The Bradykinesia Akinesia Incoordination Test (BRAIN TEST), an Objective and User-Friendly Means to Evaluate Patients With Parkinsonism *Carl Nikolaus Homann, MD, JD, *Klaudia Suppan, MD, *Karoline Wenzel, MD, †Gavin Giovannoni, MD, PhD, *Gert Ivanic, MD, *Susanne Horner, MD, *Erwin Ott, MD, and *Hans Peter Hartung, MD, PhD *Department of Neurology, Karl Franzens University Graz/Austria; and the †Departments of Neurochemistry and Clinical Neurology, Institute of Neurology, Queen Square, London, U.K. Summary: The BRAIN TEST, a computerized alternating finger tapping test, was performed on 154 patients with par- kinsonism to assess whether the test could be used as an ob- jective tool to evaluate reliably the severity of Parkinson’s dis- ease (PD). Patients were instructed to tap two marked computer keyboard keys as fast and as accurately as possible for 60 seconds. The test generates the following variables: (1) kinesia score (KS)—number of keystrokes/min, (2) akinesia time (AT)—cumulative time that keys are depressed, (3) dysmetria score (DS)—a weighted score generated from incorrectly hit keys and corrected for speed, and (4) arrhythmia score (AS)— variance of the time interval between individual keystrokes. Among parkinsonian patients, we found a significant correla- tion between the four test parameters and PD rating scores of the Hoehn & Yahr, Schwab & England, and Unified PD Rating Scales (KS, AS, and AT p <0.001 and DS p <0.05). When compared with 73 parkinsonian patients 73 age- and sex- matched control subjects showed significantly higher KS and lower AT (p <0.001) as well as lower DS and AS (p  0.05). The BRAIN TEST is a reliable and practical tool for evalu- ating the severity of parkinsonism and for distinguishing sub- jects with parkinsonism from normal control subjects. A ver- sion of the BRAIN TEST is available by FTP on the world- wide web (http://www.anaesthetist.com/software/brain.htm). Key Words: Parkinsonism—Objective evaluation—Disease severity—Computerized test—Finger-tapping. The cardinal signs of Parkinson’s disease (PD) are bradykinesia, tremor, rigidity, and disturbance of pos- tural reflexes. The search for a means to objectively evaluate motor impairment resulting from PD has been actively pursued for several decades. Finding such a means is an important aim to help assess responsiveness to medication, optimize treatment, and objectively define end points in clinical trials. An important step toward this goal was the creation of various evaluation scales, espe- cially the Unified Parkinson’s Disease Rating Scale (UPDRS) which was published in 1987. 1 Unfortunately, the limitations of subjectively rated scales, despite hav- ing been performed under standardized conditions, have become clear. Interrater reliability, although judged con- troversially by some, has proved to be the weakest point of the PD rating scales. 2,3 The advantage of using a simple apparatus for objectively evaluating and grading parkinsonian symptoms is obvious. The finger-tapping test is the most widely used method of evaluating short- term effects of apomorphine on bradykinesia and has become the gold standard to test levodopa responsive- ness. 4–8 We tested the ability of a simple computer soft- ware program (BRAIN TEST), based on the alternating finger-tapping test, to assess other aspects of movement. We hypothesized that by using the BRAIN TEST (Giovannoni and Schalkwyk, South Africa) we would be able to obtain more information on motor impairments in patients with PD compared with normal control subjects and may also be able to use this test for disease staging. Aims The primary aim of this study was to assess whether the BRAIN TEST, a simple software program designed to run on a portable computer, would prove to be a prac- Received January 6, 1999; revisions received May 7 and August 24, 1999. Accepted March 15, 2000. Address correspondence and reprint requests to Carl N. Homann, MD, Dept. of Neurology, K.F. University Medical School, Auenbrug- gerplatz 22, A-8036 Graz/Austria. Movement Disorders Vol. 15, No. 4, 2000, pp. 641–647 © 2000 Movement Disorder Society 641