Unmasking Parkinson's Disease with Smile: An AI-enabled Screening Framework

We present an efficient and accessible PD screening method by leveraging AI-driven models enabled by the largest video dataset of facial expressions from 1,059 unique participants. This dataset includes 256 individuals with PD, 165 clinically diagnosed, and 91 self-reported. Participants used webcams to record themselves mimicking three facial expressions (smile, disgust, and surprise) from diverse sources encompassing their homes across multiple countries, a US clinic, and a PD wellness center in the US. Facial landmarks are automatically tracked from the recordings to extract features related to hypomimia, a prominent PD symptom characterized by reduced facial expressions. Machine learning algorithms are trained on these features to distinguish between individuals with and without PD. The model was tested for generalizability on external (unseen during training) test videos collected from a US clinic and Bangladesh. An ensemble of machine learning models trained on smile videos achieved an accuracy of 87.9+-0.1% (95% Confidence Interval) with an AUROC of 89.3+-0.3% as evaluated on held-out data (using k-fold cross-validation). In external test settings, the ensemble model achieved 79.8+-0.6% accuracy with 81.9+-0.3% AUROC on the clinical test set and 84.9+-0.4% accuracy with 81.2+-0.6% AUROC on participants from Bangladesh. In every setting, the model was free from detectable bias across sex and ethnic subgroups, except in the cohorts from Bangladesh, where the model performed significantly better for female participants than males. Smiling videos can effectively differentiate between individuals with and without PD, offering a potentially easy, accessible, and cost-efficient way to screen for PD, especially when a clinical diagnosis is difficult to access.