A Compact Stance-Indexed Anterior-Posterior COP Representation for Parkinson's Disease Classification from Plantar VGRF

Participant-disjoint cross-validation prevents direct participant overlap, but it may still produce optimistic estimates when acquisition site and diagnosis are structurally dependent. We examined Parkinson's disease classification using 159 pressure-walkway summary features from 133 WearGait-PD participants, including 65 participants with Parkinson's disease and 68 controls. The cohort was non-factorial: two sites contained only one diagnostic group, whereas VA-Seattle was the only site containing both groups. In repeated participant-level nested cross-validation, site alone achieved an area under the receiver operating characteristic curve (AUC) of 0.955 plus or minus 0.003, exceeding the gait-feature model (0.882 plus or minus 0.014). Under the evaluated logistic-regression pipelines, adding gait features to site, age, and sex produced no measurable improvement in pooled discrimination. More site-controlled evaluations produced lower and imprecise estimates: VA-Seattle same-site AUC was 0.668 (95% bootstrap confidence interval 0.477 to 0.836), and the JHOC + Bayview-to-VA-Seattle transport stress test achieved 0.576 (0.375 to 0.770). Supporting within-diagnosis site-prediction and site-conditioned permutation analyses showed that the gait representation retained substantial acquisition-site structure. These findings indicate that participant-disjoint pooled validation did not isolate disease-related discrimination from site-associated variation. They encourage careful examination of site-label dependence and, where possible, support for pooled results through within-site or independent validation before broader claims are made about generalization across institutions.

Differential diagnosis among parkinsonian syndromes remains a clinical challenge due to overlapping motor symptoms and subtle gait abnormalities. Accurate differentiation is crucial for treatment planning and prognosis. While gait analysis is a well established approach for assessing motor impairments, conventional methods often overlook hidden nonlinear and structural features embedded in foot clearance patterns. We evaluated Topological Data Analysis (TDA) as a complementary tool for Parkinsonism classification using foot clearance time series. Persistent homology produced Betti curves, persistence landscapes, and silhouettes, which were used as features for a Random Forest classifier. The dataset comprised 15 controls (CO), 15 idiopathic Parkinson's disease (IPD), and 14 vascular Parkinsonism (VaP). Models were assessed with leave-one-out cross-validation (LOOCV). Betti-curve descriptors consistently yielded the strongest results. For IPD vs VaP, foot clearance variables minimum toe clearance, maximum toe late swing, and maximum heel clearance achieved 83% accuracy and AUC=0.89 under LOOCV in the medicated (On) state. Performance improved in the On state and further when both Off and On states were considered, indicating sensitivity of the topological features to levodopa related gait changes. These findings support integrating TDA with machine learning to improve clinical gait analysis and aid differential diagnosis across parkinsonian disorders.

We describe the winning entry to the MoCha 2026 Benchmark and Challenge on Parkinsonian Gait, which predicts MDS-UPDRS gait severity from canonicalized SMPL motion recorded at clinical sites unseen during training. The system reaches 0.6945 macro-F1 on the hidden test and ranked first of 58 entries, ahead of the runner-up at 0.5807 and the organizers' baseline at 0.4289, on a frozen public motion encoder with a single $4\times512$ linear layer. Nearly all of the margin comes from three stages usually treated as bookkeeping: reproducing the reference benchmark's exact head recipe, averaging per-walk posteriors within the subject grouping the organizers ship, and a label-free transductive calibration of the feature mean and the decision operating point. Fine-tuning the encoder lost in four distinct forms, and ten alternative encoders were worse. Every ablation number is a paid read on the hidden test, because our own leave-two-cohort-out cross-validation proved anti-correlated with the deciding score over eleven configurations. We give the negative record in full, and identify our largest gain, subject-level aggregation, as the binding ceiling on this benchmark.