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Dr. Joseph Sirven: It's In The Fine Print
Sometimes an overlooked task provides the diagnosis. KJZZ's medical commentator, Dr. Joseph Sirven, explains.
“Doctor, is this really necessary?” My patient complained as I asked for a writing sample.
“All you doctors have crappy penmanship, what should it matter what mine looks like”?
“I understand you’re bothered by this,” I say, “But this is part of any neuro exam.”
“I just don’t get it. Look at you, typing away at a computer. Penmanship just doesn’t matter anymore.”
According to a recent UK survey, my patient may be right. Seventy-six percent of Brits now type more than they handwrite — and more than half prefer typing to handwriting. However, a majority believe it is important to write by hand so it doesn't become a lost skill for future generations.
One overlooked item in this debate is that handwriting is an important clinical tool in determining if someone has a neurological, psychological or medical condition. From the tiny cramped penmanship characteristic of Parkinson’s disease to shaky maneuvers of the hand such as in anxiety, handwriting can often aid a diagnosis.
Spanish scientists recently evaluated a group of 52 older patients — 23 with Alzheimer’s disease, 12 with a precursor to Alzheimer’s, and 17 healthy subjects.
Using a special handwriting device that digitizes hand movements and measures the pressure and angles that the participant uses in applying the pen to the paper, experts analyzed the handwriting samples which the device converts to quantitative statistics.
The researchers were then asked without knowing the clinical story, to diagnose each patient as either Alzheimer’s, pre-Alzheimer’s or normal aging solely based on the data.
Amazingly, investigators were able to distinguish in 77 percentof the cases between a healthy person versus those with impaired cognition. It was even better for determining between Alzheimer’s and mild cognitive impairment.
It’s a shame we spend so much time typing rather than writing, because handwriting is invaluable in compiling a clinical picture. The next time you find yourself wondering if there is a problem with your memory, write something down, copy a sentence, or transcribe a phrase and show it to your doctor. The final diagnosis, in some cases, is literally written in the fine print.
Dr. Joseph Sirven is a neurologist at the Mayo Clinic.