April 11, 2021 | ITN Communications
Five years ago, Alice Jones* noticed she was having trouble wiggling her toes and using her left shoulder for everyday tasks like washing her hair.
“These difficulties seemed disconnected,” said Jones. “At that time, I thought they were annoying challenges and hoped to get help with each.”
After a referral to a neurologist, Jones was diagnosed with a frozen shoulder and pinched nerve. She was sent to physiotherapy, but as weeks went on, her mobility didn’t improve. Then, on a visit out-of-town to see her daughter, she met with two new physiotherapists who immediately noticed something different.
“Those two physiotherapist visits were the turning point in my diagnosis,” said Jones. “They saw what nobody else had seen: my arms weren’t swinging naturally when I was walking. They identified my arms not swinging as a sign of Parkinson’s.”
After connecting with the right specialists, Jones was diagnosed with Parkinson’s disease, a nervous system disorder afflicting over 100,000 Canadians; the disease affects movement and currently has no cure.
Difficulties with Parkinson’s diagnosis
Dr. Penny MacDonald, a movement disorders neurologist and associate professor in neurology at Western University, explained that Parkinson’s is a complex disease with many symptoms. “Parkinson’s is an aging-associated disorder and the fastest growing neurological disease in the world,” said Dr. MacDonald. “Patients often have symptoms that are confusing to them, as well as their general practitioners, neurologists and even sometimes movement disorder specialists.”
According to Dr. Alain Dagher, a McGill University professor and neurologist at the Neuro (Montreal Neurological Institute-Hospital) who specializes in movement disorders and brain imaging, there are often cases in which a Parkinson’s diagnosis is uncertain. “This can happen when patients don’t have a good response to medication,” said Dr. Dagher. “There are several other diseases like progressive supranuclear palsy and multi-system atrophy that can resemble Parkinson’s, and it’s important to make the correct diagnosis.”
In addition to this uncertainty, Dr. MacDonald explained that the current system of diagnosis also requires multiple steps that delay a patient getting access to the care they need sooner. “A family doctor who might suspect Parkinson’s now refers their patient, and the patient has to wait for a movement disorder neurologist or a neurologist for an assessment.”
Using biomarkers to diagnose Parkinson’s
To diagnose Parkinson’s faster and more accurately, Dr. MacDonald recently teamed with Dr. Dagher and Dr. Ali Khan, assistant professor in the Department of Medical Biophysics and Medical Imaging at Western.
This cross-institutional research team has developed a project that will use magnetic resonance imaging (MRI) to identify biomarkers to diagnose Parkinson’s earlier, track progression over time and better understand the disease.
The project will take place as part of the newly developed McGill-Western Initiative for Translational Neuroscience (ITN), supported by the Canada First Research Excellence Fund through Western’s BrainsCAN and McGill’s Healthy Brains, Healthy Lives initiatives.
Helping Canadians live well
A more efficient method for diagnosis, like the one being investigated by Dr. MacDonald’s team, could also decrease the strain on Canada’s health-care system by enabling family doctors to treat patients without the need for referrals to specialists. Dr. MacDonald believes this will be especially impactful in remote areas of the country where patients don’t have access to a movement disorder neurologist. The use of biomarkers in diagnosis will allow for equality of care across Canada.
“A confirmatory test like an MRI could allow a general practitioner to order the radiological suite that will be distinct for Parkinson’s,” said Dr. MacDonald. “They’ll be able to confirm if the patient has Parkinson’s and they’ll feel empowered to start the medication.”
A faster process will also reduce stress for patients with Parkinson’s symptoms who are waiting for a diagnosis.
“Even though we can’t cure Parkinson’s, existing therapies can reduce symptoms, keeping patients in their jobs and in their lives.” Said Dr. MacDonald. “If a patient is waiting a year or more to see a neurologist or movement disorder neurologist, after their general practitioner has submitted a referral, that’s often time that they’re waiting to be treated. That wait is not trivial and huge changes happen during that time. People sell their homes, they leave their jobs, so a lot of that uncertainty could be dealt with sooner.”
For Jones, her diagnosis and treatment meant getting back to her life.
“After diagnosis, I immediately started therapy to help with the symptoms and had significant, measurable progress in two weeks,” she said. “I became rejuvenated because, it turns out that the various challenges were all related and, as the neurotransmitters were strengthened and reestablished, my abilities and confidence in my body returned. Parkinson’s has motivated me to remain very active so I retain my motor skills.”
Work on the ITN biomarker project will begin this year and is a necessary first step in understanding the changes that result from Parkinson’s. In the longer term, the researchers hope to find methods to develop therapies that address the disease itself, rather than just the symptoms.
“The ultimate aim is for these biomarkers to help us to uncover therapies that either slow the progression of Parkinson’s, stop it or reverse it,” said Dr. MacDonald. “But even if we can’t come up with a cure or a treatment that’s going to change therapy, just having a biomarker translates into better care for patients right now.”
*name changed to protect privacy[Floating-Button id=”1″]
The McGill-Western Initiative for Translational Neuroscience (ITN) is a collaborative research initiative supporting two large-scale research projects to impact the lives of those living with neurodegenerative conditions. Supported by the Canada First Research Excellence Fund (CFREF) through Western’s BrainsCAN and McGill’s Healthy Brains, Healthy Lives initiatives, the ITN brings world-renowned neuroscientists from McGill and Western together to focus on neurodegenerative research projects.