Parkinson's Disease
Conditions
Brief summary
Currently, there is no clear diagnostic test that can be used to confirm the diagnosis of Parkinson's disease, or a biomarker that can track its progression. Patients with Parkinson's have many abnormalities of the autonomic nervous system, which may be related to Parkinson's changes outside of the brain. A new device called the SudoScan, which measures autonomic sweating changes, may be a simple way to test for autonomic changes in Parkinson's. The investigator plan to see whether SudoScan can identify Parkinson's disease and whether SudoScan abnormalities might be present even in early (prodromal) Parkinson's stages. The investigator will assess SudoScan in a group of Parkinson's patients, normal healthy controls, patients with non-Parkinson's neurodegeneration, and patients with REM sleep behavior disorder (an early/prodromal Parkinson's state). Abnormalities will be correlated with standard autonomic tests and with skin biopsy findings Parkinson's degeneration in the peripheral autonomic fibers. If the investigator can find a reliable way to diagnose and follow Parkinson's disease, he will be able to correctly identify Parkinson's (even in its earliest stages). This will improve the chance to find protective treatments against Parkinson's, by preventing false diagnosis and by providing a new marker to track disease progression. If successful, the investigator will aim to validate the findings on a large sample of Parkinson's and also to track changes over time in the original cohorts
Interventions
DEVICESudoscan and clinical assessment
The primary variable will be electrochemical skin conductance (ESC), as assessed by the SudoScan (Impeto Medical, France). The clinical assessment will include a neurological evaluation (including MDS-UPDRS), evaluation of autonomic symptoms and signs, EKG, evaluation of possible neuropathy and evaluation of non-motor variables.
GENETICSkin biopsy
Evaluation of the denervation and synuclein deposition of skin biopsy
Sponsors
McGill University Health Centre/Research Institute of the McGill University Health Centre
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SCREENING
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. PD patients: All will meet criteria for probable PD, according to the new MDS Clinical Diagnostic criteria 2. Non-PD parkinsonism patients: They will have with progressive supranuclear palsy, multiple system atrophy, 'vascular parkinsonism' or corticobasal syndrome. All patients will have parkinsonism according to UK brain bank criteria, with a diagnosis of one of the above conditions made according to gold-standard expert evaluation. No patient will meet MDS Criteria for probable PD. 3. iRBD patients: All patients will have polysomnogram-confirmed RBD according to American Academy of Sleep Medicine Criteria. Patients will be free of parkinsonism and dementia according to neurological examination and will have no untreated sleep apnea, epilepsy, or other abnormalities that could cause dream enactment behavior. 4. Controls: These will be age matched (within 5 years) and sex-matched (with \>90% concordance). All controls will have an examination confirming the absence of parkinsonism, and will have no symptoms of REM sleep behavior disorder, as assessed with the RBD1Q and expert interview.
Exclusion criteria
1. Diabetes Mellitus - In addition to causing autonomic neuropathy, hyperglycemia itself is known to interfere with results of the sudomotor scan 2. Any preceding diagnosis of autonomic neuropathy (of a cause other than PD) 3. Dementia of severity sufficient to preclude informed consent, MoCA \<23. 4. Prescription of medications that directly alter peripheral autonomic function, including beta-blockers, sympatholytics (i.e. clonidine) and non-specific alpha-blockers.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Electrochemical skin conductance | up to 6 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PD severity-MDS-UPDRS | up to 6 months | PD severity will be assessed with the MDS-UPDRS |
| Autonomic symptoms and signs | up to 6 months | — |
| EKG | up to 6 months | Cardiac autonomic denervation will be assessed with analysis of heart rate variability on EKG |
| PD severity-Hoehn and Yahr stage | up to 6 months | PD severity will be assessed with the Hoehn and Yahr |
| Non-motor symptoms associated with PD | up to 6 months | Non-motor variables with be assessed with Parts I and II of the MDS-UPDRS |
| Skin biopsy | up to 12 months | Denervation and synuclein deposition of skin biopsy will include staining for proteinase-k-resistant synuclein (5C12 antibody) and neuronal markers to determine density of peripheral innervation |
| Neuropathy | up to 6 months | Patients will be screened for neuropathy with the 5-item peripheral neuropathy screening interview |
Outcome results
None listed