帕金森综合征患者手指敲击运动评分的多模态数据预测模型:一项机器学习模型的构建与内部验证研究

Multimodal data prediction model for finger tapping scores in parkinsonism: Development and internal validation of a machine learning model

  • 摘要: 背景 帕金森综合征的运动功能评估长期依赖主观性较强的运动障碍协会统一帕金森病评定量表(Movement Disorder Society-Unified Parkinson's Disease Rating Scale,MDS-UPDRS)第三部分,易受评估者主观经验影响。目的 整合一般人口学、体格检查与定量运动参数的多维机器学习模型,以客观预测帕金森综合征患者手指敲击任务的MDS-UPDRS评分。方法 本研究为一项基于单中心数据的机器学习模型开发与验证研究。连续纳入2024 年1 月10 日 — 12 月10 日于解放军总医院第一医学中心神经内科就诊的帕金森综合征患者,收集其人口统计学资料,测量小指掌长等体格参数,并使用基于计算机视觉的运动评估系统采集食指-拇指连续敲击10 次的视频,从中提取频率、幅度及其变异系数等运动学参数。主要结局为由3 名经过认证的神经科医师通过盲法视频评审确定的MDS-UPDRS手指敲击项目评分(有序多分类,0 ~ 4 分)。采用最小绝对收缩和选择算子(least absolute shrinkage and selection operator,LASSO)回归结合分组交叉验证筛选关键特征,以K近邻(k-nearest neighbors,KNN)、决策树(decision tree,DT)、有序逻辑回归(ordinal logistic regression,OLR)、随机森林(random forest,RF)、支持向量机(support vector machine,SVM)、极端梯度增强(extreme gradient boosting,XGBoost)和轻梯度增强机(light gradient boosting machine,LightGBM)等7 种主流算法进行建模,采用留一法交叉验证(Leave-One-Out Cross-Validation,LOOCV)评估模型性能。模型性能从多分类Kappa系数、准确率、曲线下面积(area under the curve,AUC)及混淆矩阵等维度进行评价。特征重要性采用Shapley 加性解释(Shapley Additive exPlanations,SHAP)方法进行分析。结果 共招募81 例患者,5 例被剔除,最终76 例(152 测试手)纳入分析。LASSO回归筛选保留的预测因子包括:频率、平均幅度、时长变异系数、小指掌长、拇指长、性别、幅度变异系数、幅度差标准差。留一法交叉验证显示,有序逻辑回归模型在多分类任务(0 ~ 4 分)中表现最优:AUC为0.893(95% CI:0.859 ~ 0.928),Kappa 系数为0.542(95% CI:0.410 ~ 0.665),准确率为66.5%(95% CI:57.2% ~ 75.0%)。SHAP特征重要性分析显示,频率(37.3%)、平均幅度(20.5%)和小指掌长(9.1%)是对模型贡献最大的3 个特征。结论 本研究成功开发并初步验证了1 个多模态机器学习模型,其证实整合个体静态体格特征可提升对手指敲击运动功能评分的客观预测能力。该模型为帕金森综合征的自动化、定量化运动评估提供了新的方法学路径。

     

    Abstract: Background The motor function assessment of Parkinson's disease has long relied on the subjective Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part Ⅲ , which is susceptible to the rater's subjective experience. Objective To develop a multidimensional machine learning model integrating general demographics, physical examination, and quantitative motor parameters for objectively predicting MDS-UPDRS scores in finger-tapping tasks of patients with Parkinson's disease. Methods This was a single‑center, model development and validation study. Patients with Parkinson's disease consecutively admitted to the Department of Neurology, the First Medical Center of PLA General Hospital from January 10 to December 10, 2024 were enrolled. Demographic data were collected, physical parameters such as the distance from the fifth metacarpal base to the distal wrist crease were measured, and a computer‑vision‑based motion assessment system was used to record videos of 10 consecutive index‑to‑thumb taps, from which kinematic parameters including frequency, amplitude, and their coefficients of variation were extracted. The primary outcome was the MDS‑UPDRS finger tapping‑tapping item score (ordinal multiclass, 0 ‑ 4) determined by three certified neurologists through blinded video review. The least absolute shrinkage and selection operator (LASSO) regression combined with group cross validation was used to select the key features. Seven mainstream algorithms were compared: k‑nearest neighbors (KNN), decision tree (DT), ordinal logistic regression (OLR), random forest (RF), support vector machine (SVM), extreme gradient boosting (XGBoost), and light gradient boosting machine (LightGBM). Model performance was evaluated using leave‑one‑out cross validation (LOOCV). Performance was assessed using the multiclass Kappa coefficient, accuracy, area under the curve (AUC), and confusion matrix. Feature importance was analyzed using the Shapley Additive exPlanations (SHAP). Results A total of 81 patients were recruited, 5 were excluded, and finally 76 patients (152 tested hands) were analyzed. LASSO regression retained the following predictors: frequency, average amplitude, coefficient of variation of duration, distance from the fifth metacarpal base to the distal wrist crease, thumb length, sex, coefficient of amplitude variation, and standard deviation of average amplitude difference. LOOCV showed that the ordinal logistic regression model performed best in the multiclass task (0 ‑ 4): AUC was 0.893 (95% CI: 0.859 ‑ 0.928), Kappa coefficient was 0.542 (95% CI: 0.410 ‑ 0.665), and accuracy was 66.5% (95% CI: 57.2% ‑ 75.0%). SHAP feature importance analysis revealed that frequency (37.3%), average amplitude (20.5%), and the fifth metacarpal base to the distal wrist crease (9.1%) were the three most contributing features. Conclusion This study successfully develops and preliminarily validates a multimodal machine learning model, confirming that integrating individual ,static anthropometric features can improve the objective prediction of finger-tapping motor function scores. This model provides a new methodological pathway for automated and quantitative motor assessment in Parkinson's disease.

     

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