Community-based assisted screening for mild cognitive impairment using gait and handwriting kinematic parameters analysis

Table 1 Participant demographics characteristics between groups, mean ± SD/n (%)

Basic characteristics	MCI group (n = 34)	CN group (n = 61)	t/χ2/Z	P value
Age	84.26 ± 7.85	80.26 ± 11.02	-1.868	0.065
Sex			0.623	0.430
Male	8 (23.53)	19 (31.15)
Female	26 (76.47)	42 (68.85)
Education level			-0.953	0.340
Primary school	10 (29.41)	23 (37.70)
Junior school	10 (29.41)	17 (27.87)
High School	9 (26.47)	16 (26.23)
College and above	5 (14.71)	5 (8.20)
Occupation1			0.411	0.522
Brain work	25 (73.53)	41 (67.21)
Physical work	9 (26.47)	20 (32.79)
Marital status			0.012	0.914
Single (divorced, widowed)	16 (47.06)	28 (45.90)
Married	18 (52.94)	33 (54.10)
Residence			2.473	0.116
Living alone	10 (29.41)	28 (73.68)
Living with spouse/children	24 (70.59)	33 (54.10)
Monthly income			-0.625	0.532
Low (≤ 1000)	1 (2.94)	0 (0.00)
Middle (1000-3000)	1 (2.94)	2 (3.28)
High (≥ 3000)	32 (94.12)	59 (96.72)
Region of residence			1.212	0.271
Urban	32 (94.12)	53 (86.89)
Rural	2 (5.88)	8 (13.11)
Physical activity2			-1.456	0.145
Low	19 (55.88)	25 (40.98)
Middle	11 (32.35)	24 (39.34)
High	4 (11.76)	12 (19.67)
Family history of Dementia	2 (5.88)	3 (4.92)	0.041	0.840
Current smoker	0 (0.00)	2 (3.28)	1.139	0.286
Alcohol Consumption	0 (0.00)	6 (9.84)	3.570	0.059
Multimorbidity3	14 (41.18)	26 (42.62)	0.019	0.891
MMSE	25.03 ± 2.04	27.07 ± 2.12	4.549	< 0.001
MoCA-B	17.35 ± 2.89	23.23 ± 2.53	10.318	< 0.001

¹Occupation: Brain work include civil servant, teacher, healthcare professional, accountant and police officer[32]; Physical work include farmer, laborer, employee and tailor.

²Use of the International Physical Activity Questionnaire-Short form questionnaire[33].

³Multimorbidity: ≥ 2 comorbidities.

MCI: Mild cognitive impairment; CN: Cognitively normal; MMSE: Mini-Mental State Examination; MoCA-B: Montreal cognitive assessment basic.

Table 2 Comparison of gait kinematic parameters between groups, mean ± SD/M (QR)

Parameters	MCI group (n = 34)	CN group (n = 61)	t/Z	P value
Ambulation time	25.08 ± 7.55	22.77 ± 7.77	-1.402	0.164
Velocity	84.55 (23.83)	93.30 (25.35)	-2.911	0.004
Cadence	106.50 ± 11.51	110.91 ± 9.05	2.060	0.042
Step time	0.57 (0.08)	0.54 (0.06)	-1.825	0.068
Step length	47.92 ± 6.42	52.56 ± 8.12	2.863	0.005
Cycle time	1.14 ± 0.12	1.09 ± 0.09	-2.274	0.025
Stride length	95.48 ± 13.35	105.52 ± 16.71	3.005	0.003
HH base support	11.24 (4.51)	10.72 (4.30)	-1.475	0.140
Swing time	0.40 ± 0.04	0.40 ± 0.03	-0.451	0.653
Stance time	0.73 (0.13)	0.69 (0.07)	-2.376	0.018
Double support time	0.32 (0.09)	0.28 (0.08)	-2.717	0.007
Stride length variability	3.25 (1.43)	3.13 (1.10)	-0.679	0.497
Swing time variability	0.02 (0.01)	0.02 (0.01)	-1.658	0.097
Double support time variability	0.03 (0.01)	0.02 (0.01)	-2.614	0.009

MCI: Mild cognitive impairment; CN: Cognitively normal.

Table 3 Comparison of graphic tasks kinematic parameters between groups, M (QR)

Parameters	Handwriting with graphic tasks
	MCI group (n = 34)	CN group (n = 61)	t/Z	P value
Tilt angle	-42.07 (22.51)	-39.79 (19.18)	-0.823	0.411
Average pressure	593.05 (258.14)	666.84 (172.65)	-2.135	0.033
Time in air	25920.00 (18039.00)	17468.00 (11452.00)	-2.865	0.004
Single stroke time	1526.07 (1304.64)	1605.43 (1058.23)	-0.116	0.907
Single stroke length	13.23 (7.44)	14.84 (7.15)	-1.623	0.105
X-axis stroke length	8.22 (4.41)	9.34 (4.69)	-1.669	0.095
Y-axis stroke length	8.32 (4.63)	9.61 (5.13)	-1.304	0.192
Total single stroke length	255.93 (71.32)	260.29 (77.99)	-0.155	0.877
Total X-axis stroke length, mean (SD)	167.93 ± 36.92	168.48 ± 35.30	0.072	0.943
Total Y-axis stroke length	157.47 (50.29)	157.95 (47.77)	-0.738	0.461
Average velocity	10.40 (4.93)	11.12 (5.53)	-1.623	0.105
Average velocity in X-axis	6.91 (2.92)	8.12 (3.46)	-1.933	0.053
Average velocity in Y-axis	7.59 (3.34)	7.71 (3.57)	-1.102	0.270
Maximum velocity in X-axis	29.07 (9.53)	36.22 (16.09)	-3.237	0.001
Minimum velocity in X-axis	0.14 (0.32)	0.08 (0.25)	-0.927	0.354
Maximum velocity in Y-axis	33.27 (16.84)	38.45 (17.21)	-1.723	0.085
Minimum velocity in Y-axis	0.13 (0.26)	0.11 (0.25)	-0.617	0.537
Number of times velocity slows down	26.33 (22.87)	28.95 (23.08)	-0.078	0.938
Average acceleration in X-axis	0.21 (0.07)	0.25 (0.09)	-2.880	0.004
Average acceleration in Y-axis	0.23 (0.11)	0.26 (0.08)	-1.987	0.047
Maximum acceleration in X-axis	1.07 (0.32)	1.38 (0.55)	-3.998	< 0.001
Minimum acceleration in X-axis	0.00 (0.01)	0.00 (0.01)	-0.163	0.870
Maximum acceleration in Y-axis	1.27 (0.64)	1.45 (0.65)	-2.050	0.040
Minimum acceleration in Y-axis	0.00 (0.01)	0.00 (0.01)	-0.513	0.608
Number of times acceleration slows down	26.19 (24.49)	30.21 (24.99)	-0.039	0.969
Task score	5.00 (3.00)	6.00 (2.00)	-2.447	0.014

MCI: Mild cognitive impairment; CN: Cognitively normal.

Table 4 Comparison of Chinese character tasks kinematic parameters between groups, mean ± SD/M (QR)

Parameters	Handwriting with Chinese character tasks
	MCI group (n = 34)	CN group (n = 61)	t/Z	P value
Tilt angle	-57.08 (9.06)	-54.93 (8.81)	-0.668	0.504
Average pressure	499.05 (213.36)	582.68 (233.95)	-2.135	0.033
Time in air	36336.00 (25185.00)	29228.00 (21512.00)	-1.394	0.163
Single stroke time	352.1 (152.30)	356.65 (160.66)	-0.303	0.762
Single stroke length	8.93 (3.87)	9.09 (5.10)	-0.753	0.451
X-axis stroke length	5.35 (2.53)	5.20 (3.10)	-0.738	0.461
Y-axis stroke length	6.02 (2.66)	6.26 (3.69)	-0.706	0.480
Total single stroke length	791.40 ± 151.25	829.42 ± 175.50	1.062	0.291
Total X-axis stroke length	455.63 ± 99.02	478.62 ± 99.95	1.078	0.284
Total Y-axis stroke length	521.39 (132.81)	557.07 (181.17)	-0.831	0.406
Average velocity	25.93 ± 8.70	27.69 ± 9.31	0.907	0.367
Average velocity in X-axis	17.29 ± 6.17	18.55 ± 6.47	0.919	0.360
Average velocity in Y-axis	21.28 ± 7.44	22.41 ± 7.89	0.680	0.498
Maximum velocity in X-axis	51.57 ± 17.45	55.05 ± 16.51	0.964	0.338
Minimum velocity in X-axis	1.47 (1.63)	1.58 (1.32)	-0.109	0.913
Maximum velocity in Y-axis	61.86 ± 20.04	65.30 ± 20.87	0.781	0.437
Minimum velocity in Y-axis	2.02 (1.55)	1.63 (1.27)	-0.606	0.545
Number of times velocity slows down	6.22 (2.97)	6.07 (3.19)	-0.008	0.994
Average acceleration in X-axis	0.59 (0.30)	0.61 (0.34)	-0.660	0.509
Average acceleration in Y-axis	0.67 (0.45)	0.72 (0.35)	-0.481	0.630
Maximum acceleration in X-axis	1.64 (0.93)	1.78 (0.99)	-1.196	0.232
Minimum acceleration in X-axis	0.08 (0.11)	0.07 (0.09)	-0.124	0.901
Maximum acceleration in Y-axis	1.97 (0.80)	2.08 (1.13)	-1.079	0.281
Minimum acceleration in Y-axis	0.11 (0.14)	0.10 (0.11)	-0.109	0.913
Number of times acceleration slows down	5.60 (3.11)	5.37 (3.07)	-0.093	0.926
Task score	20.00 (0.00)	20.00 (1.00)	-3.078	0.002

MCI: Mild cognitive impairment; CN: Cognitively normal.

Table 5 Classification power of kinematic parameters in gait and handwriting tasks between groups

	LR (%)	XGB (%)	RF (%)	GBC (%)	Gaussian NB (%)
Gait tasks
Accuracy	66.33	69.33	63.00	69.44	69.44
Sensitivity	29.17	49.83	44.50	54.00	50.67
Specificity	91.87	85.44	82.06	82.88	85.02
Positive predictive value	53.33	65.33	49.17	64.17	64.00
Negative predictive value	68.00	73.74	71.94	73.53	72.90
AUC	0.61	0.68	0.63	0.68	0.68
Brier	0.34	0.31	0.37	0.31	0.31
Graphics handwriting tasks
Accuracy	69.56	72.44	70.44	60.78	73.44
Sensitivity	54.17	64.00	57.33	43.67	66.00
Specificity	86.51	81.21	81.81	74.41	83.27
Positive predictive value	66.67	72.00	69.00	43.33	71.67
Negative predictive value	74.82	75.82	73.19	68.51	78.76
AUC	0.70	0.73	0.70	0.59	0.75
Brier	0.30	0.28	0.30	0.39	0.27
Chinese character handwriting tasks
Accuracy	63.22	63.00	64.44	55.78	68.44
Sensitivity	18.67	26.83	59.33	25.33	20.67
Specificity	90.98	84.88	74.45	76.95	92.40
Positive predictive value	31.67	34.17	53.50	39.17	36.67
Negative predictive value	66.32	67.99	74.51	65.13	68.37
AUC	0.55	0.56	0.67	0.51	0.57
Brier	0.37	0.37	0.36	0.42	0.32
Gait and graphics handwriting tasks
Accuracy	69.67	69.44	71.67	74.44	73.67
Sensitivity	48.67	57.67	46.67	59.00	68.50
Specificity	87.78	76.90	90.10	88.21	83.17
Positive predictive value	66.67	57.50	55.83	77.50	68.33
Negative predictive value	72.66	72.74	72.63	75.73	80.29
AUC	0.68	0.67	0.68	0.74	0.76
Brier	0.30	0.31	0.28	0.26	0.26
Gait and Chinese character handwriting tasks
Accuracy	62.44	68.44	67.44	60.33	69.78
Sensitivity	42.50	44.33	37.00	39.50	41.50
specificity	80.66	85.71	87.52	76.39	85.04
Positive predictive value	47.50	56.67	58.17	44.83	57.50
Negative predictive value	69.86	71.77	71.81	67.96	71.92
AUC	0.62	0.65	0.62	0.58	0.63
Brier	0.38	0.32	0.33	0.40	0.30

AUC: Area under the receiver operating characteristic curve; LR: Logistic regression; XGB: EXtreme Gradient Boosting; RF: Random forest; GBC: Gradient boosting classifier; Gaussian NB: Gaussian Naive Bayes.