Artificial intelligence-based video monitoring of movement disorders in the elderly: a review on current and future landscapes

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Abstract

Due to global ageing, the burden of chronic movement and neurological disorders (Parkinson’s disease and essential tremor) is rapidly increasing. Current diagnosis and monitoring of these disorders rely largely on face-to-face assessments utilising clinical rating scales, which are semi-subjective and time-consuming. To address these challenges, the utilisation of artificial intelligence (AI) has emerged. This review explores the advantages and challenges associated with using AI-driven video monitoring to care for elderly patients with movement disorders. The AI-based video monitoring systems offer improved efficiency and objectivity in remote patient monitoring, enabling real-time analysis of data, more uniform outcomes and augmented support for clinical trials. However, challenges, such as video quality, privacy compliance and noisy training labels, during development need to be addressed. Ultimately, the advancement of video monitoring for movement disorders is expected to evolve towards discreet, home-based evaluations during routine daily activities. This progression must incorporate data security, ethical considerations and adherence to regulatory standards.

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Most cited references 54

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MDS clinical diagnostic criteria for Parkinson's disease.

Ronald Postuma, Daniela Berg, Matthew Stern … (2015)

This document presents the Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's disease (PD). The Movement Disorder Society PD Criteria are intended for use in clinical research but also may be used to guide clinical diagnosis. The benchmark for these criteria is expert clinical diagnosis; the criteria aim to systematize the diagnostic process, to make it reproducible across centers and applicable by clinicians with less expertise in PD diagnosis. Although motor abnormalities remain central, increasing recognition has been given to nonmotor manifestations; these are incorporated into both the current criteria and particularly into separate criteria for prodromal PD. Similar to previous criteria, the Movement Disorder Society PD Criteria retain motor parkinsonism as the core feature of the disease, defined as bradykinesia plus rest tremor or rigidity. Explicit instructions for defining these cardinal features are included. After documentation of parkinsonism, determination of PD as the cause of parkinsonism relies on three categories of diagnostic features: absolute exclusion criteria (which rule out PD), red flags (which must be counterbalanced by additional supportive criteria to allow diagnosis of PD), and supportive criteria (positive features that increase confidence of the PD diagnosis). Two levels of certainty are delineated: clinically established PD (maximizing specificity at the expense of reduced sensitivity) and probable PD (which balances sensitivity and specificity). The Movement Disorder Society criteria retain elements proven valuable in previous criteria and omit aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of PD expands, the Movement Disorder Society criteria will need continuous revision to accommodate these advances.

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Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results.

Christopher G. Goetz, Barbara C. Tilley, Stephanie Shaftman … (2008)

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.

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Parkinson's disease: clinical features and diagnosis.

J. Jankovic (2008)

Parkinson's disease (PD) is a progressive neurological disorder characterised by a large number of motor and non-motor features that can impact on function to a variable degree. This review describes the clinical characteristics of PD with emphasis on those features that differentiate the disease from other parkinsonian disorders. A MedLine search was performed to identify studies that assess the clinical characteristics of PD. Search terms included "Parkinson's disease", "diagnosis" and "signs and symptoms". Because there is no definitive test for the diagnosis of PD, the disease must be diagnosed based on clinical criteria. Rest tremor, bradykinesia, rigidity and loss of postural reflexes are generally considered the cardinal signs of PD. The presence and specific presentation of these features are used to differentiate PD from related parkinsonian disorders. Other clinical features include secondary motor symptoms (eg, hypomimia, dysarthria, dysphagia, sialorrhoea, micrographia, shuffling gait, festination, freezing, dystonia, glabellar reflexes), non-motor symptoms (eg, autonomic dysfunction, cognitive/neurobehavioral abnormalities, sleep disorders and sensory abnormalities such as anosmia, paresthesias and pain). Absence of rest tremor, early occurrence of gait difficulty, postural instability, dementia, hallucinations, and the presence of dysautonomia, ophthalmoparesis, ataxia and other atypical features, coupled with poor or no response to levodopa, suggest diagnoses other than PD. A thorough understanding of the broad spectrum of clinical manifestations of PD is essential to the proper diagnosis of the disease. Genetic mutations or variants, neuroimaging abnormalities and other tests are potential biomarkers that may improve diagnosis and allow the identification of persons at risk.

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Author and article information

Journal

Journal ID (nlm-ta): Singapore Med J

Journal ID (iso-abbrev): Singapore Med J

Journal ID (publisher-id): SMJ

Journal ID (publisher-id): Singapore Med J

Title: Singapore Medical Journal

Publisher: Wolters Kluwer - Medknow (India )

ISSN (Print): 0037-5675

ISSN (Electronic): 2737-5935

Publication date Collection: March 2024

Publication date (Electronic): 26 March 2024

Volume: 65

Issue: 3

Pages: 141-149

Affiliations

[1 ]Pacific Parkinson Research Centre, University of British Columbia, Vancouver, British Columbia, Canada

[2 ]Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada

Author notes

Correspondence: Dr. Martin J McKeown, Professor and Head, Division of Neurology, University of British Columbia, S-192, Koerner Pavilion, University Hospital, UBC Site, 2211 Wesbrook Mall, Vancouver, British Columbia, V6T 2B5 Canada. E-mail: martin.mckeown@ 123456ubc.ca

Article

Publisher ID: SMJ-65-141

DOI: 10.4103/singaporemedj.SMJ-2023-189

PMC ID: 11060643

PubMed ID: 38527298

SO-VID: d1bfb024-5865-4230-9954-eb1db6a25ee2

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This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Artificial intelligence-based video monitoring of movement disorders in the elderly: a review on current and future landscapes

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Artificial Intelligence in Medicine

Most cited references 54

MDS clinical diagnostic criteria for Parkinson's disease.

Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results.

Parkinson's disease: clinical features and diagnosis.

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