Theme 1 Lead: Dr Michele Hu
We have grown the OPDC Discovery cohort into one of the largest and best-characterised cohorts of people with Parkinson's in the world. We have now recruited over 1500 subjects to the cohort, including over 1000 people with Parkinson's, plus 300 healthy controls and 180 individuals thought to be ‘at-risk’ of developing future Parkinson's. All patients have a clinical assessment repeated every eighteen months so we can better understand the progression of Parkinson's over time. Over 400 patients have been seen for a second visit which has allowed us to identify some important differences in the way Parkinson's progresses in different people.
The Discovery cohort has provided us with an excellent opportunity to understand more about how Parkinson's develops over time, and how Parkinson’s affects different people in different ways- which doctors call disease stratification. We have found important gender differences in how Parkinson’s manifests (Szewczyk-Krolikowski et al., 2014). Furthermore, even early on in their Parkinson’s diagnosis, individuals can be classified into different patient clusters depending on how their motor, non-motor and thinking ability is affected early on (work currently in submission for publication).
We have tested and validated simple screening tests for detecting early memory dysfunction in Parkinson’s (Hu et al., 2014). We have also used highly sensitive MRI imaging of the brain to detect early pre-symptomatic damages and changes in connections between neurons which may be used to predict disease progression (Menke et al., 2013 read news story). Other exciting tests in the pipeline, which we are currently working on, include a blood-based test for Parkinson’s (Tomlinson et al., 2015) and eye movement function in Parkinson’s (Antoniades et al., 2015).
Delineation of Parkinson's at-risk groups (diagnosed REM sleep behaviour disorder [RBD] and asymptomatic GBA/LRRK2 mutation carriers), and patient stratification using clinical heterogeneity, extreme phenotypes and, ultimately, neuropathological analysis, will provide a unique window into Parkinson's progression.
Looking to the future, the OPDC remains very committed to harnessing novel and innovative technologies to better diagnose and monitor symptoms of Parkinson’s. We have worked with mathematician Dr Max Little to implement an android phone-based 6 minute assessment of movement and speech ability that can be affected early in Parkinson’s across all participants attending research visits in our cohort (watch video). We hope to validate this exciting technology in the research and home-based settings, and harness this innovative technology or Telemedicine to better manage Parkinson’s in the future and give back affected individuals an element of control over their symptom fluctuation (see this article on telemedicine for more details, or watch Michele Hu’s lecture at the Royal Institution for a demonstration of this technology in action with a Parkinson’s individual).