UC first in the world using advanced technique to identify Parkinson's decline

A University of Canterbury brain research project is believed to be the first in the world using advanced technique to identify declining Parkinson’s disease.

UC PhD student Nadia Borlase is working with the New Zealand Brain Research Institute and Canterbury Medical Research Foundation in creating a medical break-through.

`` These techniques have been used in healthy people, but as far as we know, we are the first to use them in a neuro-degenerative condition like Parkinson's disease,’’ Borlase said today.

The clinical study has used a new technique for the first time that allowed them to look at the brain while the patient is still alive to find cellular degeneration in the thalamus, though many people had previously found cellular degeneration at an autopsy.

With New Zealand’s aging population the demand for healthcare has significantly increased and taxpayers are now facing the harsh reality of costly long term care and the greater need for disability services.

Parkinson’s disease is the second most common degenerative disorder after Alzheimer’s disease and although motor symptoms are the most visible the onset of dementia is the most debilitating symptom and largest contributor to resource expenditure.

A large number of patients will be diagnosed with dementia as a result of Parkinson’s disease diagnosis so it is important to be able to identify those most at risk for this. Nursing home placement, although a secondary alternative for most families, is a frequent necessity once dementia has presented.

There is no cure for Parkinson’s disease but there are treatment methods to treat the motor and cognitive symptoms which will significantly improve the patients and their caregiver’s quality of life.

To achieve the best result these interventions need to be applied as early in disease course as possible.

``Our research group aims to use advanced neurological imaging to identify the subtle brain changes that occur prior to the cognitive symptoms of Parkinson’s disease being identifiable clinically.

``We are focussing on the thalamus, a structure at the centre of the brain as it is involved in all aspects of function except smell processing.  The architecture of the thalamus is almost identical to that of the rest of the brain so we have used mathematical algorithms to segment it into pieces, each of which is thought to be responsible for a specific area of behaviour.

``We have also used another procedure which allows us to follow the pathways that these pieces take from the centre of the brain out to the cortex (rest of the brain).  In line with other work we have found there is some association with the whole thalamus and multiple areas of cognition and that the thalamus is significantly degenerated in dementia.

Prior to the onset of dementia we have demonstrated, for the first time that there is cellular degeneration in some areas of the thalamus – but not others and that this has a domain-specific association with cognition, where some regions are heavily influential on one or two components of cognition while others are only influential in another area.

Borlase said in one of their groups of patients which had absolutely no discernible cognitive dysfunction they found significant cellular disruption in areas that were known to influence the first cognitive symptoms of Parkinson’s disease, executive function and attention difficulties.

Although this would not be a first line response for the identification of potential dementia in a Parkinson’s disease patient they hoped the method would be applicable in wider clinical research settings and potentially enable early identification of those most at risk for dementia in order for treatment intervention to be applied as early as possible.

The research project when completed will aid in potential treatments being able to be applied as early as possible.

``In terms of significance we are excited about it.  It greatly expands what’s been done previously and combined with what else is going on at the New Zealand Brain Research Institute, fits with what we're finding in the rest of the brain.

Borlase is working under the supervision of UC Associate Professor John Dalrymple-Alford and  Tim Anderson, clinical director at the New Zealand Brain research Institute. Anderson is also a neurologist in the department of neurology for the Canterbury District Health Board.