Differences in Writing and Drawing may Help Differentiate Parkinson’s Disease from Essential Tremor

Authors

  • Daniel Ferreira Serviço de Neurologia / Centro Hospitalar Universitário de São João, Porto, Portugal https://orcid.org/0000-0003-2276-7985
  • Carolina Soares Serviço de Neurologia / Centro Hospitalar Universitário de São João, Porto, Portugal https://orcid.org/0000-0001-6545-1863
  • Catarina Damas Serviço de Neurologia / Centro Hospitalar de Setúbal, Setúbal, Portugal
  • Maria José Rosas Serviço de Neurologia / Centro Hospitalar Universitário de São João, Porto, Portugal
  • Rui Araújo Serviço de Neurologia / Centro Hospitalar Universitário de São João, Porto, Portugal https://orcid.org/0000-0002-3610-3437

DOI:

https://doi.org/10.46531/sinapse/AO/230041/2024

Keywords:

Drawing, Essential Tremor, Movement, Neurologic Examination, Parkinson Disease, Task Performance and Analysis

Abstract

Introduction: The ability to draw figures requires preserving visuospatial functions and motor pathways. The floating door sign (FDS) reflects the inability to join the vertical lines of a door with the floor when a patient is asked to draw a house. This signal was described as a positive predictive factor for Parkinson’s Disease (PD), but not essential tremor (ET). Nevertheless, conflicting literature has emerged recently. We aim to evaluate the features of the FDS and other graphomotor tasks in patients with PD and ET.
Methods: Patients recruited from 2 hospital centers were asked to draw 3 pictorial elements (house, flower, and sun), write a sentence and perform 2 cognitive evaluations (pentagons copy and clock drawing test). Clinical and demographic characteristics from both groups were obtained.
Results: A total of 54 patients (PD: 38; ET: 16) were included. FDS was more prevalent in PD patients (PD: 45% vs ET: 6%; p = 0.005), who also drew a significantly smaller house. PD patients drew a sun with a significantly smaller diameter, increased number of smaller sunbeams and a higher distance sun-sunbeam. Additionally, a significantly smaller flower and lower, flatter petals, with an increase distance petalsflower were also found in the PD patients’ group. Comparing PD patients with positive versus negative FDS, we found that those with a positive FDS scored less on the pentagons copy (4.1 ± 1.8 vs 5.2 ± 1.2; p=0.025), with no significant differences in the UPDRS motor or micrographia-related scores.
Conclusion: Graphomotor tasks, including the FDS, can be useful in the distinction of patients with PD and ET. The presence of the FDS could be associated to a mild visuospatial cognitive dysfunction. This potential interplay warrants further exploration in future studies.

Downloads

Download data is not yet available.

References

Kulkarni O, Lafaver K, Tarsy D. The “floating door sign” in Parkinson’s disease. Parkinsonism Relat Disord. 2013;19:825-6. doi: 10.1016/j.parkreldis.2013.04.013.

Räty V, Eklund M, Nuuttila S, Jaakkola E, Mäkinen E, Murtomäki K, et al. Floating door sign does not differentiate Parkinson’s disease from essential tremor. Clin Park Relat Disord. 2023;8:100184. doi: 10.1016/j.prdoa.2023.100184.

Bhatia KP, Bain P, Bajaj N, Elble RJ, Hallett M, Louis ED, et al. Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord. 2018;33:75-87. doi: 10.1002/mds.27121.

Postuma RB, Poewe W, Litvan I, Lewis S, Lang AE, Halliday G, et al. Validation of the MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord. 2018;33:1601-8. doi: 10.1002/mds.27362.

Sunderland T, Hill JL, Mellow AM, Lawlor BA, Gundersheimer J, Newhouse PA, et al. Clock drawing in Alzheimer’s disease. A novel measure of dementia severity. J Am Geriatr Soc. 1989;37:725-9. doi: 10.1111/j.1532-5415.1989.tb02233.x.

Bourke J, Castleden CM, Stephen R, Dennis M. A comparison of clock and pentagon drawing in Alzheimer’s disease. Int J Geriat Psychiatry. 1995;10:703-5. doi: 10.1002/gps.930100811.

Schwab RS, England AC. Projection technique for evaluating surgery in Parkinson’s disease. In: Gillingham FJ, Donaldson IML, editors. Third symposium on Parkinson’s disease. Edinburgh: E S Livingstone;1969. p. 152–7.

Movement Disorder Society Task Force on Rating Scales for Parkinson’s Disease. The Unified Parkinson’s Disease Rating Scale (UPDRS): status and recommendations. Mov Disord. 2003;18:738-50. doi: 10.1002/mds.10473.

Weil RS. Visual Dysfunction and Parkinson’s Disease. Mov Disord. 2020;35:1499-501. doi: 10.1002/mds.28212.

Downloads

Published

2024-04-02

How to Cite

1.
Ferreira D, Soares C, Damas C, Rosas MJ, Araújo R. Differences in Writing and Drawing may Help Differentiate Parkinson’s Disease from Essential Tremor. Sinapse [Internet]. 2024 Apr. 2 [cited 2024 May 18];24(1):6-11. Available from: https://sinapse.pt/index.php/journal/article/view/41

Issue

Section

Original Articles