Quantifying Parkinson's disease motor severity under uncertainty using MDS-UPDRS videos

Parkinson's disease (PD) is a brain disorder that primarily affects motor function, leading to slow move-ment, tremor, and stiffness, as well as postural instability and difficulty with walking/balance. The sever-ity of PD motor impairments is clinically assessed by part III of the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), a universally-accepted rating scale. However, experts often disagree on the exact scoring of individuals. In the presence of label noise, training a machine learning model using only scores from a single rater may introduce bias, while training models with multiple noisy ratings is a challenging task due to the inter-rater variabilities. In this paper, we introduce an or-dinal focal neural network to estimate the MDS-UPDRS scores from input videos, to leverage the ordinal nature of MDS-UPDRS scores and combat class imbalance. To handle multiple noisy labels per exam, the training of the network is regularized via rater confusion estimation (RCE), which encodes the rating habits and skills of raters via a confusion matrix. We apply our pipeline to estimate MDS-UPDRS test scores from their video recordings including gait (with multiple Raters, R = 3 ) and finger tapping scores (single rater). On a sizable clinical dataset for the gait test ( N = 55 ), we obtained a classification accuracy of 72% with majority vote as ground-truth, and an accuracy of similar to 84% of our model predicting at least one of the raters' scores. Our work demonstrates how computer-assisted technologies can be used to track patients and their motor impairments, even when there is uncertainty in the clinical ratings. (C) 2021 Elsevier B.V. All rights reserved.