10 0,0 0 0 people,
men being more susceptible to the disease [8]. PD is character-
ized by a loss of neurons in the region of the brain known as
the substantia nigra. The neurons of this region are responsible
for synthesizing the neurotransmitter dopamine. Despite interna-
✩
Conflict of Interest Statement: The authors declare that there is no conflict of
interest regarding the publication of this article.
∗
Corresponding author.
E-mail addresses: lucass.bernardo_@edu.unifor.br (L.S. Bernardo),
angeles.quezada@tectijuana.edu.mx (A. Quezada), roberto.munoz@uv.cl
(R. Munoz), fernandamaia@unifor.br (F.M. Maia), clayton@fc.unesp.br (C.R. Pereira),
wuwanqing@mail.sysu.edu.cn (W. Wu), victor.albuquerque@unifor.br
(V.H.C. de Albuquerque).
ment has yet been seen to reduce or prevent the progression of
the disease [5]. However, technology has facilitated a better under-
standing of the characteristics of the disease [3]. The use of sensors
makes possible the collection of a range of data characteristics of
dopamine; an example would be the sensors used by the Mobility
Lab System to measure the walking parameters of individuals ad-
ministered with Parkinson’s Disease and are being used to monitor
the signs of the disease [11]. Software and mobile applications such
as the ones developed by [2] are used to monitor dopamine activi-
ties by means of a series of activities carried out on the cellular de-
vice itself. In [12] extracted five characteristics from the drawings
made by patients. Their objective was to determine the distance
between the drawings and generate an Euclidean sum. In [6] used
a digital drawing table to obtain differences in hand movement
and muscular coordination of patients administered with PD. Their
objective included obtaining a metric that could differentiate peo-
ple with this disease based on their characteristic movements.
In [15] used, as attributes, the fundamental frequency of the high

https://doi.org/10.1016/j.patrec.2019.04.003
0167-8655/© 2019 Elsevier B.V. All rights reserved.
 L.S. Bernardo, A. Quezada and R. Munoz et al. / Pattern Recognition Letters 125 (2019) 78–84 79

and low voice patterns and reinforced the effectiveness of the use premature stage. The proposed model is evaluated using various
of machine learning techniques for detection in the early stages of types of datasets of voice, handwriting (spiral and meander), and
the disease. Lastly, in [1] developed a device for monitoring and speech. The proposed algorithm can help predict PD with an esti-
diagnosing PD through the progress of patients. As a result of this, mated accuracy of 94.83%, detection rate of 98.28%, and false alarm
they observed a percentage of 91% sensitivity and 95% of specificity rate of 16.03%, and further aid individuals in receiving a functional
for the 3 m gait and, in the 10m path, 96% sensitivity and 100% treatment at an early stage. To finish, in [1] developed a device
sensitivity were observed, respectively. for monitoring and diagnosing PD based on patientsâ gait. As a re-
Currently, there is no specific test that can diagnose PD. For sult, they observed 91% sensitivity and 95% specificity for the gait
this reason, the diagnosis of the disease is carried out by a set of 3 m and, for the stroke of 10m, 96% sensitivity and 100% of
of especific clinical criteria designed by movement disoreders spe- sensitivity, respectively.
cialists and neurological laboratory tests [4]. PD should be consid-
ered if a patient has one or more of the characteristic symptoms, 3. Methodology
including bradikinesia, resting tremor and rigidity. Resting tremor
make the diagnosis more propitious although, in about 20% of the In this section, the experimental, computational, and mathe-
cases, the patient does not present with tremor at rest [13]. PD is a matical procedures used for the acquisition and extraction of the
disease that progresses slowly, making it difficult to diagnose it in characteristics for the construction of the vector are detailed.
its first stage [9]. This information is used to train the algorithms In order to classify volunteers based on their drawings (using
so that they can distinguish between healthy individuals and those machine learning), it was necessary to extract a set of characteris-
with PD. The objective of this research is to develop a software tics that comprised a set of mathematical values from which the
that allows, with the help of a neurologist, selection of patterns mean and variance can be extracted for the construction of the
through specific drawings, collecting data from healthy individuals’ vector of the characteristics of the image subsequently classified
drawings and patients with Parkinson’s disease to develop image through three supervised machine learning algorithms: Optimum-
processing routines capable of extracting characteristics from the Path Forest (OPF), Support Vector Machines (SVM), and Naive
images collected. This software can also compare the level of pre- Bayes classifiers. These three algorithms were used to obtain the
cision of the algorithms in order to establish which algorithm is best result regarding the classification of individuals.
the most precise and to generate a confusion matrix to determine For the extraction of the characteristics, our work was divided
which attribute and pattern are the most significant to diagnose into three stages: (1) pre-processing, (2) processing, and (3) extrac-
somenone with Parkinson’s disease. tion of attributes (shown in Fig. 1).
The remainder of this paper is organized as follows:
Section 2 presents a review of the literature on related problems; 3.1. Interface
Section 3 explains in detail the methodology used to address this
work. Finally, the experimental results and the conclusions of this The first stage of the classification process involved selecting
study are presented in Sections 4 and 5, respectively. two-dimensional design patterns that individuals would draw. To
this end, the drawings commonly used in clinical settings were
2. Related works selected in order to diagnose or determine the degree of PD. As
shown in Fig. 2, the selected patterns included a cube, a triangle,
In recent years, many works in the fields of automatic classi- and an Archimedean spiral.
fication have been conducted with the main purpose of detecting After the selection of the patterns, an easy-to-use interface was
diseases. developed with the aim of processing the drawings made by the
For example, in [12], the authors determined five characteris- individuals and extracting the attributes of the same. The inter-
tics from the drawings made by patients. Their objective was to
determine the distance between the drawings and generate an Eu-
clidean sum in order to determine whether a pattern of fine motor
skills existed in a patient with PD. In [6] used a digital drawing
table to obtain differences in hand movement and muscular coor-
dination of patients with PD. They aimed to obtain a metric that
could differentiate characteristic movements of people with PD.
In [15] used, as attributes, the fundamental frequency of the
high and low voice patterns and reinforced the effectiveness of the
use of machine learning techniques for the detection of the dis-
ease in its early stages. In [7] the aim of this paper was to create
a computerized behavioural model that could predict an impaired
reaction condition for Huntington Disease (HD) patients. They de-
veloped a mobile application to collect a dataset by extracting fin-
ger touch coordinates and reaction time features extracted from
test subjects (healthy and HD patients). They created an artificial
neural network (ANN) to predict the functional capacity level and
Fig. 1. Strategy proposed approach.
fuzzy logic system (FLS) in order to determine the reaction con-
dition (stage) for an individual. They combined ANN with FLS to
create a hybrid model to predict the impaired reaction condition
for HD patients and simulate an experimental setup for test sub-
jects to perform a suggested exercise at the different points of time
to predict a possible impaired reaction condition with the help of
the proposed hybrid model.
In [14], this paper presents the Modified Grey Wolf Optimiza-
tion algorithm that can help identify the symptoms of PD at a Fig. 2. Design patterns.
80 L.S. Bernardo, A. Quezada and R. Munoz et al. / Pattern Recognition Letters 125 (2019) 78–84
Fig. 3. Main interfaces.
face was developed for Windows using Visual Studio in C#; it
comprised two main screens, one for the drawing to be exhib-
ited for the individual during the collection and another for con-
trolling and monitoring the works by the examiner (as shown in
Fig. 3). Initially, the examiner needs to load the drawing patterns
by clicking on the “load” button and then select the drawing pat-
tern that needs to be made by the individual. After selecting this
pattern, they need to click on the “start” button so that the collec-
tion screen can open, presenting the selected pattern.
3.2. Pattern processing
In the case of both types of images, the noises consist of in-
terferences in the color channels. This causes the images to not
present a pure coloration in one of the base channels. To avoid this
situation, that is, to eliminate or attenuate the noises, it is neces-
sary to prepossess the images. Both images are present on the RGB
scale. The noises present in each image consist of pixels of tonality
that are do not match up to the maximum tone of one of the chan-
nels of the scale, that is, they do not have a value equal to 255 in
any of the channels. Once the background of the images becomes
solid black in color, zero in the three channels of the RGB scale,
the filtering process can detect pixels with a tone above a given
threshold value, the value being chosen empirically, of 40.
After choosing this threshold value, a scan is conducted in the
matrices of both images and substitute values with an intensity
greater than the threshold value by 255. Algorithm 1 presents the
Algorithm 1: White image color filter.
Data: RGB image to filter
Result: Composite image only of minimum ormaximum
value of the RGB scale
begin
RGBfiltered[m,n] ← 0;
k← 1;
for i ← 1 & i≤m do
for j ← 1 & j≤n do
R ← RGB[i,j].red;
G ← RGB[i,j].green;
B ← RGB[i,j].blue;
if R≥40 or R≥40 or R≥40 then
RGBfiltered[i,j] ← 255;
process of prepossessing images. The resulting image consists of an
image on the RGB scale whose pixels have values of 255 or 0 on
all channels. This image can then be converted to grayscale using
the Gray scale method included in the image processing library (as
shown in Fig. 4).
The last stage of preprocessing requires converting the image in
grayscale to black and white (BW). At this stage, a threshold value
of five for the conversion is adequate. After this process, the image
expands to 1 px. This is done in order to minimize the potential
Fig. 4. Results of applied the Algorithm 1. (a) original Image (b) dilated image.
Fig. 5. Result of dilated image. (a) grayscale image (b) dilated image.
Fig. 6. Skeleton of the image. (a) dilated image (b) skeletal image.
failures generated after the use of filtering methods. The dilated
image, shown in Fig. 5 (b), is then used for processing.
3.3. Processing
The processing stage consists of a set of operations for image
processing. These operations are performed using mathematical
equations that are applied to extract the attributes of the image
and generate its feature vector.
• Skeletonization process
After being converted to the BW format, both images go
through a skeletal process. The morphological operation of the
skeletonization in the binary image requires obtaining the base
form on which the image was constructed or, in other words,
the baseline of the image. The skeletonization of images is useful
in that it simply represents the action, maintaining several of its
topological information and the size of the original image, which
makes it crucial for a series of applications, such as identification
of writing and OCR among others (15).The refined image, repre-
sented in Fig. 6 (b), is used to obtain the attributes.
After obtaining the skeletons, the software makes a new explo-
ration, this time to obtain the points of the base frame of both the
images and add them to a list of points that will be used for the
realization of the mathematical operations for the extraction of the
characteristics from an image. Algorithm 2 was used to obtain the
point vectors of the image.
On several occasions, the images are presented in different di-
mensions. This factor precluded the comparison of both once the
comparison was made following the position of the vectors. To
solve this problem, it is necessary that they are equal to the di-
mensions of the data. The process used to resize the vector in-
volved removing the additional possessions of the largest vector,
eliminating the values with positions that exceeded the number of
positions of the smallest vector. In other words, a “truncation” of
the largest vector was performed so that the dimensions are equal.
The process of “truncation” was obtained using Algorithm 3.
 L.S. Bernardo, A. Quezada and R. Munoz et al. / Pattern Recognition Letters 125 (2019) 78–84 81

Algorithm 2: Obtaining the vector of points of the skeleton of

the image.
Data: ImageSkeletonized
Result: Vector with the position of the points ofthe skeleton
begin
SkeletonStitches[m ∗ n] ← 0;
Fig. 8. Relative distances.
k← 1;
for i ← 1 & i≤m do
for j ← 1 & j≤n do
if ImageSkeletonized[m, n] > 0 then
SkeletonStitches[k] ←[i,j];
k++;
k++;

Fig. 9. Representation of circular distance.

Algorithm 3: Equating the size of vectors.
Data: Vector of skeleton points of image and standard
Result: Vectors of equal size
begin
if DrawingV ectorLength > StandardV ectorLength then
StandardVectorLength ← StandardVectorLength;
if Lengt ho f t heStandardV ector > DrawingV ectorLength then
DrawingVectorLength ← StandardVectorLength;

Fig. 10. Manhattan distance between pixels.

calculate the mean and the standard deviation.


P¯Q = (X p − X q )2 + (Y p − Y q )2 (1)

• Relative distance

To obtain the relative distance, represented in Fig. 8, an average

between two points of the same position in the vectors of points of
Fig. 7. Representation of distances.
the skeleton of the image (P) and of the pattern (Q) was obtained.

3.4. Feature vector
For the feature extraction, seven attributes were taken into ac-
count: (1) Euclidean distance, (2) relative distance, (3) circular dis-
tance, (4) Manhattan distance, (5) pixel similarity, (6) design speed,
and (7) design time.
• Circular distance
The measurement of the circular distance, presented in Fig. 9,
consists of the relative distance between the pattern, the design,
and an imaginary circular drawn using the center of the regions
the images and the most distant point present in both images; this
circumference can be represented by Eq. (2).

• Euclidean distance R2 = (X − X (center ))2 + (Y − Y (center ))2 ; (2)

To calculate the Euclidean distance between the points of the
image and the pattern to be drawn, both images were explored re-
garding the vector of points (as shown in Fig. 7). This process was
conducted using Algorithm 4. For this, the distance of each point
in a vector to its corresponding in the other vector was calculated.
This value was then stored in a third vector that would be used to
Algorithm 4: Obtaining the distance vector of the images.
Data: ImageSkeletonized
Result: Vector with the position of the points of the skeleton
begin
distances[m* n] ← 0;
k ← 0;
for i←1 & i≤m*n do
k++;
distances[k]2 ← (Drawing(x ) − Standard (x ))2 +
(Drawing(y ) − Standard (y ))2 ;
To determine the circular distance, the distance of the points P
of the drawing and points Q of the pattern to the circumference C
and are calculated and then their values subtracted.
• Manhattan distance
Manhattan distance consists of the sum of the difference be-
tween the coordinates of the points of the images. At each point
of the image, a Manhattan distance of a point corresponds to the
vector of the pattern. Subsequently, the mean and the standard de-
viation of the values are calculated (as shown in Fig. 10).

DManhattan = |Px − Qx| + |Py − Qy| (3)
• Mouse pointer speed
In order to determine the speed of the pointer, the position of
the cursor is captured at a fixed interval of 50 ms, and the move-
ment of the cursor in this interval is determined. At the end of the
set, the average speed of the drawing is calculated. This procedure
is shown in Fig. 11.
82 L.S. Bernardo, A. Quezada and R. Munoz et al. / Pattern Recognition Letters 125 (2019) 78–84
Fig. 11. Mouse pointer speed.
Algorithm 5: Similarity algorithm.
Data: Standard; Design
Result: Percentage of similarity between images
begin
similarity ← 0;
k ← 0;
for i←1 & i≤m do
for j←1 & j≤n do
if Standard[m,n] > 0 & Design[m,n] > 0 then
similarity++;
else
difference++;
similarity ← (similarity/(similarity+difference)) * 100
• Similarity between pixels
The last attribute extracted from the image requires establish-
ing its similarity with the standard figure. To do this, a new explo-
ration of the image is made in order to determine the presence of
a pixel with white coloration in specific points of the images and
compare if the same position presents the same coloration in the
base image. Algorithm 5 represents the process of obtaining the
similarity of the images.
3.5. Data capture
For the purpose of collection, the project was made to go
through an approval process by the HGF medical ethics committee.
In order to carry out the collections, an office was assigned to the
department of the Nucleus of Neurology of the hospital, which has
a computer monitor that was used to make the drawings. When
collecting, the monitor was connected to a notebook responsible
for running the software; the monitor was then directed to the
individual. In order to maintain constant collection condition, the
same mouse and mouse-pad were used for the collections, result-
ing in factors such as DPI (Dots Per Inch or device sensitivity) and
resistance to mouse movement due to the mouse pad, if they re-
mained constant. For collection, each drawing was required to be
retaken three times using the same hand that was used for writing.
The data storage was conducted only when the individuals con-
firmed that they had completed the drawings to the best of their
efforts.
After removing the attributes of the image, the software added
them to the.xlsx files generated for the storage of the collected
data in order to be later used in the training and test the efficiency
of the machine-learning algorithms used. For the training of these
algorithms, 50% of the data collected from each design pattern was
selected. The data was then passed through the three selected al-
gorithms, which then returned a ".txt" file containing the informa-
tion on efficiency and effectiveness.
3.6. Mindwave EEG
To determine the level of care of the patients who underwent
the examination and observe the correlation between the pre-
Fig. 12. Control individual.
Fig. 13. Individual with Parkinson’s initial tremulous form.
Fig. 14. Individual with Parkinson’s advanced flutter.
sented precision and the level of attention, Mindwave was used.
Mindwave has two channels and can detect brain waves as waves
a and b by measuring information from 0 to 100% of the values of
attention, meditation, and eye blink detection. We used the Mind-
wave EEG to determine the level of attention of the patients per-
forming the exam and observed the correlation between the accu-
racy presented and the level of attention. For the reception of the
data from the EEG, a software was developed, which was stored
in a database. When starting to draw, the software starts as a pro-
gram in the background for the user. This software is used as a flag
in the system and by the EEG software to detect the flag indicating
the start of the drawing and capture the attention levels presented.
When closing the drawing form, the software stops the process of
data collection, calculates the average of the read values, and then
stores them in the database.
4. Results
As a result of this work, a software was developed. Its main
function involved acquiring patterns of drawings and extracting
characteristics. The data were used in three different classifiers:
OPF, SVM and a Bayesian classifier. The environment was used to
collect data from patients diagnosed with PD.
The study was conducted for three months, which allowed the
collection of data from 10 individuals diagnosed with PD with ages
between 40 and 80 years. Nine out of these patients exhibited with
the disease in the advanced stage while one was found to be in a
mild stage. For the control group, 10 random individuals of dif-
ferent ages were used to evaluate the algorithm and the chosen
attributes.
4.1. Data capture process
The time of realization of the drawings were seen to vary with
the degree of advancement of the disease. In the most advanced
case of EP, patients took approximately an hour and thirty min-
utes to complete the nine designs requested. On the other hand, in
milder cases, the time was reduced to 20 min. For healthy indi-
viduals, the design time varied between 10 and 20 min. For the
control group, the most difficult pattern was the cube, as shown
in Figs. 12(c), 13(b), 14(b), and 15(b) whereas, for users with PD, it
was the spiral pattern, as shown in the Figs. 14(c), 15(c) y (c). Be-
fore starting the process of data collection, the participants were
 L.S. Bernardo, A. Quezada and R. Munoz et al. / Pattern Recognition Letters 125 (2019) 78–84 83

Table 2
Sensitivity.

Algorithm Triangle Cube Spiral

Bayes 0.86 0.68 0.75

OPF 0.89 0.68 0.88
SVM 1 1 1
Fig. 15. Individual with Parkinson’s initial rigid-akinetic form.

Table 1
Accuracy.

Algorithm Triangle Cube Spiral

Bayes 0.85 0.87 0.89

OPF 0.83 0.87 0.89
SVM 0.96 1 1

Fig. 16. Confusion matrix – Bayesian classifier.

asked if they were familiar with a computer; if not, the partici-

pants were asked to use the software freely until they felt con-
fident enough to make the drawings. For both the groups of indi-
viduals, the triangle pattern, Figs. 12(a), 13(a), 14(a), and 15(a), was
considered the easiest to draw.

4.2. Data collection from drawing

Fig. 17. Confusion matrix – OPF.

The subjects in the study generated a total of 76 data for the

cube pattern, 80 for spiral Archimedean pattern, and 85 for the
triangle pattern. These data were classified as follows: healthy – 1
and with PD – 2. Through the data collected, it was possible to ob-
serve that the degree of advancement of the disease significantly
influenced the values generated. Individuals with the disease in its
early stages, as shown in Fig. 13, obtained results similar to that
of healthy individuals, presented in Fig. 12, and concluded the de- Fig. 18. Confusion matrix – SVM.
signs at the same time. Individuals with advanced disease, shown
in Fig. 14, had a worse performance and needed more time to fin-
ish the drawings. The individual with the tremor-shaped disease in 4.5. Sensitivity
the initial stage, whose designs can be seen in Fig. 15, performed
worse than individuals with the disease in the akinetic form in the Sensitivity measures the proportion of real positives that are
initial stage. correctly identified. For the algorithms used, it is possible to see
that the SVM obtained a better sensitivity for the three patterns,
correcting 100% of the classifications of individuals with PD accord-
4.3. Machine learning ing to the input data shown in Table 2.

The generated data were stored in three different vectors where
the data is collected for each of the drawing patterns used in this
study. These vectors were used in three different machine learning
algorithms: OPF, SVM, and Bayesian classifier. For the training, 50%
of the data generated was used, adding a total of 43 data for the
triangle pattern (21 class 1, 22 class 2), 38 for the cube pattern (20
class 1, 18 class 2), and 26 for the spiral pattern of Archimedes (20
class 1, 20 class 2). For training, 42 data were used for the triangle
pattern, 38 for the cube pattern, and 40 for the Archimedes spiral
pattern.
4.4. Accuracy
Precision can be defined as the percentage of correctly classified
instances and can be observed through the OPF, SVM, and Bayesian
classifier algorithms presented in Table 1. Through these data, it is
possible to see that for the three patterns used in this work, the
SVM classifier obtained a better precision. In contrast, the OPF and
the Bayesian classifiers presented similar results in the patterns,
presenting results inferior to the SVM. From the patterns used, the
Archimedes cube and spiral patterns presented a greater precision
than the triangle pattern, which indicates that the cube and spiral
patterns provide a better response to identifying individuals with
PD according to the attributes and data used.
4.6. Confusion matrix
Through the confusion matrix, it is possible to observe graphi-
cally the way in which algorithms classify data. At the vertex (1,1)
of the matrix presented in Figs. 16–18, we can observe the number
of individuals correctly classified as sick, class 2, has been calcu-
lated the total data collected. At the vertex (0,0), we can observe
the number of individuals correctly classified as healthy, class 1, is
based on the input data. The vertex (1.0) presents the number of
individuals who have been incorrectly classified as patients while
the apex (0,1) presents the number of individuals incorrectly clas-
sified as healthy. Matrices are presented for all the three machine-
learning algorithms.
4.7. Discussion
Based on the results, it can be seen that amongst all the
three algorithms used, SVM obtained a better response to the pre-
sented data set. This algorithm, used in the patterns of cube and
Archimedean spiral obtained a 100% accuracy with a sensitivity of
100% during the classification stage of the two classes in which the
data sets presented in this work were divided.
Regarding the three patterns used in this work, the SVM clas-
sifier has obtained a better precision. The results obtained in the
84 L.S. Bernardo, A. Quezada and R. Munoz et al. / Pattern Recognition Letters 125 (2019) 78–84
present work support this. On the other hand, the OPF classifiers
and Bayesian classifier presented similar results in the patterns,
presenting results inferior to the SVM. Of the patterns used, the
bucket and spiral patterns of Archimedes presented better accu-
racy than the triangle pattern, indicating that the cube and spi-
ral patterns provide a better response for the identification of
individuals presented with PD based on the attributes and data
used.
It should also be emphasized that of the individuals who partic-
ipated in this survey, only one ended up desisting from collecting
the drawings until the end, as he presented fatigue and headache
during the realization of the drawings, having made only the cube
and triangle patterns in the time interval of one hour and thirty
minutes.
The other individuals used in this study did not complain about
the performance of the drawings, although individuals with the
disease at more advanced stages faced difficulty in making the
designs without interruptions. In conclusion, regarding the draw-
ings, it was necessary that the participants stopped drawing to give
their hands a rest and continue only when they felt comfortable to
do so.
One of the limitations of the software used is that it was de-
veloped for desktop computers. Currently, due to the increasing
growth in technology, it is necessary to develop the same applica-
tion as a platform for mobile devices as well. Also another limita-
tion of this software is that it is not developed for a web platform;
therefore, it cannot be accessed from anywhere.
5. Conclusions and future work
We developed a system capable of capturing drawings made
by healthy individuals and those diagnosed with PD in the soft-
ware developed. The attributes were successfully extracted and
subjected to the selected machine learning algorithms. The system
presented a new approach, based on the bibliographic survey car-
ried out, to capture the input data, presenting a good performance
in terms of precision and sensitivity when presenting 100% success
for the of patterns cube and Archimedean spiral and 96% for the
triangle pattern using a vector support machine (SVM) as a ma-
chine learning algorithm.
Based on the values used for the tool test, it was possible to
observe that the system presented a viable and low-cost solution
for the detection of PD, which offers a good solution for future de-
tection of the disease.
As a part of future work, the following points are proposed:
More data needs to be collected from healthy individuals and those
diagnosed with PD to make the more complete data for more in-
dividuals presenting with PD in the trembling form. The system
needs to be incorporated into a web platform with the goal of
being accessible from any location and by any individual without
the need of installation. A mobile platform needs to be developed,
since access to a smartphones often becomes simpler and easier
than accessing a computer, further extending the reach of such a
tool.
Acknowledgments
This effort has been supported by Brazilian National Coun-
cil for Research and Development (CNPq) via grants nos.
304315/2017-6 and 430274/2018-1 and in part by the Shen-
zhen Governmental Basic Research Grant (JCYJ20160429174426094,
JCYJ20170552198154152), the National Natural Science Foundation
of China under grants (61873349, U180120019).
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