For patients with brain disorders like Parkinson’s disease, early diagnosis can mean earlier intervention and treatment.
Right now most patients are not diagnosed until they are showing symptoms of the disease. Researchers have now developed a system that can detect Parkinson’s-like brain changes well before anyone sees signs of the disease.
Seventy-one year old Timothy “Ted” McCarthy is retired from the NYPD, but prides himself on staying sound in mind and body.
McCarthy told Ivanhoe, “I see other people and they are around the same age as me. I don’t think they are as spry or mentally alert.”
With a family history of dementia, McCarthy is determined to stay healthy as long as he can.
Researchers studying the link between mobility and cognition are using a new approach: a real-time imaging system called fNIRS, functional near-infrared spectroscopy. FNIRS uses light to monitor changes in blood oxygenation in a person’s pre-frontal cortex.
The pre-frontal cortex ,“is involved in many important higher order functionings, like task switching, organization, planning, everything we need on a daily basis,” explained Jeannette R. Mahoney, PhD, an assistant professor at Albert Einstein College of Medicine in New York City.
During tests, researchers ask participants to walk and talk at the same time.
“Dividing this attention is sometimes a problem when you get old, or when you have early signs of disease of the brain, like Alzheimer’s, Parkinson’s or stroke,” said Joe Verghese, MD, the chief of geriatrics at Albert Einstein College of Medicine.
With fNIRS , patients are able to move around freely, unlike an MRI. Researchers say those who have mild parkinsonian symptoms don’t look like they are having a tough time.
“Until you examine the brain using fNIR and you discover it is actually straining the brain to do a simple task,” Dr. Verghese told Ivanhoe.
Researchers say by identifying problems early on, they can intervene right away.
McCarthy said, “For 71, I think I’m doing okay.”
McCarthy has been part of the research for five years and is showing no indication of dementia or Parkinson’s. The fNIRS system was developed by Drexel University in Philadelphia and is also being used by researchers at Albert Einstein College of Medicine in New York City.
Contributors to this news report include: Cyndy McGrath, Supervising and Field Producer; Milvionne Chery, Assistant Producer; Tony D’Astoli, Editor; Kirk Manson, Videographer.
BACKGROUND: Parkinson’s disease is a neurodegenerative brain disorder that progresses slowly. As many as one million Americans live with Parkinson’s, and approximately 60,000 are diagnosed each year. Many cases go undetected. Symptoms may take years to develop, and people live for years with the disease. Parkinson’s occurs when a person’s brain stops producing a neurotransmitter called dopamine. The shortage of dopamine leads to less ability to regulate movements, body, and emotions. The disease itself is not fatal; however, complications from the disease are serious. Complications due to Parkinson’s disease are the 14th cause of death in the United States. The four main motor symptoms of Parkinson’s disease are shaking or tremor, slowness of movement, stiffness or rigidity of the arms, legs or trunk, and trouble with balance. Non-motor symptoms are widely varied and may include mood disorders, cognitive changes, hypotension, vision changes, sleep disorders, and speech and swallowing problems. A neurologist may diagnose Parkinson’s during a bedside examination and using PET and DAT scans. Parkinson’s disease progresses in five different stages of severity. During the stages four and five, an individual is unable to live alone.
TREATMENT: Currently, there is no cure for Parkinson’s disease, but therapies are available to treat its symptoms. The treatment for each person with Parkinson’s disease is individualized and based on his or her symptoms. Treatments may include medication, surgical therapy, or lifestyle modifications. Since most symptoms of Parkinson’s disease are caused by a lack of dopamine, many medications temporarily replenish dopamine or mimic dopamine. These are called dopaminergic medications. These medications tend to improve the motor symptoms of Parkinson’s. Medication is usually only a part of an overall treatment plan. Surgical treatment options include deep brain stimulation, thalamotomy, pallidotomy, and subthalamotomy. Exercise is always recommended as a part of treatment since it helps maintain patient’s balance, mobility, and the ability to perform normal daily activities.
NEW TECHNOLOGY: With a goal of being able to intervene with Parkinsonian symptoms early, researchers at Albert Einstein College of Medicine have identified differences in brain activation patterns associated with postural stability in people with Parkinson’s and healthy adults using a portable fNIR, or functional near-infrared, device. This device allows scientists to better understand the role of the brain’s prefrontal cortex while performing activities for the first time. Unlike other imaging systems, the fNIR system is portable, allowing for the monitoring of the cognitive component of staying balanced while walking. This could lead to better treatment options, and the ability to detect Parkinson’s disease much earlier than before.
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Joe Verghese, M.D., Professor of Neurology and Medicine at Albert Einstein College of Medicine and Director of the Montefiore Einstein Center for the Aging Brain in New York, talks about a new technology that could provide an early warning system for Parkinson’s disease.
Interview conducted by Ivanhoe Broadcast News in April 2016.
What are problems associated with aging and what we can do to intervene and see if there is something that can be done earlier? Let’s start there and ask you about the link between mobility and cognition, the ability to move and mind health?
Dr. Verghese: Sure.
Is there a link?
Dr. Verghese: Absolutely. We take walking for granted; it’s something that we automatically do. For the most part in daily life, walking is automatic; but if you have a challenging circumstance, say you’re walking outside on the street and you’re talking to someone, then your brain has to not only figure out how to walk, but also how to talk. Dividing attention sometimes is a problem either when you get old or when you have early stages of disease in the brain like Alzheimer’s, or Parkinson’s, or strokes. The difficulty to do what seems like a simple task like walking, and more so, a more complex task like walking while talking might be the first sign that there’s some disease process in the brain that’s happening, and we could use this information to identify people at risk.
The study that you’re doing with the fNIRS, how does that help pinpoint some of these potential problems?
Dr. Verghese: One of the main limitations of studying walking patterns in older people is that most of the current imaging techniques don’t allow us to image a person while they’re walking. fNIRS is functional near infrared spectroscopy. This is a light based technology that allows us to measure the blood flow in the front part of the brain. So what it allows us to do is we can actually see what is happening in the brain while somebody is walking. What we discovered is that during normal walking, the brain is engaged, but more so during a challenging condition where you get people to walk and talk. Then you can actually see the brain activity ramping up to deal with the challenge.
When you’re able to identify these potential signals in real time, what are the implications? What could be done with that information down the road?
Dr. Verghese: There are a few things I think that these results lead to. One, is we can identify people at risk. In this particular study, where we looked at three groups of people; we looked at normal people, we looked at people with Parkinson’s disease and then interestingly, an in-between group of people who have some features of Parkinson’s disease, but not severe enough to meet the criteria for the disease. What we found is that a simple task, just asking them to stand still, patients with Parkinson’s disease had difficulty doing; they sway. Whereas, people with the mild Parkinson’s signs, they don’t look like they have a problem doing it until you examine the brain using the fNIRS and then you discover they’re actually straining their brain to do a simple task. This might be one of the earlier signs that the brain is dysfunctioning and it precedes obvious clinical signs. From a research, as well as a clinical practice perspective, hopefully it will not only helps us identify people at risk, but maybe this is something we can target; if we can have interventions that improve brain activity and function down the road we can improve the way people walk. We can prevent them from falling, maybe we can prevent further cognitive decline.
The only other question I was going to ask you in terms of a message to people, is there is anything I didn’t ask or one thing that you would want people to know about the research that you’re doing here?
Dr. Verghese: The focus of our research is to understand how the brain is involved in thinking, moving, feeling and how all these activities go together. In, the traditional research world, people who study cognitive problems haven’t focused as much on motor function. Our research is showing that, there’s a link between both of these. You literally can’t walk without a brain and, understanding the mind body connection, hopefully, will give us a better understanding of what are the earliest changes that occur when you get a disease like Alzheimer’s or Parkinson’s disease. How do we identify it and potentially, how do we develop interventions that can prevent the disease from getting much worse? The work that we do in our laboratories over here and in our population studies is something that we translate over to our clinical practice. For instance, in the Center for Aging Brain where we see patients an important aspect of the assessment is, if somebody comes with memory complaints, is not only asking about the memory complaints and testing them with memory tests, but also asking them about their walking, finding out if they’re falling and actually examining their walk while they’re in our clinic to get a better understanding of the kinds of problems that patients face.
Specifically with some of this research, it’s Parkinson-like symptoms that seem to be able to be picked up by the fNIRS?
Dr. Verghese: No, the focus of this study was for Parkinson-like symptoms, but the fNIRS also picks up problems, in seemingly normal people who might be at the earliest stages of Alzheimer’s disease or patients who have poor circulation in the brain. They also have difficulty with certain tasks that require the brain to switch attention between walking and talking. And the fNIRS allows us to actually quantify the effort that the brain is putting into these kinds of activities.