{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:53:37Z","timestamp":1791968017903,"version":"4.3.4"},"reference-count":69,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: The Digitized Archimedes Spiral Drawing Test (DAST) provides objective assessment of fine motor function, but its utility as a biomarker for neuromodulatory interventions in Parkinson\u2019s disease (PD) remains underexplored. Objective: To explore longitudinal changes in a comprehensive set of DAST parameters following a course of intermittent theta-burst stimulation (iTBS) of the left dorsolateral prefrontal cortex (DLPFC) in PD patients as a feasibility study. Methods: Twenty-seven participants (17 PD patients, 10 healthy controls) underwent DAST testing at baseline and at 1.5 and 6 months; the immediate post-course assessment was performed only in the PD group, whereas the controls received a single sham session. Forty kinematic, temporal, spatial and tremor-related metrics were extracted. Clinical assessment was performed using MDS-UPDRS. Linear mixed models, ANCOVA, and Friedman tests were applied for statistical analysis. Results: Temporal and kinematic parameters showed modest changes over the study period, including mean velocity (p = 0.0437), trial duration (p = 0.0437), and mean number of movements (p = 0.0485). In contrast, spatial parameters (total error and length-normalized error) showed no significant change over the study period but maintained stable between-group differences across all stages (p = 0.0251 and p = 0.0123 at 6 months). Age and sex significantly influenced several DAST metrics: age affected mean error for spiral types 2, 3, and 4 (p = 0.008\u20130.047), while sex influenced dominant tremor frequency, tremor power ratio (p = 0.005\u20130.007), and mean error for spiral types 3 and 4 (p = 0.023\u20130.039). The DAST showed limited ability to differentiate adjacent PD stages: only mean velocity of spiral type 2 differed between Hoehn and Yahr stages 2 and 3 at baseline (p = 0.0176), with no significant differences between subgroups at 6 months. Conclusions: The changes over the study period were observed in kinematic and temporal DAST measures, but not in spatial parameters. These preliminary findings may suggest a possible dissociation between parameters predominantly reflecting motor planning and those reflecting trajectory execution. It may be tentatively hypothesized that DLPFC stimulation primarily modulates motor planning processes and movement execution strategies, whereas trajectory implementation and spatial coordination appear to be mediated by other cortico-subcortical structures. DAST shows potential as an objective tool for monitoring motor changes in PD; nevertheless, its responsiveness should be further evaluated in larger studies.<\/jats:p>","DOI":"10.3390\/jcm15197754","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:40:17Z","timestamp":1791596417000},"page":"7754","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal Changes in the Digitized Archimedes Spiral Drawing Test Following iTBS of the Left DLPFC in Parkinson\u2019s Disease: An Exploratory Feasibility Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Alexander","family":"Zakharov","sequence":"first","affiliation":[{"name":"Research Institute of Neurosciences, Samara State Medical University, 443099 Samara, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0926-8551","authenticated-orcid":false,"given":"Mariya","family":"Sergeeva","sequence":"additional","affiliation":[{"name":"Research Institute of Neurosciences, Samara State Medical University, 443099 Samara, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3435-1477","authenticated-orcid":false,"given":"Yuliya","family":"Komarova","sequence":"additional","affiliation":[{"name":"Research Institute of Neurosciences, Samara State Medical University, 443099 Samara, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3522-6803","authenticated-orcid":false,"given":"Natalia","family":"Romanchuk","sequence":"additional","affiliation":[{"name":"Research Institute of Neurosciences, Samara State Medical University, 443099 Samara, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Vladimir","family":"Khorev","sequence":"additional","affiliation":[{"name":"Research Institute of Neurosciences, Samara State Medical University, 443099 Samara, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7670-6566","authenticated-orcid":false,"given":"Igor","family":"Shirolapov","sequence":"additional","affiliation":[{"name":"Research Institute of Neurosciences, Samara State Medical University, 443099 Samara, Russia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"ref_1","first-page":"S257","article-title":"Defining Parkinson\u2019s Disease: Past and Future","volume":"14","author":"Kulcsarova","year":"2024","journal-title":"J. Park. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Arias-Carri\u00f3n, O. (2026). Parkinson\u2019s Disease: From Gene\u2014Environment Risk to Precision Therapy. Med. Sci., 14.","DOI":"10.3390\/medsci14010072"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Emamzadeh, F.N., and Surguchov, A. (2018). Parkinson\u2019s Disease: Biomarkers, Treatment, and Risk Factors. Front. Neurosci., 12.","DOI":"10.3389\/fnins.2018.00612"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e01669","DOI":"10.1002\/brb3.1669","article-title":"Neural substrates underlying progressive micrographia in Parkinson\u2019s disease","volume":"10","author":"Kanno","year":"2020","journal-title":"Brain Behav."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1002\/mdc3.12552","article-title":"Handwriting Analysis in Parkinson\u2019s Disease: Current Status and Future Directions","volume":"4","author":"Thomas","year":"2017","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Burgio, F., Pezzetta, R., Gooijers, J., Nordio, S., and Mantini, D. (2026). Neural and motor mechanisms of handwriting: From healthy aging to neurodegenerative disorders. Front. Aging Neurosci., 18.","DOI":"10.3389\/fnagi.2026.1758541"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.artmed.2016.01.004","article-title":"Evaluation of handwriting kinematics and pressure for differential diagnosis of Parkinson\u2019s disease","volume":"67","author":"Mekyska","year":"2016","journal-title":"Artif. Intell. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.1002\/mdc3.70278","article-title":"Clinical Applications and Measurement Properties of the Digitized Archimedes Spiral Drawing Test: A Scoping Review","volume":"12","author":"Wang","year":"2025","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Zham, P., Kumar, D.K., Dabnichki, P., Poosapadi Arjunan, S., and Raghav, S. (2017). Distinguishing Different Stages of Parkinson\u2019s Disease Using Composite Index of Speed and Pen-Pressure of Sketching a Spiral. Front Neurol., 8.","DOI":"10.3389\/fneur.2017.00435"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"106878","DOI":"10.1016\/j.clineuro.2021.106878","article-title":"Using computerized spiral analysis to evaluate deep brain stimulation outcomes in Parkinson disease","volume":"208","author":"Radmard","year":"2021","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"San Luciano, M., Wang, C., Ortega, R.A., Yu, Q., Boschung, S., Soto-Valencia, J., Bressman, S.B., Lipton, R.B., Pullman, S., and Saunders-Pullman, R. (2016). Digitized spiral drawing: A possible biomarker for early Parkinson\u2019s disease. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0162799"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"907","DOI":"10.20965\/jaciii.2023.p0907","article-title":"Detection of mild cognitive impairment using a spiral drawing test","volume":"27","author":"Fujiwara","year":"2023","journal-title":"J. Adv. Comput. Intell. Intell. Inform."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Neupokoeva, A., Bratchenko, I., Bratchenko, L., Khivintseva, E., Shirolapov, I., Shusharina, N., Khoimov, M., Zakharov, V., and Zakharov, A. (2025). Raman Liquid Biopsy: A New Approach to The Multiple Sclerosis Diagnostics. Front. Neurol., 16.","DOI":"10.3389\/fneur.2025.1516712"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"S\u00e1nchez M\u00e9ndez, J.I., Fernandez, E., Bergareche, A., and Lopez-de-Ipina, K. (2025). Essential Tremor Severity Assessment Using Handwriting Analysis and Machine Learning. Sensors, 26.","DOI":"10.3390\/s26010244"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1002\/mdc3.14201","article-title":"Archimedes Spiral Ratings: Determinants and Population-Based Limits of Normal","volume":"11","author":"Hopfner","year":"2024","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.brainres.2013.07.025","article-title":"Decreased parvalbumin mRNA expression in dorsolateral prefrontal cortex in Parkinson\u2032s disease","volume":"1531","author":"Lanoue","year":"2013","journal-title":"Brain Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"331","DOI":"10.23736\/S0390-5616.25.06526-9","article-title":"Unilateral repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex in Parkinson\u2019s Disease: A systematic review and meta-analysis","volume":"69","author":"Fernandes","year":"2025","journal-title":"J. Neurosurg. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1002\/hbm.21245","article-title":"Cognitive status correlates with white matter alteration in Parkinson\u2019s disease","volume":"33","author":"Hattori","year":"2012","journal-title":"Hum. Brain Mapp."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1093\/brain\/awm086","article-title":"Changes in network activity with the progression of Parkinson\u2019s disease","volume":"130","author":"Huang","year":"2007","journal-title":"Brain"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s40035-015-0045-x","article-title":"Transcranial magnetic stimulation to understand pathophysiology and as potential treatment for neurodegenerative diseases","volume":"4","author":"Ni","year":"2015","journal-title":"Transl. Neurodegener."},{"key":"ref_21","first-page":"84","article-title":"Mechanism of Repetitive Transcranial Magnetic Stimulation for Depression","volume":"30","author":"Peng","year":"2018","journal-title":"Shanghai Arch. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Shirolapov, I., Bazanova, O., and Zakharov, A. (2026). Personalizing Sleep Therapy: Integrating EEG Neurofeedback Into the Sleep Disorders Management. CRANIO, 1\u201313.","DOI":"10.1080\/08869634.2026.2666591"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1007\/s00415-026-13713-4","article-title":"Efficacy of rTMS and TBS on the motor symptoms in Parkinson\u2019s disease: A network meta-analysis","volume":"273","author":"Zhang","year":"2026","journal-title":"J. Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e00577","DOI":"10.1016\/j.neurot.2025.e00577","article-title":"Concurrent TMS-EEG to characterize cortical responses in the motor and prefrontal cortices in Parkinson\u2019s disease","volume":"22","author":"Zhu","year":"2025","journal-title":"Neurotherapeutics"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Cheng, B., Zhu, T., Zhao, W., Sun, L., Shen, Y., Xiao, W., and Zhang, S. (2022). Effect of Theta Burst Stimulation-Patterned rTMS on Motor and Nonmotor Dysfunction of Parkinson\u2019s Disease: A Systematic Review and Metaanalysis. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.762100"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1002\/mds.26671","article-title":"Transducer-based evaluation of tremor","volume":"31","author":"Haubenberger","year":"2016","journal-title":"Mov. Disord."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"481","DOI":"10.5334\/tohm.344","article-title":"Digitizing tablet and Fahn-Tolosa-Mar\u00edn ratings of Archimedes spirals have comparable minimum detectable change in essential tremor","volume":"7","author":"Elble","year":"2017","journal-title":"Tremor Other Hyperkinet. Mov."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/j.clinph.2015.02.001","article-title":"Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee","volume":"126","author":"Rossini","year":"2015","journal-title":"Clin. Neurophysiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1038\/npp.2008.233","article-title":"A randomized trial of rTMS targeted with MRI based neuro-navigation in treatment-resistant depression","volume":"34","author":"Fitzgerald","year":"2009","journal-title":"Neuropsychopharmacology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.neuron.2004.12.033","article-title":"Theta burst stimulation of the human motor cortex","volume":"45","author":"Huang","year":"2005","journal-title":"Neuron"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.2174\/1389557516666160523145154","article-title":"The Neuroprotective Role of Repetitive Transcranial Magnetic Stimulation (rTMS) for Neurodegenerative Diseases: A Short Review on Experimental Studies","volume":"16","author":"Yulug","year":"2016","journal-title":"Mini-Rev. Med. Chem."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Komarova, Y., Zakharov, A., Sergeeva, M., Romanchuk, N., Vladimirova, T., and Shirolapov, I. (2025). Modeling Working Memory in Neurodegeneration: A Focus on EEG Methods. Diagnostics, 15.","DOI":"10.3390\/diagnostics15232992"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Yang, N., Liu, J., Sun, D., Ding, J., Sun, L., Qi, X., and Yan, W. (2025). Motor symptoms of Parkinson\u2019s disease: Critical markers for early AI-assisted diagnosis. Front. Aging Neurosci., 17.","DOI":"10.3389\/fnagi.2025.1602426"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1007\/s00221-020-05843-6","article-title":"Effects of high-frequency repetitive transcranial magnetic stimulation on reach-to-grasp performance in individuals with Parkinson\u2019s disease: A preliminary study","volume":"238","author":"Thanakamchokchai","year":"2020","journal-title":"Exp. Brain Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e01132","DOI":"10.1002\/brb3.1132","article-title":"Repetitive transcranial magnetic stimulation therapy for motor recovery in Parkinson\u2019s disease: A Meta-analysis","volume":"8","author":"Yang","year":"2018","journal-title":"Brain Behav."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1038\/s41531-024-00793-0","article-title":"TMS-evoked potentials unveil occipital network involvement in patients diagnosed with Parkinson\u2019s disease within 5 years of inclusion","volume":"10","author":"Zifman","year":"2024","journal-title":"npj Park. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1177\/15459683241310984","article-title":"Exploring Non-invasive Brain Stimulation Effects on Physical Outcomes in People with Parkinson\u2019s Disease: An Umbrella Evidence Mapping Review with Meta-analyses","volume":"39","author":"Harris","year":"2025","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2609","DOI":"10.1093\/brain\/awg268","article-title":"Striatal dopamine release induced by repetitive transcranial magnetic stimulation of the human motor cortex","volume":"126","author":"Strafella","year":"2003","journal-title":"Brain"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Cho, S.S., and Strafella, A.P. (2009). RTMS of the left dorsolateral prefrontal cortex modulates dopamine release in the ipsilateral anterior cingulate cortex and orbitofrontal cortex. PLoS ONE, 4.","DOI":"10.1371\/journal.pone.0006725"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s10020-021-00301-7","article-title":"Clinical implications for dopaminergic and functional neuroimage research in cognitive symptoms of Parkinson\u2019s disease","volume":"27","author":"Hirano","year":"2021","journal-title":"Mol. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1002\/mds.23270","article-title":"The impact of left prefrontal repetitive transcranial magnetic stimulation on depression in Parkinson\u2019s disease: A randomized, double-blind, placebo-controlled study","volume":"25","author":"Pal","year":"2010","journal-title":"Mov. Disord."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"133437","DOI":"10.1016\/j.neulet.2018.02.045","article-title":"Protocols of non-invasive brain stimulation for neuroplasticity induction","volume":"719","author":"He","year":"2020","journal-title":"Neurosci. Lett."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Chervyakov, A.V., Chernyavsky, A.Y., Sinitsyn, D.O., and Piradov, M.A. (2015). Possible Mechanisms Underlying the Therapeutic Effects of Transcranial Magnetic Stimulation. Front. Hum. Neurosci., 9.","DOI":"10.3389\/fnhum.2015.00303"},{"key":"ref_44","first-page":"221","article-title":"Efficiency of computerized cognitive training for prevention of cognitive impairments and stimulation of neuroplasticity","volume":"37","author":"Shirolapov","year":"2024","journal-title":"Adv. Gerontol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"119534","DOI":"10.1016\/j.biopha.2026.119534","article-title":"Distinctive characteristics of dopamine neuron release mechanisms: Insights into Parkinson\u2019s Disease","volume":"200","author":"Martino","year":"2026","journal-title":"Biomed. Pharmacother."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.brs.2012.04.009","article-title":"Cerebellar rTMS stimulation may induce prolonged clinical benefits in essential tremor, and is associated with functional changes in the cerebellar circuitry: An open label trial","volume":"6","author":"Popa","year":"2013","journal-title":"Brain Stimul."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.clinph.2019.11.002","article-title":"Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014\u20132018)","volume":"131","author":"Lefaucheur","year":"2020","journal-title":"Clin. Neurophysiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e34960","DOI":"10.1097\/MD.0000000000034960","article-title":"Comparative motor effectiveness of non-invasive brain stimulation techniques in patients with Parkinson\u2019s disease: A network meta-analysis","volume":"102","author":"Liu","year":"2023","journal-title":"Medicine"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.brs.2024.12.005","article-title":"Effects of non-invasive brain stimulation over the supplementary motor area on motor function in Parkinson\u2019s disease: A systematic review and meta-analysis","volume":"18","author":"Chen","year":"2025","journal-title":"Brain Stimul."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Hoogendam, Y.Y., van der Lijn, F., Vernooij, M.W., Hofman, A., Niessen, W.J., van der Lugt, A., Ikram, M.A., and van der Geest, J.N. (2014). Older age relates to worsening of fine motor skills: A population-based study of middle-aged and elderly persons. Front. Aging Neurosci., 6.","DOI":"10.3389\/fnagi.2014.00259"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Heintz, B.D., and Keenan, K.G. (2018). Spiral tracing on a touchscreen is influenced by age, hand, implement, and friction. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0191309"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Frolov, N.S., Pitsik, E.N., Maksimenko, V.A., Grubov, V.V., Kiselev, A.R., Wang, Z., and Hramov, A.E. (2020). Age-related slowing down in the motor initiation in elderly adults. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0233942"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1038\/s41514-024-00182-0","article-title":"Aging modulates the impact of cognitive interference subtypes on dynamic connectivity across a distributed motor network","volume":"10","author":"Son","year":"2024","journal-title":"npj Aging"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Wunderle, V., Kuzu, T.D., Tscherpel, C., Fink, G.R., Grefkes, C., and Weiss, P.H. (2024). Age- and sex-related changes in motor functions: A comprehensive assessment and component analysis. Front. Aging Neurosci., 16.","DOI":"10.3389\/fnagi.2024.1368052"},{"key":"ref_55","first-page":"107","article-title":"Spiral analysis in subjects with Parkinson\u2019s disease before and after levodopa treatment: A new protocol with stereophotogrammetric systems","volume":"12","author":"Galli","year":"2014","journal-title":"J. Appl. Biomater. Funct. Mater."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Smits, E.J., Tolonen, A.J., Cluitmans, L., van Gils, M., Conway, B.A., Zietsma, R.C., Leenders, K.L., and Maurits, N.M. (2014). Standardized handwriting to assess bradykinesia, micrographia and tremor in Parkinson\u2019s disease. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0097614"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Toffoli, S., Lunardini, F., Parati, M., Gallotta, M., De Maria, B., Longoni, L., Dell\u2019ANna, M.E., and Ferrante, S. (2023). Spiral drawing analysis with a smart ink pen to identify Parkinson\u2019s disease fine motor deficits. Front Neurol., 14.","DOI":"10.3389\/fneur.2023.1093690"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.parkreldis.2017.05.018","article-title":"Task-dependent variability of essential tremor","volume":"41","author":"Schuhmayer","year":"2017","journal-title":"Park. Relat. Disord."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1007\/s10072-018-3331-4","article-title":"The difference in visuomotor feedback velocity control during spiral drawing between Parkinson\u2019s disease and essential tremor","volume":"39","author":"Chen","year":"2018","journal-title":"Neurol. Sci."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1134\/S036211972360056X","article-title":"Study of Psychophysiological Indicators of Sensorimotor Integration in PTSD. Justification of the Choice of Targets for Biofeedback","volume":"50","author":"Bazanova","year":"2024","journal-title":"Hum. Physiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.humov.2006.05.005","article-title":"Spiral drawing performance as an indicator of fine motor function in people with multiple sclerosis","volume":"25","author":"Longstaff","year":"2006","journal-title":"Hum. Mov. Sci."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.1007\/s00415-013-6996-x","article-title":"Handwriting as an objective tool for Parkinson\u2019s disease diagnosis","volume":"260","author":"Rosenblum","year":"2013","journal-title":"J. Neurol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1002\/mds.21874","article-title":"Validity of spiral analysis in early Parkinson\u2019s disease","volume":"23","author":"Derby","year":"2008","journal-title":"Mov. Disord."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"23727","DOI":"10.3390\/s150923727","article-title":"Automatic Spiral Analysis for Objective Assessment of Motor Symptoms in Parkinson\u2019s Disease","volume":"15","author":"Memedi","year":"2015","journal-title":"Sensors"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"63","DOI":"10.5334\/tohm.1105","article-title":"Archimedes Spiral Looping in Functional and Essential Tremor","volume":"15","author":"Murgai","year":"2025","journal-title":"Tremor Other Hyperkinet. Mov."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"108497","DOI":"10.5498\/wjp.v15.i9.108497","article-title":"Advances in transcranial magnetic stimulation for psychological symptom management in Parkinson\u2019s disease","volume":"15","author":"Zhou","year":"2025","journal-title":"World J. Psychiatry"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"4789","DOI":"10.1140\/epjs\/s11734-024-01449-z","article-title":"Deep learning of surface-enhanced Raman spectroscopy data for multiple sclerosis diagnostics","volume":"234","author":"Zakharov","year":"2025","journal-title":"Eur. Phys. J. Spec. Top."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Mazzara, D., Torrente, A., Alonge, P., Gerardi, G., Renda, A., and Monastero, R. (2026). The Use of Non-Invasive Brain Stimulation Techniques in Subjects with Parkinson\u2019s Disease and Mild Cognitive Impairment: A Systematic Review. Brain Sci., 16.","DOI":"10.3390\/brainsci16030325"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Pokharel, A., Tamrakar, A., and Chopra, N. (2026). Use of AR\/VR for Treatment of Freezing of Gait (FoG) in Parkinson\u2019s Disease (PD). J. Clin. Med., 15.","DOI":"10.3390\/jcm15052076"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7754\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:32:45Z","timestamp":1791966765000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7754"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":69,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197754"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197754","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,8]]}}}