Handwriting process variables among elderly people with mild Major Depressive Disorder: A preliminary study

Background and aims: Despite evidence of cognitive impairment and difficulties in performing daily activities among elderly people with major depression, studies implementing objective performance-based evaluation of functional deficits in this patient population are scarce. With the aid of a computerized device we examined functional handwriting performance among elderly patients with mild Major Depressive Disorder (MDD) in comparison with controls. Methods: Participants were 20 elderly participants with mild MDD and 20 matched controls. Both groups performed four functional writing tasks with a computerized system. Kinematic measures were: in-air time per stroke (temporal), stroke width (spatial), pressure applied (pressure). Results: A MANOVA yielded statistically significant between-groups differences for the four writing tasks across the temporal, spatial and pressure measures. A univariate ANOVA revealed that the significance was due to differences between mild MDD and controls on the pressure measure in all four tasks. Moderately significant correlations were found in all tasks between in-air time and pressure while writing and the GDS score, and between the in-air time of three tasks (except writing one's name) and the Mini-Mental State Examination (MMSE) score. Handwriting pressure, and temporal and spatial measures of the task of writing one's name allowed us to classify 84.2% of the participants correctly. Conclusions: Computerized evaluation of handwriting, a daily task, was found to be sensitive to altered performance among participants with mild MDD, and was correlated with cognitive impairment and depression status. The theoretical importance and practical implications of handwriting process measures are discussed.