Distinctive Handwriting Signs in Early Parkinson’s Disease

Round 1

Reviewer 1 Report

Although Authors provide sufficient background and include relevant references the article must be seen in the light of some limitations:

The authors did not include in the manuscript what was the specific aim of this study. Nor in the abstract or in the text.

Line 86 The authors provide inclusion criteria in methods section. ‘…b) modified Hoehn and Yahr (mH&Y) stage ≤2 meaning that they were mostly unilaterally affected by PD”. In stage 1 we observe unilateral involvement while in stage 2 we observe bilateral involvement without impairment of balance!. It would make a difference.

The materials and methods section is adequately described

Line 426 the authors use the expression :” non-dominant side of the body” in addition to hand – „the one that is not used for performing handwriting:. Do the authors also check which leg was dominant, as it may be different for the leg and hand?

Author Response

We are very grateful to the reviewer for her/his precious comments and suggestions. For your convenience we have highlighted in yellow the changes we made in the revised version of the manuscript.

In the following we report in red the way the issues raised by the reviewer have been addressed:

Although Authors provide sufficient background and include relevant references the article must be seen in the light of some limitations:

POINT1. The authors did not include in the manuscript what was the specific aim of this study. Nor in the abstract or in the text.

We have further elaborated the purpose of the study in the abstract, introduction and conclusion sections.

POINT 2. Line 86 The authors provide inclusion criteria in methods section. ‘…b) modified Hoehn and Yahr (mH&Y) stage ≤2 meaning that they were mostly unilaterally affected by PD”. In stage 1 we observe unilateral involvement while in stage 2 we observe bilateral involvement without impairment of balance!. It would make a difference.

Ten patients were unilaterally affected by the disease, whereas three patients were mostly unilaterally affected by the disease, with a slight involvement of the dominant side, i.e. the one used for performing handwriting (and then they were classified as being in stage 2). We have clarified this point also in the text.

The materials and methods section is adequately described

POINT 3. Line 426 the authors use the expression :” non-dominant side of the body” in addition to hand – „the one that is not used for performing handwriting:. Do the authors also check which leg was dominant, as it may be different for the leg and hand?

In order to make more clear the expression we have modified the sentence as follow: “for which the disease affects predominantly the non-dominant hand (i.e. the one that is not used for performing handwriting)”.

We have evaluated the handedness of the participants through the Edinburg Handedness Inventory test, which requires to indicate (besides other information) both the hand used for writing and the leg used for kicking. According to the handedness score obtained by all participants, their dominant side was the right side, even though not everyone always uses the right side of the body for performing all the actions reported in the EHI test. Given the goal of the study, we also checked that the dominant side obtained with the handedness score was the same used for handwriting (we have added this comment in the text too). According to the data we collected, even the right leg was used for kicking by all participants.

Reviewer 2 Report

Report on manuscript

Distinctive Handwriting Signs in Early Parkinson’s Disease

by

Rosa Senatore, Angelo Marcelli, Rosa De Micco, Alessandro Tessitore, Hans-Leo Teulings

·       Overview of manuscript

The authors presented research about handwriting movements of patients in the early stage of PD, on which the disease affects the contralateral side with respect to the one used for writing. They investigated that early detection of PD, even when the disease affects the contralateral side with respect to the one used for writing, could be achieved by analyzing specific features measured during the execution of specific handwriting tasks.

·       Comments on text

1.     New contribution

The authors found that the signs characterizing the early stage of PD differ from those appearing in later stages. And also, how about other stages of PD, is there any study about how it changes during different stages of this disease.

2.      English

The English in this paper is good.

Comments

Very interesting study and well performed analysis. The authors have provided enough supporting information for their findings.

The only comment would be if the authors can provide the weaknesses or strengths of their study compared to other techniques such as AI-based and so on.

·       Recommendation

After all the revisions, I can recommend acceptance of this paper.

Author Response

We are very grateful to the reviewer for her/his comments and suggestions.

For your convenience we have highlighted in yellow the changes we made in the revised version of the manuscript.

In the following we report in red the way the issues raised by the reviewer have been addressed:

Overview of manuscript

The authors presented research about handwriting movements of patients in the early stage of PD, on which the disease affects the contralateral side with respect to the one used for writing. They investigated that early detection of PD, even when the disease affects the contralateral side with respect to the one used for writing, could be achieved by analyzing specific features measured during the execution of specific handwriting tasks.

• Comments on text

1. New contribution

The authors found that the signs characterizing the early stage of PD differ from those appearing in later stages. And also, how about other stages of PD, is there any study about how it changes during different stages of this disease.

2. English

The English in this paper is good.

Comments

Very interesting study and well performed analysis. The authors have provided enough supporting information for their findings.

We are thankful to the reviewer for his comments

POINT 1. The only comment would be if the authors can provide the weaknesses or strengths of their study compared to other techniques such as AI-based and so on.

We have added some considerations about strengths and weaknesses of our study compared to AI-based techniques in the introduction.

       Recommendation

After all the revisions, I can recommend acceptance of this paper.