Elsevier

Expert Systems with Applications

Volume 80, 1 September 2017, Pages 284-296
Expert Systems with Applications

Joint detection and clinical score prediction in Parkinson's disease via multi-modal sparse learning

https://doi.org/10.1016/j.eswa.2017.03.038Get rights and content

Highlights

  • A novel framework for joint PD detection and clinical score prediction is proposed.

  • A effective feature selection method for PD detection and prediction is proposed.

  • Multi-modal neuroimaging data enhances performance of PD detection.

Abstract

Parkinson's disease (PD) is the world's second most common progressive neurodegenerative disease. This disease is characterized by a combination of various non-motor symptoms (e.g., depression, olfactory, and sleep disturbance) and motor symptoms (e.g., bradykinesia, tremor, rigidity), therefore diagnosis and treatment of PD are usually complex. There are some machine learning techniques that automate PD diagnosis and predict clinical scores. These techniques are promising in assisting assessment of stage of pathology and predicting PD progression. However, existing PD research mainly focuses on single-function model (i.e., only classification or prediction) using one modality, which limits performance. In this work, we propose a novel feature selection framework based on multi-modal neuroimaging data for joint PD detection and clinical score prediction. Specifically, a unique objective function is designed to capture discriminative features which are used to train a support vector regression (SVR) model for predicting clinical score (e.g., sleep scores and olfactory scores), and a support vector classification (SVC) model for class label identification. We evaluate our method using a dataset of 208 subjects, which includes 56 normal controls (NC), 123 PD and 29 scans without evidence of dopamine deficit (SWEDD) via a 10-fold cross-validation strategy. Our experimental results demonstrate that multi-modal data effectively improves the performance in disease status identification and clinical scores prediction as compared to one single modality. Comparative analysis reveals that the proposed method outperforms state-of-art methods.

Introduction

Parkinson's disease (PD) (a.k.a, hypokinetic syndrome rigid or primary Parkinsonism) is caused by the deterioration of nervous system (Martínez-Murcia, Górriz, Ramírez, Illán, & Ortiz, 2014), and its main symptoms are derived from the death of dopamine-generating cells in an area of the brain known as the substantia nigra. However, existing studies also found no evidence of dopaminergic deficit in some PD patients, specifically, scans without evidence of dopamine deficit (SWEDDs) (Aerts et al., 2012, Nicastro et al., 2016). This discovery greatly increases the challenges of PD diagnosis. Currently, PD diagnosis is mainly based on the presence of primary symptoms (e.g., shaking, stiffness, slowness of movement) and the subject's response to medication (Prashanth, Roy, Mandal, & Ghosh, 2014). Although it is known that these symptoms are derived from the degeneration of a type of nerve cell called dopamine (Mahfuz et al., 2015), there is still no definitive cure for PD because the cause for death of this cell is still unknown (Feinsod, Kreinin, Chistyakov, & Klein, 1998). Dorsey et al. (2007) predicted that there will be about nine million individuals over 50 with PD in 15 nations by 2030. Hence, it is imperative to take effective measures for diagnosis and treatment of PD.

Machine learning techniques play increasingly important role for PD prognosis and diagnosis and have become a hot topic recently (Long et al., 2012, Prashanth et al., 2014, Salamanca et al., 2015, Singh and Samavedham, 2015; Wang, Long, & Chen, 2013). However, most of existing research mainly focuses on the single-function model (Lee and Lim, 2012, Rana et al., 2015). For example, Yuvaraja et al. proposed a new functional connectivity indexed feature via bispectral analysis to perform the classification of PD patients without dementia (Yuvaraj et al., 2016). Bhalchandra et al. employed shape-based features pre-processed from single photon emission computed tomography (SPECT) to conduct discriminant analysis (Bhalchandra, Prashanth, Roy, & Noronha, 2015). In addition, most existing methods only adopt single modality features for PD clinical score prediction (Hou et al., 2016, Prashanth et al., 2014), and it is argued that different brain's functional or structural imaging modalities preserve different information. For example, diffusion tensor imaging (DTI) reveals microscopic details about tissue architecture either in a normal or diseased state (Bendlin et al., 2012), whereas magnetic resonance imaging (MRI) provides structure information about the brain tissue type.

In recent years, multi-modality has become a hot topic and many studies have shown that the combination of different modalities can produce better performance in disease diagnosis (Liu, Wee, Chen, & Shen, 2014; Zhu, Suk, & Shen, 2014a; Zhu, Suk, Lee, & Shen, 2016a). A method introduced in Lei, Chen, Ni, and Wang (2016) improves classification performance of neurodegenerative brain disease by capturing both individual and shared information via multimodal features and canonical correlation analysis (CCA). Therefore by using multi-modal data, we expect to boost the PD diagnosis and prediction performance of our technique.

Machine learning methods can be used to predict neurological disease progression and assess the stage of pathology (Cheng, Zhang, Chen, Kaufer, & Shen, 2013). Hence, some researchers have applied machine learning methods to estimate clinical scores from brain images (Cheng et al., 2013, Hou et al., 2016, Lei et al., 2015) and found reliable correlation between estimated clinical scores and different PD stages. Appropriate and targeted treatment can then be carried out to treat PD effectively. For example, Hou et al. predicted clinical scores of unified Parkinson's disease rating scale (UPDRS) in PD patients using resting-state functional magnetic resonance imaging (fMRI) (Hou et al., 2016).

Unlike many previous studies concentrated on only one task (i.e., classification or prediction), Zhang and Shen proposed a novel method to jointly address the regression and classification (JRC) problem (Zhu, Suk, & Shen, 2014b) for Alzheimer's disease (AD), which tackled both problems simultaneously in a unified framework. However, there is no prior method and framework to jointly conduct PD disease classification and clinical score prediction. For PD, the clinical scores mainly comprise of the Montreal cognitive assessment (MoCA) (Kandiah et al., 2014), the UPDRS (Hou et al., 2016), the Epworth sleepiness scale (ESS) (Johns, 1991), the mini-mental state examination (MMSE) (Tombaugh & McIntyre, 1992), the geriatric depression scale (GCS) (Yesavage, 1988), and the university of Pennsylvania smell identification test (UPSIT) (Doty, Shaman, Kimmelman, & Dann, 1984). In our study, we adopted the values of ESS as sleep scores and the degrees of UPSIT as olfactory scores.

In general, there are three key steps for classification or regression, i.e., feature extraction, feature selection, and classification or regression. In the field of medical image analysis, it is challenging to select informative features to solve the problem of small sample size and high feature dimension. For example, there are only 42 subjects (i.e., 28 PD patients and 14 NC) in Bowman's study (Bowman, Drake, & Huddleston, 2016), and 46 samples (i.e., 19 PD patients and 14 NC) in Long et al. (2012), but the feature dimension of both studies is quite large. It is hard to improve the signal-to-noise ratio (SNR) (Lu et al., 2015) and construct a universal robust model (Zhu, Huang, Tao Shen, Cheng, & Xu, 2012). Due to over-fitting problem caused by the high-dimensional data, feature selection has become a well-researched topic due to its effectiveness to address this problem. Once highly correlated features have been selected, classification, and regression can be straightforwardly implemented by support vector machine (SVM) and multivariate logistic regression (MLR) (Alexopoulos, 2010). In the neuroimaging field, dimensionality reduction is often carried out by subspace learning (Guerrero et al., 2014, Lei et al., 2015; Liu, Tosun, Weiner, & Schuff, 2013) or feature selection (Chu et al., 2012, Young et al., 2012). The idea of subspace learning method is to transform original feature to a low-dimensional space using Fisher's linear discriminant analysis (LDA) (Perronnin, Sánchez, & Mensink, 2010) and locally linear embedding (LLE) (Roweis & Saul, 2000). Meanwhile, the main goal of feature selection such as t-test method (Wang, Zhang, Liu, Lv, & Wang, 2014) and sparse linear regression (Mateos, Bazerque, & Giannakis, 2010) is to obtain the most discriminative and highly noise-resistant subsets from its original feature sets. Existing study shows that it is more effective to use feature selection methods than subspace learning, especially for neurodegenerative diseases since the selected features may be directly related to its essential features (Zhu, Suk, Lee, & Shen, 2016b). In addition, the performance of feature selection can be further improved by manifold learning techniques according to the recent neuroimaging studies (Zhu et al., 2013, Zhu et al., 2013).

To harness multi-modal data motivated by study in Bowman et al. (2016), Salamanca et al. (2015) and Zhu, Suk, and Shen (2014a), we propose a new united novel feature selection framework via multi-modal neuroimaging data for PD diagnosis, which simultaneously performs classification and clinical sores prediction based on a novel loss function. Specifically, we combine three features, gray matter (GM) of MRI images, cerebrospinal fluid (CSF) of MRI images, and fractional anisotropy (FA) coefficient of DTI images to discriminate normal controls (NCs) and PD/SWEDD. In addition, we jointly predict two clinical scores (i.e., sleep and olfactory score). Our proposed method has been evaluated using the public available Parkinson's progression markers initiative (PPMI) database (http://www.ppmi-info.org).

Section snippets

Materials and dataset

The experimental data of this study was acquired from the PPMI database (http://www.ppmi-info.org). PPMI (Marek et al., 2011) is the first all-around, broad-scale, multi-focus, observational, and international study to identify PD progression biomarkers [2]. Since PPMI is a longitudinal study, the state of participants varies depending on the study time. All data used in this work were acquired by a Siemens MAGNETOM Trio 3.0T MRI scanner. The high-resolution 3-dimensional (3D) T1-weighted

Experimental settings

In our experiments, we perform two binary classifications via SVM: NC vs. PD, NC vs. SWEDD. For each set of experiment, the feature selection model is trained using four different feature sets, namely, GM of MRI (T1G for short), CSF of MRI (T1C for short), FA coefficient of DTI (DTI for short), and T1G+T1C+DTI (GCD for short). For each feature set, two regression models are obtained, where the first model is to predict olfactory scores, and the second model is to predict sleep scores, and the

Limitations and future direction

In spite of the appealing performance achieved by the proposed method, there are several limitations of our method. First, the template used to extract features in our study is AAL atlas, which only has 116 ROIs segmented from brain areas. In fact, the extended AAL map (AAL-290) used in Bowman et al. (2016) has excellent classification performance and contains 290 regions. AAL-290 may provide more detailed and robust features by combining the theory of pivot selection (Mao, Zhang, Li, Liu, &

Conclusions

In this study, a united feature selection framework based on a novel objective function was proposed to simultaneously perform classification and clinical sores prediction in PD based on multi-modal neuroimaging data. From our experimental results, we observed that fusing different modalities enhances classification performance. We also observed that the proposed feature selection method based on a novel objective function outperformed its counterpart for single modality and multiple

Disclosure statement

The authors have no financial and personal conflicts of interest.

Acknowledgments

This work was supported partly by China 863 program (No. 2015AA015305), National Natural Science Foundation of China (Nos. U1301252, 61402296, and 61471243), Guangdong Key Laboratory Project (No. 2012A061400024), Guangdong Medical Grant (No. B2016094), Natural Science Foundation of Shenzhen (No. JCYJ20140418095735561, No. JCYJ20150731160834611), Shenzhen Key Basic Research Project (No. JCYJ20150525092940986), the Open Fund Project of Fujian Provincial Key Laboratory of Information Processing

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