Abstract
Background: Accurate differentiation of Parkinson's disease (PD) from healthy aging is crucial for timely intervention and effective management. Postural sway abnormalities are prominent motor features of PD. Quantitative stabilometry and machine learning (ML) offer a promising avenue for developing objective markers to support the diagnostic process. This study aimed to develop and validate high-performance ML models to classify individuals with PD and age-matched healthy older adults (HOAs) using a comprehensive set of stabilometric parameters. Methods: Thirty-seven HOAs (mean age 70 ± 6.8 years) and 26 individuals with idiopathic PD (Hoehn and Yahr stages 2-3, on medication; mean age 66 years ± 2.9 years), all aged 60-80 years, participated. Stabilometric data were collected using a force platform during quiet stance under eyes-open (EO) and eyes-closed (EC) conditions, from which 34 parameters reflecting the time- and frequency-domain characteristics of center-of-pressure (COP) sway were extracted. After data preprocessing, including mean imputation for missing values and feature scaling, three ML classifiers (Random Forest, Gradient Boosting, and Support Vector Machine) were hyperparameter-tuned using GridSearchCV with three-fold cross-validation. An ensemble voting classifier (soft voting) was constructed from these tuned models. Model performance was rigorously evaluated using 15 iterations of stratified train-test splits (70% train and 30% test) and an additional bootstrap procedure of 1000 iterations to derive reliable 95% confidence intervals (CIs). Results: Our optimized ensemble voting classifier achieved excellent discriminative power, distinguishing PD from HOAs with a mean accuracy of 0.91 (95% CI: 0.81-1.00) and a mean Area Under the ROC Curve (AUC ROC) of 0.97 (95% CI: 0.92-1.00). Importantly, feature analysis revealed that anteroposterior sway velocity with eyes open (V-AP) and total sway path with eyes closed (TOD_EC, calculated using COP displacement vectors from its mean position) are the most robust and non-invasive biomarkers for differentiating the groups. Conclusions: An ensemble ML approach leveraging stabilometric features provides a highly accurate, non-invasive method to distinguish PD from healthy aging and may augment clinical assessment and monitoring.