{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T01:22:26Z","timestamp":1789348946743,"version":"build-2803163510"},"reference-count":105,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T00:00:00Z","timestamp":1694476800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Alzheimer\u2019s Disease"],"published-print":{"date-parts":[[2023,10,24]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Handwriting is a complex process involving fine motor skills, kinesthetic components, and several cognitive domains, often impaired by Alzheimer\u2019s disease (AD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Provide a systematic review of handwriting changes in AD, highlighting the effects on motor, visuospatial and linguistic features, and to identify new research topics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A search was conducted on PubMed, Scopus, and Web of Science to identify studies on AD and handwriting. The review followed PRISMA norms and analyzed 91 articles after screening and final selection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Handwriting is impaired at all levels of the motor-cognitive hierarchy in AD, particularly in text, with higher preservation of signatures. Visuospatial and linguistic features were more affected. Established findings for motor features included higher variability in AD signatures, higher in-air\/on-surface time ratio and longer duration in text, longer start time\/reaction time, and lower fluency. There were conflicting findings for pressure and velocity in motor features, as well as size, legibility, and pen lifts in general features. For linguistic features, findings were contradictory for error patterns, as well as the association between agraphia and severity of cognitive deficits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Further re-evaluation studies are needed to clarify the divergent results on motor, general, and linguistic features. There is also a lack of research on the influence of AD on signatures and the effect of AD variants on handwriting. Such research would have an impact on clinical management (e.g., for early detection and patient follow-up using handwriting tasks), or forensic examination aimed at signatory identification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3233\/jad-230438","type":"journal-article","created":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T13:42:45Z","timestamp":1694526165000},"page":"1-11","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":24,"title":["Handwriting Changes in Alzheimer\u2019s Disease: A Systematic Review"],"prefix":"10.1177","volume":"96","author":[{"given":"Carina Pereira","family":"Fernandes","sequence":"first","affiliation":[{"name":"NCForenses Institute, Porto, Portugal"},{"name":"Instituto Universitario de Investigaci\u00f3n en Ciencias Policiales (IUICP), Universidad de Alcal\u00e1, Alcal\u00e1 de Henares, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"Montalvo","sequence":"additional","affiliation":[{"name":"Instituto Universitario de Investigaci\u00f3n en Ciencias Policiales (IUICP), Universidad de Alcal\u00e1, Alcal\u00e1 de Henares, Spain"},{"name":"Universidad de Alcal\u00e1, Departamento de Qu\u00edmica Anal\u00edtica, Qu\u00edmica F\u00edsica e Ingenier\u00eda Qu\u00edmica, Alcal\u00e1 de Henares, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Caligiuri","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of California San Diego, La Jolla, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Pertsinakis","sequence":"additional","affiliation":[{"name":"Ingenier\u00eda Qu\u00edmica, Alcal\u00e1 de Henares, Spain"},{"name":"City Unity College, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Guimar\u00e3es","sequence":"additional","affiliation":[{"name":"Department of Neurology, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, Porto, Portugal"},{"name":"Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal"},{"name":"MedInUP \u2013 Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,9,12]]},"reference":[{"key":"ref001","doi-asserted-by":"publisher","DOI":"10.1186\/s12929-019-0524-y"},{"key":"ref002","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12694"},{"key":"ref003","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)10203-8"},{"key":"ref004","unstructured":"Castro-CaldasA, MendoncaA (2005) A Doenca de Alzheimer e outras Dem\u00eancias em Portugal, Lidel, Lisbon."},{"key":"ref005","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13439"},{"key":"ref006","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(20)30440-3"},{"key":"ref007","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2005.01094.x"},{"key":"ref008","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/61.4.P228"},{"key":"ref009","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref010","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"ref011","unstructured":"CaligiuriM, MohammedL (2012)\n                      The Neuroscience of Handwriting: Applications for Forensic Document Examination\n                      , CRC Press, Boca Raton, Florida."},{"key":"ref012","unstructured":"European Network of Forensic Science Institutes (2022)\n                      Best Practice Manual for the Forensic Handwriting Examination\n                      Edition 04, European Network of Forensic Science Institutes, Wiesbaden."},{"key":"ref013","doi-asserted-by":"publisher","DOI":"10.1109\/ACCESS.2021.3083176"},{"key":"ref014","doi-asserted-by":"publisher","DOI":"10.1520\/JFS11638J"},{"key":"ref015","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2019.109880"},{"key":"ref016","doi-asserted-by":"crossref","unstructured":"FernandesC, MontalvoG, PertsinakisM, Guimar\u00e3esJ (2022) Signature execution in Alzheimer\u2019s disease: An analysis of motor features. 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