Parkinson’s is a neurodegenerative disorder. Its most recognizable features are tremors and difficulty moving, but people with Parkinson’s also have a reduced ability to smell. By the time Parkinson’s is diagnosed, a large number of nerve cells have already been damaged or lost.
The goal of the Predict Parkinson’s study is to research how we can identify or Predict Parkinson’s earlier – before a lot of damage has been done. Figuring out how to Predict Parkinson’s could lead to better treatments or even preventing Parkinson’s.
Smell and Parkinson’s, Alzheimer’s, REM-BD
The development of new, improved methods for early diagnosis of Parkinson’s is vital for advances in the treatment of this disease. Predict Parkinson’s will study the sense of smell as a way to Predict Parkinson’s earlier.
Impairment in olfactory function (sense of smell) can occur for various reasons but it is known to be an early symptom of both Parkinson’s and Alzheimer’s. In Parkinson’s, loss of smell often happens before motor symptoms begin. Thus, it is possible that changes in a person’s ability to smell can be used to identify those who are at risk for developing Parkinson’s. Whether reduced smell ability is present at an early stage Parkinson’s and if it is related to changes in the brain’s organization is not yet known.
A recent study has shown that people with early Parkinson’s have changes in brain cell organization in a region of the brain that is highly involved in the sense of smell. We need to know if this accounts for changes in the ability to smell and if these changes in brain organization are another early sign of Parkinson’s.
The same smell problems seen in Parkinson’s are also seen in people with Alzheimer’s even though the areas of the brain affected by these conditions are quite different. So far, no one has looked to see if the same changes in organization of brain cells in the parts of the brain involved in smell are similar or different in Parkinson’s and Alzheimer’s.
Patients with REM sleep behaviour disorder (REMBD) are a very interesting group. Because many patients diagnosed with REMBD also develop Parkinson’s, REMBD may be an early indicator of an increased risk of Parkinson’s. We now know that people with Alzheimer’s also have changes in their sleep and activity patterns early in the disease. For this reason, characterizing early changes in sleep and activity patterns in people with Alzheimer’s and REMBD to determine whether sleep and brain organization changes are specific to Parkinson’s or are similar in both neurological conditions is of great interest.
Changes in attention, memory, and other thinking skills are also seen in both Parkinson’s and Alzheimer’s, although these changes differ and are usually only seen late in Parkinson’s. However, because there may be some specific and subtle changes in Parkinson’s, we will be looking at this as well.
An important part of the study of Parkinson’s is looking at first-degree relatives (siblings, parents, children) of people who have already been diagnosed with Parkinson’s. These individuals have a slightly increased risk than the general population of developing Parkinson’s. First-degree relatives may not show any motor symptoms but may have changes in their sense of smell like the affected member of their family. We are interested in finding out whether an alteration in the sense of smell in these individuals means that they have a higher risk of developing Parkinson’s.
The Predict Parkinson’s study uses a combination of the University of Pennsylvania Smell Identification Test (UPSIT), diffusion-weighted Magnetic Resonance Imaging (DW-MRI), diffusion-tensor imaging (DTI-MRI) and measures of sleep behaviour and mental abilities. Our goal is to determine whether we can use a simple, inexpensive screening test (the UPSIT), followed by non-invasive MRI and behavioural measures, to provide reliable, early diagnosis of Parkinson’s that will lead to better treatment and prevention.
1) Physically and mentally healthy adults aged 45-70 (45)
2) Adults aged 45-70 who have been diagnosed with Parkinson’s (45)
3) Adults aged 45-75 who have been diagnosed with Alzheimer’s (45)
4) Adults aged 45-70 who have been diagnosed with REM Behavior Disorder (45)
5) Adults between the ages of 40 and 65 who have a first-degree relative (sibling, parent, child) who has been diagnosed with Parkinson’s (1200)
If you belong to one of these groups, please visit our Sign Up section!
The Predict Parkinson’s pilot study uses a combination of the University of Pennsylvania Smell Identification Test (UPSIT), diffusion-tensor imaging (DTI-MRI), sleep and activity monitoring, and cognitive tests. Our goal is to determine whether we can use a simple, inexpensive screening test (the UPSIT), followed by non-invasive MRI and behavioural measures to provide reliable, early diagnosis of Parkinson’s that will lead to better treatment and prevention.
An important part of the Predict Parkinson’s study looks at first-degree relatives (siblings, parents, children) of people who have already been diagnosed with Parkinson’s. First-degree relatives may not show any motor symptoms but may have changes in their sense of smell like the affected member of their family. We want to find out if this means that they have a higher risk of developing Parkinson’s.
There are four parts to the study: smell testing, sleep assessments and activity monitoring, MRI scanning, and cognitive ability testing. See the “Who does what?” section below to determine which portions of the study you will complete.
A) Smell testing
This test is a “scratch and sniff” test of 40 items. For each item, there is a small patch to scratch to release an odour. Once released, you will be asked to smell the odour and pick which one of four answers match the odour on the page (multiple choice format). The test determines how well you can identify different odours. You can take as much time as you need, but it should take no more than 25 minutes to finish. This test can be completed at home or at the Health Centre.
B) Sleep/Activity Questionnaire & Activity Monitoring
During an in-lab session, you and your caregiver (if applicable), will complete a questionnaire regarding your sleep history and sleep habits and activity patterns. Sleep questions focus on general sleep quality, duration of sleep, and the frequency and causes of sleep fragmentation and disruption. Activity questions focus on the level, type and amount of activity that you are typically engaged in.
Following the questionnaires, you will be provided with an activity monitoring device (a watch-like wrist band) that will measure your daily motor activity for a week. We will ask you to also keep a sleep diary during this week to give us an accurate measure of your sleep and activity patterns. You will be asked to bring the activity monitoring device and the sleep diary with you to your MRI visit (completed about one week after the in-lab session).
C) Diffusion Weighted and Diffusion Tensor Magnetic Resonance Imaging (DW-MRI and DT-MRI)
For the MRI, pictures of your brain will be taken while you rest quietly in the MRI scanner. You will need to stay very still while the scan is happening. Magnetic fields will be turned off and on rapidly. When exposed to these changing magnetic fields, the tissues of the body release signals from which a computer makes an image of the internal anatomy of the region being examined. The MRI scan produces no X-rays and is approved by the Health Protection Branch of Health Canada. There are no hazardous effects known to occur as a result of MRI scanning, unless you have metal in or near the body part being examined. The MRI scan will take place at the IWK Children’s Hospital. The entire MRI procedure will be completed in approximately 45-55 minutes.
D) Tests of Cognitive Abilities
Part D is a separate but related study that requires an additional consent form. To complete parts A, B and C, you DO NOT have to complete Part D.
If you do choose to participate in Part D, you will undergo various cognitive assessments. These involve pencil and paper tests as well as computer tasks. Many of these tasks are commonly used to assess brain functioning in patients with Parkinson’s, while some tests are experimental. These measures will assess your ability to
- remember lists of words
- correctly pronounce words that do not follow common English spelling rules
- provide words that conform to a given category, and
- remember and manipulate information in your mind.
You will be provided with as many breaks as you need during the cognitive testing. The cognitive tests can also be done over the course of two days, rather than in one session, if that is easier for you.
Who does what?
Participants who will complete all four components include:
1) participants with Parkinson’s
2) participants with Alzheimer’s
3) participants with REM-BD
4) healthy participants who do not have any close relatives with Parkinson’s, Alzheimer’s or REM behaviour disorder.
All participants with relatives who have been diagnosed with Parkinson’s complete the smell identification testing; some will also be asked to complete the MRI scanning and cognitive testing. The smell test will be mailed to the participant’s home. Depending on their score on the smell test, some participants will be asked to come to Halifax to complete the MRI scan at the IWK and the cognitive testing at Capital Health. TRAVEL EXPENSES AND PARKING WILL BE REIMBURSED FOR THESE TRIPS.
Dr. Harold Robertson
Dr. John Fisk
Dr. Chris MacKnight
Dr. David King
Dr. Gosia Klonowska-Philips
Dr. Benjamin Rusak
Dr. Naeem Kahn
Dr. Tyler Rolheiser
Dr. Ron Leslie
Dr. Kerrie Schoffer
Dr. Roger McKelvey
Dr. Matthias Schmidt
Dr. Aaron Newman
Dr. Ken Rockwood
Denise Lewis (research technician)
Mackenzie Armstrong (research technician)
Rose Gan (research technician)
Olga Theou, Ph.D. Dr.
Paula Chiasson, MScOT
Dr. Magdalena Wojtowicz
To contact the Predict Parkinson’s team: