Efficient Computer-Aided Diagnosis

of Alzheimer’s Disease and Parkinson’s

Disease—A Survey

R. S. Nancy Noella and J. Priyadarshini

Abstract Dementia is a broad category of brain-related diseases that continues for

a long term and severely affects thinking and daily functioning of a human being.
Among different types of dementia the fatal type of brain problems are Alzheimer’s
Disease (AD) and Parkinson’s Disease (PD). More than 70% of cases are reported
as dementia is in the Alzheimer’s category. In AD, the patient’s brain gets severely
damaged, especially the outer part of the brain like cerebral cortex, hippocampus,
ventricles, etc. The AD patients have enlarged ventricles, shrinkage in hippocampus
and cortex. PD is also a common dementia after AD. In PD, the patient’s mid-brain
gets damaged, i.e., substantia nigra. The proposed work presents an efficient
automation for the detection of the AD and PD with Machine Learning Techniques
(MLT). To detect the presence of PD and AD, two different types of brain image
databases have to be selected: Positron Emission Tomography (PET) and Single
Photon Emission Computed Tomography (SPECT) database images, both of them
contain data for AD and PD patients in comparison with the healthy brain images.
From the input image, different features have to be extracted like statistical
moments, geometrical moments, texture features, etc. Then Region of Interest
(ROI) has to be selected to differentiate disease-affected areas. The results have to
be generated automatically by comparing input image with the trained samples in
the database. The proposed system concentrates on applying the MLT for segre-
gating the outer part of brain with central part of brain for diagnosing the AD and
PD in comparison with the healthy brain data.

Keywords Alzheimer’s Disease (AD) Parkinson’s Disease (PD)


Computed Tomography (CT) Positron Emission Tomography (PET)
Single Photon Emission Computed Tomography (SPECT) Computer-Aided




Diagnosis (CAD) Region of Interest (ROI) Machine Learning Techniques


(MLT) Fisher Discriminant Ratio (FDR)

R. S. Nancy Noella (&)
J. Priyadarshini

School of Computing Science and Engineering, VIT University, Chennai 600127, India
e-mail: nancynoella@ymail.com
J. Priyadarshini
e-mail: priyadarshini.j@vit.ac.in

© Springer Nature Singapore Pte Ltd. 2019 53

V. Nath and J. K. Mandal (eds.), Nanoelectronics, Circuits and Communication
Systems, Lecture Notes in Electrical Engineering 511,
https://doi.org/10.1007/978-981-13-0776-8_5
54 R. S. Nancy Noella and J. Priyadarshini

1 Introduction

Alzheimer’s Disease is one of the major types of dementia which affects more than
50 million aged people throughout the world. The drastic change in number of
AD-affected patients per year and their growing dependence on other individuals
provokes an important social repercussion. AD severely affects daily routines and
cognitive functioning of the patients, by which patient’s individual ability blurs [1].
The nerve cells in the brain die and it stops functioning. The death or partially func-
tioning of these nerve cells causes changes in patient’s memory, character and thinking
ability. The AD-affected patient’s ability to do the basic body functions like swal-
lowing, walking, etc. also get affected. It is a chronic neurodegenerative disease usually
starts slowly and continues over time. The primary symptoms of AD are difficulty in
recalling recent incidents, names, etc. and later symptoms include impaired judgment,
disorientation, confusion, behavioral changes and difficulty in speaking, swallowing
and walking. The effects of Alzheimer’s Disease affect not only in terms of familiar
affliction and dependence but also economically too. In AD, the patient’s brain gets
severely damaged, especially the outer part of the brain like cerebral cortex, hip-
pocampus, ventricles, etc. The AD patient will have enlarged ventricles, shrinkage in
hippocampus and cortex. For the efficient diagnosis of different types of dementias,
functional imaging techniques are mainly used. The early diagnosis of dementias still
remains as a demanding task because it is carried out based on the data provided by a
careful clinical examination carried out by clinical experts (Fig. 1).
Parkinson’s Disease (PD) is a progressive disorder of the nervous system that
severely affects movement [2]. More than 10 million people are affected by PD in
worldwide. The PD disorder mostly restricts free movement. So, the patient feels
difficulty in moving, walking, etc. Parkinson’s Disease is the second most common
neurodegenerative disorder surpassed only by Alzheimer’s Disease. If a proper

Fig. 1 Healthy brain versus Alzheimer’s brain

Efficient Computer-Aided Diagnosis of Alzheimer’s Disease … 55

Fig. 2 Healthy brain versus Parkinson’s brain

diagnosis carried out at the early stage, it can result in saving patient’s life. In PD
Alpha—synuclein starts to aggregate in the mid-part of the brain called as sub-
stantia nigra. This causes degeneration of the nerve cells that produce dopamine.
In PD, the patient’s mid-brain gets damaged, i.e., substantia nigra. The PD patient
will have diminished substantia nigra (Fig. 2).
Automation is mainly focused on the proposed work so that researchers in the
field of medical image processing can improve the accuracy in detection of any
abnormalities in brain. Recently, engineers working on digital image processing are
introducing software improvements by enabling computers to help the clinical
experts by providing an amount of precise medical information which add more
sense to the diagnosis work. A CAD system helps doctors in the analysis of medical
images and it is an interdisciplinary technology combines the elements of computer
vision and artificial intelligence with radiological image processing. CAD is mainly
used by physicians in their diagnosis work that provides a blueprint of critical areas;
moreover it helps in similar pattern identification of the disease which has been
unnoticed by a physician.
The design and validation of Alzheimer’s and Parkinson’s Disease detection,
with proper description of feature selection, extraction, classification and any other
abnormalities in the brain are the main challenges of this work.

2 Literature Survey

The different works designed in the related area are studied and listed below:
Evanthia E. Tripoliti et al. developed a work on automated diagnosis of diseases
based on classification: dynamic determination of the number of trees in random
56 R. S. Nancy Noella and J. Priyadarshini

forests algorithm. The main advantage is that it runs efficiently on large databases.
But that work failed to meet proper classification on datasets [3].
Carmen Paz Suarez Araujo et al. designed work on a new gating neural
ensemble for automatic assessment of the severity level of dementia using neu-
ropsychological tests. The main advantage of the work was easiness in training
sample data sets. But they failed to meet the estimate level of confidence in the
discrimination process [4].
Amira Ben et al. had worked on early diagnosis of Alzheimer’s diseases using
support vector machine. The main advantage of that method was it minimized the
number of convex functions. The disadvantage in that work was complicated kernel
selection [5].
Oriehi Edisemi Destiny Anyaiwe et al. had developed a work on weighted
Manhattan distance classifier; SELDI data for Alzheimer’s Disease diagnosis. In
that work weighted Manhattan Distance Classifier is used. The highlight of the
work was complex concepts can be learned by local approximation using simple
procedures. But the work was computationally expensive [6].
Muhammad Aksam Iftikhar et al. proposed a work on automated detection of
Alzheimer’s Disease and mild cognitive impairment using ensemble classification.
The benefits of that method were handling of high-dimensional spaces as well as
large number of training samples. The main drawback was that in most cases it
required much iteration to truly obtain high accuracy [7].
Alexander Luke Spedding et al. had developed a work on the detection of
Alzheimer’s Disease from structural MRI using an LDA and probability-based
classifier. Naive Bayesian Classifier was used in that work. The main advantage of
the work was that it required only small amount of training data to estimate the
parameters. The main disadvantage was loss of accuracy because of class condi-
tional independence [8].
A.Valli et al. had done work in Parkinson’s Disease diagnosis using image
processing techniques. Statistical Parametric Mapping (SPM) is the method they
adopted in their work. The main advantage of that work was the control of false
positive rate (errors). The main drawback of the algorithm was high time con-
sumption [9].
Yue Peng et al. proposed work on Entropy Chain Multi-Label Classifiers for
Traditional Medicine Diagnosing Parkinson’s Disease. In that work, they used
classifier chains algorithm. The advantage of that work was low memory con-
sumption and low run time complexity. But the disadvantage of the method was
low efficient compared to automated approaches [10] (Table 1).
Ali H. Al-Fatlawi et al. had worked on deep belief network for the efficient
diagnosis system for Parkinson’s Disease. The main advantage was simple sample
distribution. The disadvantage was handling of time series data in the networks was
a very complicated [11].
Made Satria Wibawa et al. had done work on performance evaluation of com-
bined feature selection and classification methods based on voice feature in diag-
nosing Parkinson’s Disease. In that work, they used Principal Component Analysis
Method. The advantages of that work were lack of redundancy and reduction of
Table 1 Summary of literature survey
Author and Title Proposal Advantages Disadvantages Proposed work
year
Evanthia E. Automated diagnosis of diseases based on Random Suitable for large Improper Works on large data set and
Tripoliti classification forests data sets classification proper classification
et al. algorithm
Carmen Paz A new gating neural ensemble for automatic Neural Ease in training Misclassification Haar training is simple and
Suarez assessment of the severity level of dementia using ensemble data sets proper classification
Araujo et al. neuropsychological tests classifier
Amira Ben Diagnosis of Alzheimer diseases in early step Support Less number of Complicated Training and classification
et al. using SVM vector functionality Kernel selection can be done with minimum
machine number of functionality
Oriehi Weighted Manhattan distance classifier; SELDI Weighted Ease in training Complicated Proper classification with
Edisemi data for Alzheimer’s Disease diagnosis Manhattan data sets classification fewer steps
Destiny distance
Anyaiwe classifier
et al.
Muhammad An ensemble classification approach for Ensemble Suitable for high More number of Suitable for any type of data
Aksam automated diagnosis of Alzheimer’s Disease and classifier dimensional data iterations for and classify the diseases
Iftikhar et al. mild cognitive impairment classification with few number of steps
Efficient Computer-Aided Diagnosis of Alzheimer’s Disease …

Alexander An LDA and probability-based classifier for the Naive Less number of Less accurate More accuracy compared to
Luke diagnosis of Alzheimer’s Disease from structural Bayesian training data is Naïve Bayesian Classifier
Spedding MRI classifier enough for
et al. classification
A. Valli Parkinson’s Disease diagnosis using image Statistical Less error rate Time More accuracy
et al. processing techniques. Statistical parametric parameter consumption is
mapping mapping more for
classification
(continued)
57
Table 1 (continued)
58

Author and Title Proposal Advantages Disadvantages Proposed work

year
Yue Peng Entropy Chain Multi-Label Classifiers for Classifier Low memory Low efficient Highly efficient
et al. traditional medicine diagnosing Parkinson’s chain consumption
disease
Ali H. Efficient diagnosis system for Parkinson’s Disease Deep belief Sample Time series of Classification carried out
Al-Fatlawi using deep belief network network Distribution is easy data in the with fewer steps
et al. network is
complicated
Made Satria Performance evaluation of combined feature Principal Lack of Comparatively More accuracy
Wibawa et. selection and classification methods in diagnosing component redundancy and low accuracy
Parkinson’s Disease based on voice feature analysis reduction of noise
method
R. S. Nancy Noella and J. Priyadarshini
Efficient Computer-Aided Diagnosis of Alzheimer’s Disease … 59

noise. But they failed to reach accurate result compared to other different algorithms
[12].
The literature survey infers that the detection of AD and PD from same brain
image data set is not processed. So, automation for detection of AD and PD is
proposed in this work.

3 Proposed Work—Discussion

The proposed work aims in diagnosing the AD and PD among people. The existing
works portrays various methods to identify the AD and PD. A work on diagnosis of
AD using Decision Tree (DT) for classifying the stages of Alzheimer’s Disease
already implemented in [13] and have attained an accuracy of 80%.
Now this work is planning to extend the work with advancement in the tech-
niques using Machine Learning Algorithm for diagnosing both AD and PD.
By MLT the results of diagnosis will have more accuracy. The proposed systems
plan to use Haar training and Ada boost classifier for training the data set. The
overall architecture for the proposed system is in Fig. 3. The outer part of the brain
is diagnosed for AD and central part for PD. The outer and central part segregation
is done using MLT for more accuracy in which the existing system has not work.
The proposed system concentrates on applying the MLT for segregating the outer

Image Acquisition

Input Layer
Preprocessing

Feature
Extraction Fisher Discriminant
Layer

Haar Training
+
Adaboost Classifier

Automation
Layer Region of Interest

Outer Center
part of part of
brain brain

Alzheimer’s Parkinson’s
Classification Disease Disease
Layer

Fig. 3 Architectural diagram of diagnosis of AD and PD

60 R. S. Nancy Noella and J. Priyadarshini

Layer Description

Image PET & SPECT Images

Input layer Acquisition
Intensity Normalization
Preprocessing

Feature Extraction layer Fisher Discriminant Ratio

Haar Training + Ada boost

Training Classifier
Automation
Layer
Outer Region and Center
Region of
Region
selection
Alzheimer’s Disease

Classification Layer Parkinson’s Disease

Healthy Brain

Fig. 4 Different layers included in the diagnosis of AD and PD

part of brain with central part of brain for diagnosing the AD and PD in comparison
with the healthy brain data and AD- and PD-affected brain images.
Figure 4 shows the different layers included in the diagnosis procedure and the
description of each step is as follows:

3.1 Image Acquisition

For the proposed system, the images selected are PET and SPECT. Computed
Tomography is a diagnosing test use to build detailed images of different parts of
human body like bones, internal organs, blood vessels, and soft tissues. The
cross-sectional images created by the CT scan can be reformatted in multiple
planes. This can also produce three-dimensional images that can be transferred to
electronic media, seen on a computer monitor or printed on film. Emission
Computed Tomography images are usually used in biomedical research field and
medical field for the past few years. These emissions based functional images
reproduce a blueprint of physiological functions along with anatomical structure
images and this provides data about physiological phenomena and its position in the
body. Emission computed tomography types include: Positron Emission
Tomography (PET) [14] and Single Photon Emission Computed Tomography
(SPECT) [15]. In this work, PET and SPECT are the two different brain image
datasets used for brain image acquisition. PET is a nuclear medicine functional
imaging practice used to view metabolic processes in the body. The diagnosis is
done by emitting pairs of gamma rays indirectly introduced into the body of the
Efficient Computer-Aided Diagnosis of Alzheimer’s Disease … 61

patient on a biologically active molecule by a positron emitting radionuclide (tra-

cer). Three-dimensional images of tracer concentration within the body are then
constructed by computer analysis. SPECT is other gamma rays based nuclear
medicine tomographic imaging technique. This is like other conventional nuclear
medicine planar imaging using a gamma camera (scintigraphy). It provides the
trusted three-dimensional information to the clinical experts. These data are typi-
cally showed as cross-sectional slices and it can be easily reformatted or manipu-
lated according to the requirement. Both PET and SPECT systems are noninvasive
nuclear medicine imaging techniques. PET and SPECT images create 3D medical
image of functional processes in the body, such as blood pressure or metabolism of
glucose by means of tracers. In both methods, the detected emissions are processed
and a 3D image of the region is acquired by consequent computer-based
investigation.

3.2 Preprocessing

The selected brain images have to be preprocessed. The preprocessing method used
here is intensity normalization. In the further steps, input image has to be compared
with the healthy brain and other brain data sets to detect the presence of AD or PD.
For that the input data have to be normalized in terms of intensity to make com-
parison between the images according to their voxel normalized intensity levels. To
avoid the problems that can be caused due to the presence of voxels with maximum
intensity level, the intensity normalization is processed. The peak intensity values
could not process properly due to noise. Sometimes there is a chance of images to
get badly normalized if the normalization process carried out based on wrong noisy
voxels. In the proposed work, intensity normalization is carried out based on the
mean value of voxels with the highest intensity values in used to avoid the possible
normalization errors.

3.3 Feature Extraction

The Fisher Discriminant Ratio (FDR) method for feature extraction is described by
its separation capability and this helps for the suitable extraction of features from
the given set of images. For the two set value, FDR can be defined as follows:

ðl1  l2 Þ2
FDR ¼ ð1Þ
ðr1 Þ2 þ ðr2 Þ2

where µ1, µ2 and r1, r2 in Eq. (1) denote the two class set values of mean value and
variance for each input variable, respectively. The cumulative scattering in each
62 R. S. Nancy Noella and J. Priyadarshini

class decreases or the ratio value increases as the difference of the mean values of
each two classes increases for a given set of variables as seen in Eq. (1). The voxels
that satisfy a specific FDR threshold level get nominated as the most discriminative
variables in the functional images selected for analysis. Together with the selection
of voxels, the feature extraction using FDR helps in dimensionality reduction of the
process by choosing the voxels within the FDR threshold alone. This results in
selection of minimum number of variables in each observation and so the com-
plexity of process gets decreased.

3.4 Automation Layer

The training and classification are done by Haar Training and AdaBoost Classifier.
The proposed system improves the output by enhancing the existing Haar training
method using the AdaBoost classifier.

3.4.1 Haar Training

The Haar trainer’s is a weak learner because its detection quality is slightly better than
random guessing [16]. In spite of this, the training technique is still preferred. Wavelet
coding is suitable for the applications where tolerable degradation and scalability are
important. Haar wavelet transform decomposes the input signals into a set of the basis
function are called wavelets. It identifies the relevant feature results which helps in
easier, faster and better understanding of images. Relevant information of input data
can be predicted by feature extraction. Algorithms are used to isolate and detect the
shapes and desired portions significantly. The quality of the process of feature
extracting affects the classification process. Thresholding helps to obtain the normal
or abnormal images. Most effective techniques are used to isolate the object by
converting in binary image from gray level and image with high contrast levels.

3.4.2 AdaBoost Algorithm

The AdaBoost algorithm [17] is a well-known method to build ensembles of classi-

fiers with very good performance. AdaBoost algorithm along with decision trees gives
excellent performance can be considered as a hybrid model for classification. The
AdaBoost algorithm, proposed in [17], learns a combination of the output, Hm(x) to
produce the final decision of classification given by,

X
M
H ð xÞ ¼ sign am H m ð x Þ ð2Þ
m¼1
Efficient Computer-Aided Diagnosis of Alzheimer’s Disease … 63

where M is the maximum number of classifiers, am is the computed weight factor of

each classification in Eq. (2). The weight distribution of the training set patterns is
reorganized between iterations according to the accuracy of classification of the
previous classifiers. The weight of the misclassified patterns is increased for the
next iteration, whereas the weight of the correctly classified patterns is decreased.
The next classifier is trained with a re-weighted distribution. The amount of change
on the weight of each pattern is proportional to the classification error of the pattern.
The training set is always the same in each iteration and each input pattern is given
a weight according to its misclassification by the previous classifiers. On subse-
quent iterations, the weight of the misclassified patterns by the ensemble is
increased, whereas the weight of the correctly classified patterns decreases. This
allows for the current classifier to be focused on the most difficult patterns, that is,
the ones that were not well classified by the previous classifiers.

3.4.3 Region of Interest and Classification

The Region of Interest (ROI) has to be selected select to differentiate

disease-affected areas. The two diseases AD and PD can be differentiated by the
difference in the voxels present in the input brain image by comparing the healthy
brain. Here, the machine learning techniques have to be applied for segregating the
outer part of the brain with central part of the brain. If in the classification, the
varying pixels are seen most in the outer region, then the patient is having
Alzheimer’s Disease. If the variation is seen most in the center part of the input
image while classifying, then the patient is having Parkinson’s Disease. If no
variation and the voxels quality matches with the healthy brain in the dataset, then
the patient is not having any dementia.

4 Conclusion

The proposed work aims in detecting the AD and PD among people. The existing
works portray various methods to identify the DA and PD. The efficient
Computer-Aided Diagnosis (CAD) for the early diagnosis of the AD and PD with
Machine Learning Techniques (MLT) proposed in the paper will surely achieve more
accuracy than any other existing system. The proposed work has special specifications
like automated system that will improve the quality of the previous work.
64 R. S. Nancy Noella and J. Priyadarshini

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