From Visual Attribution to Clinical Reasoning: Explainable Parkinson's Disease Screening from Hand-Drawn Patterns

Abstract

Parkinson's disease (PD) manifests early neuromotor impairments that become observable in controlled hand-drawn patterns such as spirals and meanders, where tremor-induced oscillations, stroke irregularity, and curvature instability reflect underlying motor degradation. In this work, we present an explainable framework for PD screening from offline hand-drawn patterns that integrates discriminative visual modeling with clinically grounded reasoning. The predictive model captures distributed structural distortions and fine-grained texture variations. It is evaluated under subject-disjoint protocols to ensure reliable generalization. To move beyond black-box classification, we introduce a multi-stage explainability pipeline that combines visual attribution with structured symptom abstraction. Salient regions are identified using attention- and gradient-based localization, followed by extraction of clinically meaningful motor descriptors quantifying contour roughness, curvature irregularity, stroke variability, and tremor-frequency energy. These descriptors are subsequently translated into coherent clinical rationales through a language-based reasoning module, linking model evidence to established PD symptomatology. By bridging visual attribution and clinical interpretation, the proposed framework advances interpretable document intelligence for neurological screening using hand-drawn patterns. Experimental results on publicly available Parkinson's disease handwriting datasets demonstrate competitive predictive performance and clinically consistent explanations.