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Despite the high prevalence of micrographia in PD, its neurobiological mechanisms are not known. Given that levodopa may alleviate consistent micrographia and that nondopaminergic essential tremor (ET) is not associated with micrographia, micrographia could possibly be used as an ancillary diagnostic method that reflects nigrostriatal dopamine function. We evaluated the usefulness of micrographia as a simple one-sentence writing test in differentiating PD from ET. A total of 146 PD patients, 42 ET patients and 38 healthy controls provided writing samples and were scanned with brain [\n                    <jats:sup>123<\/jats:sup>\n                    I]FP-CIT dopamine transporter (DAT) SPECT imaging with ROI-based and voxelwise analyses. The diagnostic accuracy of micrographia was evaluated and compared to that of DAT binding. Compared to ET and healthy controls, PD patients showed micrographia (consistent, 25.6% smaller area of handwriting sample in PD compared to ET,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002, and 27.2% smaller area of handwriting compared to healthy controls,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004). PD patients showed 133% more severe progressive micrographia compared with ET patients (median\n                    <jats:italic>b<\/jats:italic>\n                    \u2009=\u2009\u2009\u2212\u20090.14 in PD,\n                    <jats:italic>b<\/jats:italic>\n                    \u2009=\u2009\u2009\u2212\u20090.06 in ET,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.021). In early unmedicated cognitively normal patients, consistent micrographia showed 71.2% specificity and 87.5% sensitivity in PD versus ET differentiation, but micrographia had no correlation with striatal or extrastriatal [\n                    <jats:sup>123<\/jats:sup>\n                    I]FP-CIT binding in patients with PD. The one-sentence micrographia test shows moderately good accuracy in PD versus ET differentiation. The severity of micrographia has no relationship with DAT binding, suggesting nondopaminergic mechanism of micrographia in PD.\n                  <\/jats:p>\n                  <jats:p>ClinicalTrials.gov identifier: NCT02650843 (NMDAT study).<\/jats:p>","DOI":"10.1007\/s00702-022-02517-1","type":"journal-article","created":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T12:03:00Z","timestamp":1653652980000},"page":"895-904","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Diagnostic value of micrographia in Parkinson\u2019s disease: a study with [123I]FP-CIT SPECT"],"prefix":"10.1007","volume":"129","clinical-trial-number":[{"clinical-trial-number":"nct02650843","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1947-712X","authenticated-orcid":false,"given":"Mikael","family":"Eklund","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simo","family":"Nuuttila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juho","family":"Joutsa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elina","family":"Jaakkola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elina","family":"M\u00e4kinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma A.","family":"Honkanen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"Lindholm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tero","family":"Vahlberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommi","family":"Noponen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toni","family":"Ihalainen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsi","family":"Murtom\u00e4ki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanja","family":"Nojonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reeta","family":"Levo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuomas","family":"Mertsalmi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip","family":"Scheperjans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valtteri","family":"Kaasinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,5,27]]},"reference":[{"issue":"5","key":"2517_CR1","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1212\/WNL.0000000000000641","volume":"83","author":"CH Adler","year":"2014","unstructured":"Adler CH, Beach TG, Hentz JG et al (2014) Low clinical diagnostic accuracy of early vs advanced Parkinson disease: clinicopathologic study. 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Mikael Eklund reports grants from the Finnish Parkinson Foundation (FPF), Turku University Hospital (TUH) and Finnish Medical Foundation (FMF) and pending grant applications from Funding: Maire Taponen Foundation and Finnish Brain Foundation related to submitted work. Simo Nuuttila reports grants from FPF, TUH, The P\u00e4ivikki and Sakari Sohlberg Foundation (PSSF) and Finnish Alcohol Research Foundation (FARF), payment for manuscript writing from Turunmaan Duodecim association, support for attending a meeting from Turku University Foundation (TUF) Kosti H\u00e4mm\u00e4r\u00f6 fund, outside of submitted work. Elina Jaakkola reports grants from FPF outside of submitted work. Elina M\u00e4kinen reports grants from FPF, TUF and Finnish Cultural Foundation (FCF) outside of submitted work. Emma Honkanen reports grants from TUF, TUH, FPF and FMF outside submitted work. Kirsi Murtom\u00e4ki reports grants from FPF and The Hopital District of Helsinki and Uusimaa (HUS). Tuomas Mertsalmi reports grants from FPF, Finnish Norwegian Medical Foundation (FNMF) and Elias Aaltonen Foundation (EAF). Valtteri Kaasinen reports grants from FCF, PSSF, TUH related to submitted work and FARF outside of submitted work, consulting fees from Nordic Infucare Ab, Abbvie, Adamant Health and Orion Pharma, payments from Nordic Infucare, Abbvie and GE Healthcare, payment for expert testimony and support for attending meetings from Nordic Infucare Ab, has a patent concerning a novel method of minimal non-invasive diagnosis of Parkinson\u2019s disease and is an expert for the Finnish patient injury board. Juho Joutsa, Kari Lindholm, Tero Vahlberg, Tommi Noponen, Toni Ihalainen, Tanja Nojonen, Reeta Levo and Filip Scheperjans report no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The study was accepted by the local ethics committee (Ethics Committee, Hospital District of Southwest Finland) and was conducted according to the 1964 Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}]}}