RU2691521C1 - Method for evaluating small hand motility function for early detection of cognitive disorders - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: method refers to medicine, namely to vascular neurology, and can be used for early detection of cognitive disorders. Patient is suggested to write a standard extract of 60 characters for dictation. Speed of writing is measured using an electric stopwatch. If the writing speed is more than 23 s, a degree of fine motor motility disorder and early manifestations of cognitive impairment are stated. If the letter is more than 31 s, lung light cognitive impairment is stated. If the letter is more than 36 s, moderate cognitive impairment is stated.EFFECT: method provides adequate assessment of motor function of hand in patients with organic damage of nervous system due to consideration of quantitative characteristics of writing.1 cl, 2 tbl, 1 dwg, 2 ex

Description

Technical field

The invention relates to medicine, in particular, to neurology, rehabilitation medicine, rehabilitation and can be used to assess changes in the motor function of the hand for early detection of cognitive impairment.

The level of technology

There is a method of assessing difficulties in writing, “systematic screening of handicaps” (Systematic Screening of Handwriting Difficulties; SOS-test), conducted in 87 (61 men, 26 women) patients with Parkinson's disease (BP) aged 58-71 years and 26 healthy subjects (8 men, 18 women) aged 54-71 years, writing in English and German (Nackaerts E, Heremans E, Smits-Engelsman VSM, Broeder S, Vandenberghe W, Bergmans B, Nieuwboer A. Validity and reliability of a new tool for evaluating handwriting in Parkinson's disease // PLoS ONE. 2017; 12 (3): e0173157. doi: 10.1371 / journal.pone.0173157).

Participants were asked to copy as many sentences (words) as possible from the proposed passage of text in 5 minutes, while writing was necessary as quickly and accurately as possible, the handwriting had to correspond to what it was in everyday life. Next, a correlation analysis was performed between a number of indicators evaluating the fine motor function of the hand (writing speed for 5 minutes, letter size (in mm), handwriting quality), and the results of the SOS-test. It was found that patients with PD had a significantly smaller letter size (p = 0.043), reduced writing speed (p <0.001) and worse handwriting quality indicators (p = 0.031) in comparison with the control group. It was revealed that the indicators of the SOS-test have a significant correlation with the function of fine motor motility of the hand (performance), the duration of the disease and the severity of PD. This method is used to identify and monitor difficulties in writing in patients with PD.

The disadvantage of the method lies in the fact that the proposed SOS-test (fluency of the letter, changes in the handwriting, regularity of the height of the letters, the distance between the letters, deviation from the main line) is intended for use in the clinical analysis of handwriting exclusively in Parkinson's disease, i.e. It has limited use only to assess the quality characteristics of a letter for a certain category of subjects in a narrow age range - for older people (54-71 years), to assess writing difficulties, and cannot be used to diagnose disorders of the fine motor function of the hand during early detection cognitive impairment in other patients.

Atasavun Uysal, Meltem

Arik, Naciye Vardar

. Relation to visual perception and hand functions of speed and legibility of handwriting in healthy adults // Journal of Exercise Therapy and Rehabilitation. 2016; 3(3):102-107. available et http://www.jetr.org.tr).There is also a known method for assessing the motor function of the hand, in which the speed of writing was studied, the handwriting intelligibility of 76 volunteers (39 men and 37 women) aged 23.38 ± 1.94 years (20-29 years); Subjects who had the consequences of an acute arm / hand injury or pain in the wrist area were excluded from the study (

Atasavun Uysal, Meltem

Arik, Naciye Vardar

. Journal of Exercise Therapy and Rehabilitation. 2016; 3 (3): 102-107. available et http://www.jetr.org.tr).

Patients were asked to write a text of 24 letters and then evaluated the intelligibility of words / letters and the speed of writing the text (Jebsen-Taylor Hand Function Test). The intelligibility of words was assessed by a formula that includes the ratio of the number of read words to the total number of written words. The main emphasis in assessing the quality of writing was focused on the visual memory of the subjects: persons with visual memory / perception deficiencies had difficulty remembering punctuation, and bad cursive writing was also noted when rewriting a word (fusion when writing large and small letters).

The disadvantage of the proposed method is the small sample size (regarding the assessment of visual memory deficit) and the narrow age range - young people (20-29 years), which does not allow to summarize these results and extrapolate to use in clinical practice, since this method evaluates only the visual deficit memory and literacy, but not the viability of the motor finger / hand dexterity in patients with early detection of cognitive impairment that occurs at an older age.

There is a method for assessing the motility of the hand, in which 120 conditionally healthy subjects, selected by gender and age, were divided into groups of 60-69 years, 70-79 years, 80-89 years, 90-99 years, and asked to write text on speed (Burger DK, McCluskey A. Australian rates 60-99 // Aust Occup Ther J. 2011 Oct; 58 (5): 355-63 doi: 10.1111 / j.1440-1630.2011.00955.x .).

The subjects performed two types of writing tasks: in one of the tasks (Handwriting Speed Test) they counted the number of letters written in 1 minute, in the second they evaluated the speed of writing text from 24 letters (Jebsen-Taylor Hand Function Test). When performing writing tasks, the subjects wrote the text in a pen, followed by an assessment of the parameters, then in pencil. Subjects either copied (copied) the text or invented it themselves.

The test participants wrote that the copied text was written faster than their own invented text, the speed of writing with a pen was higher than with a pencil. Significant differences in cursive between men and women within each age group were not found.

When comparing the polar age groups (60-69 years and 90-99 years), a significant reduction in speed was obtained twice, in the same way: in both men and women. Based on the data obtained, it was concluded that with increasing age, there is a noticeable decrease in cursive writing.

The disadvantage of this method is the inability to assess the change in cursive at different age stages, since not enough wide age range (60-99 years) is selected to estimate this parameter. In addition, this method was used to evaluate conditionally healthy (without obvious cognitive impairment) individuals. To assess the speed of writing in individuals with early cognitive impairment, it is necessary to expand the age range and include age from 50 years, since the initial manifestations of cognitive dysfunction may occur at an earlier age. It is also necessary to reduce the “step” of the assessment of the age range in order to obtain a detailed dynamics of changes in the fine motor function of the hand: in this study, a “step” of 10 years was chosen, it should be reduced to 5 years.

DISCLOSURE OF INVENTION

The problem solved by the invention is the development of a method for assessing the motor function of the hand for the early detection of cognitive disorders on the background of chronic cerebrovascular diseases (CCVD).

The technical result consists in quantifying the speed of writing, and based on the data on the increase in time spent writing the standard text passage, they conclude that the motor function of the hand is impaired, which may indicate early manifestations of cognitive disorders.

The problem is solved by a method of evaluating the function of fine motor motility of the hand in patients, including fixation of cursive using an electronic stopwatch, characterized in that the subject writes a standard excerpt of text of 60 characters from dictation, and determine deviations from the indicators of healthy subjects in the form of an increase in the writing time (time) standard text excerpt more than 23 seconds (26.51 ± 3.93 seconds), and according to the degree of increase in the duration (time) of writing a standard text excerpt from healthy subjects We conclude about the degree of dysfunction of fine motor motility of the hand and the presence of early manifestations of cognitive impairment. At the same time, if the duration of a letter of a standard text passage is more than 31 seconds, it is concluded that there are slight cognitive impairments (CN), if more than 36 seconds. - about moderate CN.

Brief Description of the Drawings

- общая,

- мужчины,

- женщины).FIG. 1 is a graph of cursive changes in different age groups for men and women (

- total

- men,

- women).

The implementation of the invention

Before starting the study, the patient is interviewed on the right-handedness of the hand, then they are given instructions for completing the task: dictation to write a standard excerpt of the text with a dominant hand with a sufficiently high, but comfortable for the test, speed.

Practically, the method is as follows: the subject is asked to write a passage of text of 15 words, containing 60 written characters (letters, punctuation marks):

Here is my village

Here is my home.

Here I roll in a sled

The mountain is steep.

We give specific examples of the implementation of the proposed method.

Example number 1.

As a comparison group, conditionally healthy subjects (GI) were examined in the amount of 140 people aged from 20 to 75 years (the average age in the group was 37.65 ± 15.87 years). Of these, two subgroups comparable in number and age were distinguished: 67 males aged 37.66 ± 15.87 years and 73 females aged 36.61 ± 15.76. The general group of the subjects (men and women) was also divided into different age groups: 20-25 years, 26-30 years, 31-35 years, 36-40 years, 41-45 years, 46-50 years, 51-55 years , 55-60 years old, 61-65 years old, 66-70 years old, 71-75 years old. There was no indication in the history of any complaints of dysfunctions of fine motor motility of the hand (including arthrosis of the small joints of the hand), a recent stroke (for older people), an acute injury to the hand / hand / fingers, the presence of neuropathy of the peripheral nerves of the dominant hand; and complaints of cognitive impairment.

Subjects were asked to write a standard text excerpt at a moderately fast pace. The time of writing the text was recorded using an electronic stopwatch in seconds, rounded to fractions of seconds. Then a statistical analysis was performed, calculating the average value of the indicator and the average standard deviation for each of the selected groups.

The following indicators were obtained: for the group as a whole, the speed of writing a standard text passage is 26.51 ± 3.93 seconds, the writing speed in the group of men (n = 67) - 27.29 ± 3.39 seconds, in the group of women (n = 73 ) - 25.76 ± 3.62 seconds, the reliability of differences was obtained p = 0.048.

Cursive in men and women depending on age (Fig. 1).

The speed of writing a standard text passage in the group of women with increasing age remains unchanged: 24.3 seconds. (at the age of 20-25 years) and 24.9 seconds. (at the age of 71-75 years), the speed of writing in the group of men significantly increases with age (p = 0.028): 24.6 seconds. (20-25 years) 29.6 seconds (aged 71-75 years).

It was found that women in different age periods retain a constant cursive, unlike men, i.e. The speed of writing in women does not have significant differences when comparing different age groups of women.

Example number 2.

We examined middle-aged patients (all women) in the amount of 27 people aged from 50 to 69 years old (average age 57 ± 5.83 years) with CCVD having lungs (LCN) and mild cognitive impairment (MCI) having complaints of memory loss , dizziness, sleep disturbance, fatigue. At the time of the examination, the patients already had a verified diagnosis of CCVD, which was also confirmed upon examination of the patients, based on anamnesis, neurological and general physical examination, neuroimaging and ultrasound data (based on case histories). There was no indication in the history of any complaints about dysfunctions of the fine motor motility of the hand (including arthrosis of the small joints of the hand), a recent stroke, an acute injury to the hand / hand / fingers, and the presence of neuropathy of the peripheral nerves of the dominant hand.

Patients were asked to write a standard excerpt from dictation at a moderately fast pace. The time of writing the text was recorded using an electronic stopwatch in seconds, rounded a fraction of seconds. Then a statistical analysis was performed, calculating the average value of the indicator and the average standard deviation.

The following indicators were obtained: the speed of writing a standard text passage in patients with small, subtle cognitive impairments is 33.73 ± 3.10 sec. The obtained indicators were compared with the indicators of cursive in healthy subjects as a whole in the group without cognitive impairment.

Comparative characteristics of the indicators are presented in Table 1.

It can be concluded that the speed of writing in patients with even mild (initial stages) manifestations of cognitive impairment was significantly (p = 0.0000) reduced in comparison with healthy subjects in the group as a whole.

The obtained indicators of cursive in the group of patients with such CNs were compared with the indicators of cursive writing in the subgroup of healthy subjects of the same age group (50-70 years) as patients with CN (50-69 years).

The following indicators were obtained: the speed of a standard text passage in patients in the group with initial cognitive impairment (33.73 ± 3.10 sec) was significantly reduced (p = 0.00023) compared to the cursive performance of a standard text passage in the subgroup of healthy subjects of the same age (27.15 ± 3.44 s).

The data of a comparative analysis of indicators of cursive in patients with initial cognitive impairment (CN) and healthy subjects (ZI) of the same age group are presented in Table. 2

It can be concluded that the speed of writing varies (decreases) depending on the preservation of cognitive functions in comparison with healthy subjects of the same age range.

A comparative analysis of the obtained indicators of cursive writing within a group of patients with initial CN, depending on the severity of a cognitive decline (LCN or MCN), was carried out. It was found that the speed of writing in patients in the subgroup with CCN (36.6 ± 1.52 seconds) was significantly (p = 0.00014) lower than in patients with LCN (31.33 ± 1.51 seconds).

Thus, the method according to the invention allows to quantify the motor function of the hand in patients, depending on the severity of even the initial cognitive impairment in patients. Therefore, it can be recommended as a clinical tool for standardized screening for the deficit of fine motor motility of the hand at the initial stage of the manifestation of cognitive impairment, which will make it possible to prescribe an initial preventive therapy that prevents further increase in cognitive deficit.

Claims (2)

1. A method of evaluating the function of fine motor motility in patients for early detection of cognitive impairment, including fixing cursive using an electronic stopwatch, characterized in that the subject writes a standard excerpt of 60 characters dictation, then determine the deviations from the indicators of healthy subjects in the form increase the length of the writing speed of more than 23 s and the degree of increase in the duration of writing a standard text excerpt compared with healthy subjects make a conclusion about the degree of violation of nktsii fine motor brushes and the presence of early signs of cognitive impairment. 2. The method according to claim 1, characterized in that, with a letter duration of more than 31 seconds, it is concluded that there are mild cognitive impairments, and with a duration of more than 36 seconds, moderate cognitive impairments.

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