Inteligência Artificial no Aporte a Doença de Parkinson

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Date of publication xxxx 00, 0000, date of current version xxxx 00, 0000.

Digital Object Identifier 10.1109/ACCESS.2017.Doi Number

Evaluation of the severity of Parkinson's Disease based on fuzzy logic

Malheiro Netto, J.O., Phd Netto, O.P.2

1Universidade Anhembi Morumbi, Programa de Pós-graduação em Engenharia Biomédica da Universidade Anhembi Morumbi, São Paulo- Brasil.

Corresponding author: First A. Author (e-mail:[e-mail]).

ABSTRACT Parkinson's Disease (PD) is a debilitating and progressive disease, present mainly in the elderly. Its recurrent symptoms are diminished movements, combined with tremors, rigidity, or both simultaneously, resulting from the loss of dopamine and inability of the body to control movements. To this moment, there is no defining diagnosis for PD. There are a lot of evaluation methods and systems for its main symptoms. The severity of symptoms is usually complex, and a neurologist makes the clinical examination. The combination of multiple factors and the severity criteria of PD defines the clinical diagnosis, which can change from one specialist to another, creating uncertainty and variability in the score for such classifications. The present essay is a classification system for the severity of Parkinson's disease using Fuzzy Logic applying concepts of diagnosis from the Parkinson's Disease Movement Disorder Society (PD-MDS). Results from the method for eleven patients were compared to a specialist diagnosis. The fuzzy interference system is a reliable non-invasive computer resource evaluation system. The use of this system may provide immediate support to medical doctors by digitizing the current established criteria, allowing for improved clinical diagnosis via the use of new linguistic declarations.  

INDEX TERMS Parkinson's Disease, Fuzzy Logic, Artificial Intelligence, Computer Model.

I. INTRODUCTION

Parkinson's Disease, first described by James Parkinson in 1817, it has 100 to 200 cases in 100,000 inhabitants' prevalence. PD is a chronic and persistent illness of the central nervous system causing the death of brain cells. From a pathologic point of view, PD has a degenerative aspect, progressive and incapacitating, facing the motor modifications due to the death of dopaminergic neurons in the black substance presenting intracytoplasmic inclusions known as Lewy corpuscles. Since its first description, the clinical diagnosis has been based on the motor syndrome and the PD – MDS criteria (Parkinson's Disease Movement Disorder Society). Diagnosis usually is late and present in the elderly of over 60 years, with a greater incidence in men by 1,5 times. In light of the complex diagnosis and acknowledgment of PD, the use of diffuse logic may directly aid physicians and specialists in recognition and support of diagnosis and the complexities of PD in early stages, especially possibly describing PD in stratified severity. The article is structured for the sections, respectively: Section II describes basic and specific concepts for Parkinson's; Section III points to the criteria used by the PD-MDS. Section IV describes features proposed by the diffuse model in the Parkinson's diagnosis. Results will be discussed in Section V. Finally, Section VI emphasizes the conclusions and final considerations.

II.  PARKINSON'S DISEASE

Parkinson's is a disease that affects millions of people around the world. Its first appearance is usually after 60, being a central nervous system chronic disease-causing cells' loss. PD is progressive, and the number of people suffering from it is increasing. Various neurotransmitters carefully balance motor function in the base ganglia circuits. Disease consists of when one of these neurotransmitters is not correctly released, causing a delay in the information in the base of the brain, making it inefficient, which in turn impairs the motor function system. Within the scope of PD, the leading cause is the death of dopamine secreting neurons (2). It is believed that environmental and genetic factors demand a higher probability of developing PD if there is a familiar positive history (4). Cell degeneration leads to lower levels of dopamine and dark substance to the corpus striatum, frontal lobe, and limbic system, with time harming these non-dopaminergic areas in a crescent manner (4). Other than a presence due to degenerative process of the nigrostriatal system, which explains a series of symptoms and non-motor signs, such as olfactory changes, sleep disturbances, postural hypotension, constipation, emotional changes, depression, anxiety, psychotic symptoms, cognitive losses, and dementia, among others (5). PD manifests in different ways from one individual to another, sometimes taking years for more complex manifestations to arise in the exercise of daily activities (6). Symptoms become more evident as the disease progresses (6). During the incipient phase of the disease, symptoms may be noticed only in half of the body. Being that the most common symptoms are hand tremors, difficulty moving – bradykinesia and akinesia, coordination and balance disturbance, sleep disturbances, depression, difficulty speaking, and simple movements (1).

Individuals suffering from Parkinson's may also present impaired swallowing, especially in advanced stages, as well as non-motor characteristics, like dementia and lack of autonomy, which is a disturbance brought on by changes in the autonomous nervous system, when an imbalance in the sympathetic/parasympathetic affects the involuntary functions it helps coordinate (1). Parkinson's Disease causes cognitive loss, depression, anxiety, insomnia, anosmia in up to 90% of cases for many years. Other gastrointestinal symptoms include swelling, nausea, and intestinal discomfort (8).

Some other factors also lead to the incidence of PD, such as failure in the mitochondrial genes, exposure to pesticides, drug ingestion (heroin), free radicals, viruses (encephalitis inducing), and blows to the head (6).

III.  CRITERIA FOR THE DIAGNOSIS OF PARKINSON'S DISEASE

PD's clinical diagnosis is defined as a motor syndrome and non-motor manifestations present most patients and usually represent the clinical condition (5). Since its original description, clinical diagnosis of PD has focused on a motor syndrome by the PD-MDS criteria; central motor syndrome remains the most defining characteristic. Diagnosis is based on neurologic data, exams and medical history of patients. It may not be easy, especially in the early stages (1). In most cases, symptoms and PD progression are exclusive to one individual; progression patterns may usually be classified into five stages to describe the severity of the disease, based on the Hoehn and Yahr Scale (12). Criteria by the Central Motor Syndrome (CMS) adopt a two-phase process for the diagnosis of PD. First, parkinsonism is defined (as bradykinesia in combination with rest tremors, rigidity or both). Once diagnosed, the criteria describe if this parkinsonism is attributed to PD (13). The pre-requisite to apply criteria by PD-MDS is the diagnosis of parkinsonism, which is based on three cardinal motor manifestations (13). Parkinsonism is the medical syndrome manifested as bradykinesia, rigidity, rest tremors, and postural instability (9).