Parkinson's Foundation

Parkinson's Foundation is using its 2020 distribution to fund:

  • Unravelling the potential of specialized allied health therapy for patients with Parkinson’s Disease
  • Cognitive Correlates of Gait Impairment and Freezing in Parkinson's Disease
  • PROJECT TITLE:  Unravelling the potential of specialized allied health therapy for patients with Parkinson’s Disease

    Investigators/Authors: Darweesh Sirwan, Radboud University Medical Centre

    Objective: To explore three specific gaps in our knowledge of allied therapy in order to understand the most effective usage for people with Parkinson’s.

    Background: The social and economic burden caused by Parkinson’s disease (PD) is expected to rise substantially in the coming decades, emphasizing the need to widely implement treatment modalities that have been proven to be effective for persons with PD. Recently, community-based Allied Health Therapy (physiotherapy, occupational therapy, and speech-language therapy) delivered by specifically trained professionals has yielded beneficial effects on short-term functional outcomes in persons with PD.

    Methods/Design: There are three key gaps in our present knowledge of allied therapy which hamper optimal and wider implementation of specialized Allied Health Therapy (AHT). This study will explore: 1) which patient subgroups are most likely to respond favorably to specialized AHT interventions; 2) whether parallel delivery of specialized therapy across multiple disciplines has additional benefits for patients; and 3) whether specialized Allied Health Therapy remains effective over longer periods (more than 5 years).

    Relevance to Diagnosis/Treatment of Parkinson’s disease: This project will address these critical gaps in knowledge of Allied therapy, thereby paving the way for personalized rehabilitation for those persons with PD who need it most.

    October 2021 Project Update:

    It is vital that treatments proven to be effective for persons with PD are implemented. Specialized allied health therapy (AHT) yields good effects for persons with PD. This study looks at how specialized AHT can best be implemented for persons with PD.

    In Year 1, we designed the source study. Further, we identified subgroups of persons with PD in which specialized allied health services substantially improve quality of life. Subgroups are defined by age, gender, socioeconomic status, disease-specific characteristics, and coping strategy. Enrollment in the questionnaire-based study took place between March 1, 2020, and December 31, 2020. Because the study enrolment period coincided with the eruption of the COVID-19 crisis, several recruitment activities could not be conducted as planned. Despite this, 988 people with parkinsonism enrolled, including 940 (95%) with PD. Of these participants, 753 (76%) are currently receiving physiotherapy, including 300 participants who are treated by a specialized therapist and 453 who are treated by a generic therapist. Furthermore, 247 (25%) participants are currently receiving speech-language therapy, including 92 by a specialized and 155 by a generic therapist. Also, 221 (22%) participants are currently receiving occupational therapy, including 92 by a specialized and 129 by a generic therapist. Currently, analyses are ongoing to assess differences in quality of life between subgroups of people with PD. Additionally, analyses are ongoing to assess characteristics of people with PD receiving parallel AHT therapy across multiple disciplines. The goal of the last part of our project is to determine the long-term effectiveness of specialized AHT on the reduction of complications in persons with PD. Of note, the data show that specialized AHT becomes more common in persons with PD over time. This will boost the next steps of this project. In total, this study could pave the way for tailored specialized AHT.

    PROJECT TITLE:  Cognitive Correlates of Gait Impairment and Freezing in Parkinson's Disease

    Investigators/Authors:  Kevin Wilkins, Stanford University

    Objective: To investigate how the attention network in the brain relates to gait impairment and freezing in people with Parkinson’s.

    Background: Gait impairment and freezing of gait affect nearly 75% of individuals with advanced Parkinson’s Disease (PD). There is growing evidence that these freezing may be due to a compromised attention-network in the brain that makes individuals more vulnerable to freezing in demanding environments that stress attention.

    Methods/Design: We propose to investigate how a specific brain structure that is known to be the key node in the attention network relates to freezing and its worsening over time in PD. Additionally, we will simultaneously measure brain activity during gait tasks that are known to elicit freezing to investigate whether specific brain signals related to attention are also related to freezing and its worsening over time. Finally, we will see how both the brain structure and activity relate to validated cognitive tests for attention and similar cognitive processes.

    Relevance to Diagnosis/Treatment of Parkinson’s disease: Results from this proposal will allow us to disentangle what role attention may play in freezing behavior in PD, and possibly provide future targets for therapy.

    October 2021 Project Update:

    A lot of people with Parkinson’s disease (PD) have trouble walking. In certain places they may even freeze and not be able to move. These troubles are not always helped with therapy. We believe that some of the trouble with walking is due to a brain region that is separate from what is treated for other symptoms of PD. We took images of the brain in people and compared them with how well they were able to walk. We saw that the size of one small part of the brain, called the Nucleus Basalis of Meynert (NBM), was related to how well a person with PD walks. Those who had a smaller NBM had more trouble walking. Next, we had each person repeat the same walking test three years later. We found that those with a smaller NBM got worse over time even though their other symptoms did not. This suggests that we may need to find a new therapy to treat this problem. These results were published in the journal Neurobiology of Disease.

    The results of this study help us know why some people with PD struggle with walking and freezing even when their therapy treats other symptoms well. We believe that a smaller NBM also causes other problems besides walking. The NBM is known to be smaller in people who have trouble with attention and memory. We are now working to see how trouble walking may relate to these issues. If the NBM is found to be the problem, it may be a good target for new therapies in PD.