Digital Handwriting Kinematics and Physical Performance According to Pentagon-Copy Performance in Community-Dwelling Older Adults: Cross-Sectional Study

Abstract

Background: Cognitive decline in older adults is often accompanied by subtle motor alterations. Digital handwriting analysis has emerged as a promising noninvasive approach for detecting these changes, but its usefulness in community-based settings remains unclear. Objective: This study aims to examine the association of handwriting kinematics and physical performance measures with pentagon-copy performance classification in community-dwelling older adults. Methods: This cross-sectional study included 174 community-dwelling adults aged 60 years or older (mean age 73.9, SD 6.1 years; 108/174, 62% women). Participants completed 10 digital handwriting tasks and a battery of physical performance tests assessing strength, balance, gait, and cardiorespiratory fitness. Group classification was based on pentagon-copy performance and categorized as normal (93/174, 53% participants) or altered (81/174, 46% participants). Adjusted linear regression models included group as the main predictor and age and sex as covariates. Multiple comparisons were controlled using the Benjamini-Hochberg false discovery rate. Results: After adjustment for age, sex, and multiple comparisons, selected handwriting variables remained significantly associated with altered pentagon-copy performance, whereas no physical performance variables remained statistically significant. The most consistent differences were observed in cognitive effort and mechanical tasks, where participants with altered pentagon-copy performance showed longer contact time (β=526.8 ms; P<.001) and time on air (β=1111.5 ms; P<.001), together with lower mean writing pressure (β=–2058.8 au; P=.003). Overall, group differences were more consistently detected in handwriting-derived variables than in conventional physical performance outcomes after adjusted analyses. Conclusions: Selected digital handwriting variables, particularly temporal measures, were more consistently associated with altered pentagon-copy performance than physical performance outcomes. These findings suggest that digital handwriting analysis may represent a sensitive complementary approach for exploring subtle functional differences in community-based settings.