Resting-state functional MRI metrics to detect freezing of gait in Parkinson's disease: a machine learning approach

Among the symptoms that can occur in Parkinson's disease (PD), Freezing of Gait (FOG) is a disabling phenomenon affecting a large proportion of patients, and it remains not fully understood. Accurate classification of FOG in PD is crucial for tailoring effective interventions and is necessary for a better understanding of its underlying mechanisms. In the present work, we applied four Machine Learning (ML) classifiers (Decision Tree - DT, Random Forest - RF, Multilayer Perceptron - MLP, Logistic Regression - LOG) to different four metrics derived from resting-state functional Magnetic Resonance Imaging (rs-fMRI) data processing to assess their accuracy in automatically classifying PD patients based on the presence or absence of Freezing of Gait (FOG). To validate our approach, we applied the same methodologies to distinguish PD patients from a group of Healthy Subject (HS). The performance of the four ML algorithms was validated by repeated k-fold cross-validation on randomly selected independent training and validation subsets. The results showed that when discriminating PD from HS, the best performance was achieved using RF applied to fractional Amplitude of Low-Frequency Fluctuations (fALFF) data (AUC 96.8 ± 2 %). Similarly, when discriminating PD-FOG from PD-nFOG, the RF algorithm was again the best performer on all four metrics, with AUCs above 90 %. Finally, trying to unbox how AI system black-box choices were made, we extracted features' importance scores for the best-performing method(s) and discussed them based on the results obtained to date in rs-fMRI studies on FOG in PD and, more generally, in PD. In summary, regions that were more frequently selected when differentiating both PD from HS and PD-FOG from PD-nFOG patients were mainly relevant to the extrapyramidal system, as well as visual and default mode networks. In addition, the salience network and the supplementary motor area played an additional major role in differentiating PD-FOG from PD-nFOG patients.