Estimating Parkinsonism Severity in Natural Gait Videos of Older Adults with Dementia

Drug-induced parkinsonism affects many older adults with dementia, often causing gait disturbances. New advances in vision-based human pose-estimation have opened possibilities for frequent and unobtrusive analysis of gait in residential settings. This work proposes novel spatial-temporal graph convolutional network (ST-GCN) architectures and training procedures to predict clinical scores of parkinsonism in gait from video of individuals with dementia. We propose a two-stage training approach consisting of a self-supervised pretraining stage that encourages the ST-GCN model to learn about gait patterns before predicting clinical scores in the finetuning stage. The proposed ST-GCN models are evaluated on joint trajectories extracted from video and are compared against traditional (ordinal, linear, random forest) regression models and temporal convolutional network baselines. Three 2D human pose-estimation libraries (OpenPose, Detectron, AlphaPose) and the Microsoft Kinect (2D and 3D) are used to extract joint trajectories of 4787 natural walking bouts from 53 older adults with dementia. A subset of 399 walks from 14 participants is annotated with scores of parkinsonism severity on the gait criteria of the Unified Parkinson's Disease Rating Scale (UPDRS) and the Simpson-Angus Scale (SAS). Our results demonstrate that ST-GCN models operating on 3D joint trajectories extracted from the Kinect consistently outperform all other models and feature sets. Prediction of parkinsonism scores in natural walking bouts of unseen participants remains a challenging task, with the best models achieving macro-averaged F1-scores of 0.53 +/- 0.03 and 0.40 +/- 0.02 for UPDRS-gait and SAS-gait, respectively. Pre-trained model and demo code for this work is available: https://github.com/TaatiTeam/stgcn_parkinsonism_prediction.