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Updated: Jul 19, 2026
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Digital Handwriting Analysis of Characters in Chinese Patients with Mild Cognitive Impairment
Published on: March 11, 2021
Dysgraphia in elderly delirious medical inpatients
Dimitrios Adamis1, Shuli Reich, Adrian Treloar
1Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Aging Clinical and Experimental Research
|October 26, 2006
Summary
Handwriting abnormalities, particularly in signatures, are more common in patients with delirium. This finding suggests that assessing handwriting may aid in detecting delirium in older inpatients.
Area of Science:
- Geriatrics
- Neurology
- Psychiatry
Background:
- Delirium is a common condition in older inpatients, often associated with cognitive impairment.
- Dysgraphia, or handwriting difficulties, is a known but inconsistently studied clinical finding in delirium.
- Handwritten signatures, potentially a motor automatism, have not been previously evaluated in delirious patients.
Purpose of the Study:
- To assess signature and spontaneous writing abnormalities in delirious patients.
- To investigate the clinical utility of handwriting analysis in delirium detection.
Main Methods:
- Secondary analysis of a prospective observational study involving acutely ill inpatients aged 70 years and older.
- Utilized Mini-Mental State Examination (MMSE), Confusion Assessment Method (CAM), Delirium Rating Scale (DRS), Activities of Daily Living (ADL), and APACHE II scores.
- Evaluated signatures from consent forms and spontaneous handwriting from MMSE responses.
Main Results:
- Signatures of patients with delirium showed significantly more impairment compared to those without (p<0.0001).
- Signature analysis demonstrated a sensitivity of 0.54 and specificity of 0.88 for delirium detection (CAM-defined).
- Abnormalities in omission, illegibility, and spelling were more frequent in delirious patients, often due to inability to respond.
Conclusions:
- An abnormal signature may serve as a potential indicator for delirium.
- Handwriting problems in delirium can stem from both cognitive impairment and motor function disorders.
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