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Abstract
<p xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="first" id="d9231055e99">Adoption
of artificial intelligence (AI) by the medical community has long been anticipated,
endorsed by a stream of machine learning literature showcasing AI systems that yield
extraordinary performance. However, many of these systems are likely over-promising
and will under-deliver in practice. One key reason is the community's failure to acknowledge
and address the presence of inflationary effects in the data. These simultaneously
inflate evaluation performance and prevent a model from learning the underlying task,
thus severely misrepresenting how that model would perform in the real world. This
paper investigated the impact of these inflationary effects on healthcare tasks, as
well as how these effects can be addressed. Specifically, we defined three inflationary
effects that occur in medical data sets and allow models to easily reach small training
losses and prevent skillful learning. We investigated two data sets of sustained vowel
phonation from participants with and without Parkinson's disease, and revealed that
published models which have achieved high classification performances on these were
artificially enhanced due to the inflationary effects. Our experiments showed that
removing each inflationary effect corresponded with a decrease in classification accuracy,
and that removing all inflationary effects reduced the evaluated performance by up
to 30%. Additionally, the performance on a more realistic test set increased, suggesting
that the removal of these inflationary effects enabled the model to better learn the
underlying task and generalize. Source code is available at https://github.com/Wenbo-G/pd-phonation-analysis
under the MIT license.
</p>
We present a clinimetric assessment of the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). The MDS-UDPRS Task Force revised and expanded the UPDRS using recommendations from a published critique. The MDS-UPDRS has four parts, namely, I: Non-motor Experiences of Daily Living; II: Motor Experiences of Daily Living; III: Motor Examination; IV: Motor Complications. Twenty questions are completed by the patient/caregiver. Item-specific instructions and an appendix of complementary additional scales are provided. Movement disorder specialists and study coordinators administered the UPDRS (55 items) and MDS-UPDRS (65 items) to 877 English speaking (78% non-Latino Caucasian) patients with Parkinson's disease from 39 sites. We compared the two scales using correlative techniques and factor analysis. The MDS-UPDRS showed high internal consistency (Cronbach's alpha = 0.79-0.93 across parts) and correlated with the original UPDRS (rho = 0.96). MDS-UPDRS across-part correlations ranged from 0.22 to 0.66. Reliable factor structures for each part were obtained (comparative fit index > 0.90 for each part), which support the use of sum scores for each part in preference to a total score of all parts. The combined clinimetric results of this study support the validity of the MDS-UPDRS for rating PD.
The use of artificial intelligence, and the deep-learning subtype in particular, has been enabled by the use of labeled big data, along with markedly enhanced computing power and cloud storage, across all sectors. In medicine, this is beginning to have an impact at three levels: for clinicians, predominantly via rapid, accurate image interpretation; for health systems, by improving workflow and the potential for reducing medical errors; and for patients, by enabling them to process their own data to promote health. The current limitations, including bias, privacy and security, and lack of transparency, along with the future directions of these applications will be discussed in this article. Over time, marked improvements in accuracy, productivity, and workflow will likely be actualized, but whether that will be used to improve the patient-doctor relationship or facilitate its erosion remains to be seen.
Parkinson's disease is a neurological disorder with evolving layers of complexity. It has long been characterised by the classical motor features of parkinsonism associated with Lewy bodies and loss of dopaminergic neurons in the substantia nigra. However, the symptomatology of Parkinson's disease is now recognised as heterogeneous, with clinically significant non-motor features. Similarly, its pathology involves extensive regions of the nervous system, various neurotransmitters, and protein aggregates other than just Lewy bodies. The cause of Parkinson's disease remains unknown, but risk of developing Parkinson's disease is no longer viewed as primarily due to environmental factors. Instead, Parkinson's disease seems to result from a complicated interplay of genetic and environmental factors affecting numerous fundamental cellular processes. The complexity of Parkinson's disease is accompanied by clinical challenges, including an inability to make a definitive diagnosis at the earliest stages of the disease and difficulties in the management of symptoms at later stages. Furthermore, there are no treatments that slow the neurodegenerative process. In this Seminar, we review these complexities and challenges of Parkinson's disease.
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