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Dobreva I, Thomas J, Marr A, O'Connell R, Roche M, Hannaway N, Dore C, Rose S, Liu K, Bhome R, Baldwin-Jones S, Roberts J, Archibald N, Alston D, Amar K, Edwards E, Foley JA, Haunton VJ, Henderson EJ, Jha A, Lindop F, Magee C, Massey L, Ruiz-Mendoza E, Mohamed B, Patterson K, Ramaswamy B, Schrag A, Silverdale M, Suárez-González A, Subramanian I, Foltynie T, Williams-Gray CH, Yarnall AJ, Carroll C, Bale C, Hugill C, Weil RS. Improving Conversations about Parkinson's Dementia. Mov Disord Clin Pract 2024. [PMID: 38696333 DOI: 10.1002/mdc3.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND People with Parkinson's disease (PD) have an increased risk of dementia, yet patients and clinicians frequently avoid talking about it due to associated stigma, and the perception that "nothing can be done about it". However, open conversations about PD dementia may allow people with the condition to access treatment and support, and may increase participation in research aimed at understanding PD dementia. OBJECTIVES To co-produce information resources for patients and healthcare professionals to improve conversations about PD dementia. METHODS We worked with people with PD, engagement experts, artists, and a PD charity to open up these conversations. 34 participants (16 PD; 6 PD dementia; 1 Parkinsonism, 11 caregivers) attended creative workshops to examine fears about PD dementia and develop information resources. 25 PD experts contributed to the resources. RESULTS While most people with PD (70%) and caregivers (81%) shared worries about cognitive changes prior to the workshops, only 38% and 30%, respectively, had raised these concerns with a healthcare professional. 91% of people with PD and 73% of caregivers agreed that PD clinicians should ask about cognitive changes routinely through direct questions and perform cognitive tests at clinic appointments. We used insights from the creative workshops, and input from a network of PD experts to co-develop two open-access resources: one for people with PD and their families, and one for healthcare professionals. CONCLUSION Using artistic and creative workshops, co-learning and striving for diverse voices, we co-produced relevant resources for a wider audience to improve conversations about PD dementia.
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Affiliation(s)
- Ivelina Dobreva
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | - Joanne Thomas
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Anne Marr
- Central Saint Martins, University of the Arts, London, United Kingdom
| | | | - Moïse Roche
- Division of Psychiatry, University College London, London, United Kingdom
| | - Naomi Hannaway
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | - Charlotte Dore
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Sian Rose
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Ken Liu
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Rohan Bhome
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | | | | | - Neil Archibald
- South Tees Hospital NHS Foundation Trust, Middlesbrough, United Kingdom
| | | | - Khaled Amar
- Royal Bournemouth Hospital, NHS Foundation Trust, Bournemouth, United Kingdom
| | | | - Jennifer A Foley
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
- UCL Queen Square Institute of Neurology, Univeristy College London, London, United Kingdom
| | | | - Emily J Henderson
- Ageing and Movement Research Group, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Older People's Unit, Royal United Hospitals NHS Foundation Trust, Bath, United Kingdom
| | - Ashwani Jha
- UCL Queen Square Institute of Neurology, Univeristy College London, London, United Kingdom
| | - Fiona Lindop
- Parkinson's UK, London, United Kingdom
- Derby Hospitals NHS Foundation Trust, Derby, United Kingdom
| | - Cathy Magee
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Luke Massey
- Poole Hospital NHS Foundation Trust, Poole, United Kingdom
| | - Eladia Ruiz-Mendoza
- North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, United Kingdom
| | - Biju Mohamed
- University Hospital of Wales, Cardiff, United Kingdom
| | - Katherine Patterson
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | - Bhanu Ramaswamy
- Parkinson's UK, London, United Kingdom
- Sheffield Hallam University, Sheffield, United Kingdom
| | - Anette Schrag
- Department of Clinical Neuroscience, Institute of Neurology, UCL, London, United Kingdom
| | - Monty Silverdale
- Department of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Aida Suárez-González
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | - Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, Los Angeles, California, USA
- Parkinson's Disease Research, Education, and Clinical Center (PADRECC), Veterans Administration Greater Los Angeles Health Care System, Los Angeles, California, USA
| | - Tom Foltynie
- UCL Queen Square Institute of Neurology, Univeristy College London, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Caroline H Williams-Gray
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Newcastle University, Newcastle, United Kingdom
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Drake Circus, Plymouth, United Kingdom
| | | | | | - Rimona S Weil
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
- UCL Queen Square Institute of Neurology, Univeristy College London, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Wyse RK, Isaacs T, Barker RA, Cookson MR, Dawson TM, Devos D, Dexter DT, Duffen J, Federoff H, Fiske B, Foltynie T, Fox S, Greenamyre JT, Kieburtz K, Kordower JH, Krainc D, Matthews H, Moore DJ, Mursaleen L, Schwarzschild MA, Stott SRW, Sulzer D, Svenningsson P, Tanner CM, Carroll C, Simon DK, Brundin P. Twelve Years of Drug Prioritization to Help Accelerate Disease Modification Trials in Parkinson's Disease: The International Linked Clinical Trials initiative. J Parkinsons Dis 2024:JPD230363. [PMID: 38578902 DOI: 10.3233/jpd-230363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
In 2011, the UK medical research charity Cure Parkinson's set up the international Linked Clinical Trials (iLCT) committee to help expedite the clinical testing of potentially disease modifying therapies for Parkinson's disease (PD). The first committee meeting was held at the Van Andel Institute in Grand Rapids, Michigan in 2012. This group of PD experts has subsequently met annually to assess and prioritize agents that may slow the progression of this neurodegenerative condition, using a systematic approach based on preclinical, epidemiological and, where possible, clinical data. Over the last 12 years, 171 unique agents have been evaluated by the iLCT committee, and there have been 21 completed clinical studies and 20 ongoing trials associated with the initiative. In this review, we briefly outline the iLCT process as well as the clinical development and outcomes of some of the top prioritized agents. We also discuss a few of the lessons that have been learnt, and we conclude with a perspective on what the next decade may bring, including the introduction of multi-arm, multi-stage clinical trial platforms and the possibility of combination therapies for PD.
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Affiliation(s)
| | | | - Roger A Barker
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Mark R Cookson
- Cell Biology and Gene Expression Section, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Ted M Dawson
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Devos
- Department of Medical Pharmacology & Neurology, University of Lille, CHU Lille, Lille Neurosciences and Cognition Inserm UMR-S-U1172, Lille, France
| | | | | | - Howard Federoff
- Henry and Susan Samueli College of Health Sciences, University of California, Irvine CA, USA
| | - Brian Fiske
- Research Programs, The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Thomas Foltynie
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Susan Fox
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - J Timothy Greenamyre
- Department of Neurology, Pittsburgh Institute for Neurodegenerative Diseases, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karl Kieburtz
- Department of Neurology Center for Health & Technology, and University of Rochester, Rochester, NY, USA
| | - Jeffrey H Kordower
- ASU-Banner Neurodegenerative Disease Research Center and School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Dimitri Krainc
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | | | - David Sulzer
- Department of Neurology, Columbia University, New York, NY, USA
| | | | - Caroline M Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Camille Carroll
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - David K Simon
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Patrik Brundin
- Neuroscience and Rare Diseases, Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
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Collett J, Lawrie S, Bromley S, Harling P, Reed A, Brusco N, Coe S, Coebergh J, Carroll C, Roberts HC, Hu MT, Dawes H. A programme evaluation of 'First Steps': A peer-conceived, developed and led self-management intervention for people after a Parkinson's diagnosis. Clin Rehabil 2024; 38:403-413. [PMID: 37941369 PMCID: PMC10829422 DOI: 10.1177/02692155231210969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE A diagnosis of Parkinson's often leads to uncertainty about the future and loss of perceived control. Peer support may offer a means to address these concerns and promote self-management. DESIGN A programme evaluation of the feasibility and potential effects of 'First Steps', utilising a pragmatic step wedge approach. Comparing First Steps (intervention) to (control) conditions.Setting: In the community at four sites in southern England.Participants: Newly diagnosed (≤ 12months) people with Parkinson's.Intervention: First Steps was a 2-day peer-conceived, developed and led intervention to support self-management.Main measures: At 0, 12 and 24 weeks anxiety and depression (Hospital, Anxiety and Depression Scale, HADS), daily functioning (World Health Organisation Disability Assessment Schedule, WHODAS), physical activity, quality of life (EQ5D), carer strain and service utilisation were assessed. RESULTS Between February 2018 and July 2019, 36 participants were enrolled into intervention and 21 to control conditions, all were included in statistical analysis. Lost to follow up was n = 1 (intervention) and n = 1 adverse event was reported (control, unrelated). Of the 36 allocated to the intervention n = 22 participants completed both days of First Steps during the study period. Completion of outcome measures was >95% at 24 weeks. Small effects favouring the intervention were found for HADS (odds ratio (OR) = 2.06, 95% confidence interval (CI) 0.24:17.84), Carer Strain Index (OR = 2.22, 95% CI 0.5:9.76) and vigorous (d = 0.42, 95% CI -0.12:0.97) and total physical activity (d = 0.41, 95% CI -0.13:0.95). EQ5D, WHOSDAS and service utilisation, was similar between groups. CONCLUSIONS First Steps was feasible and safe and we found potential to benefit physical activity, mental health and carer strain. Further research with longer-term follow up is warranted.
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Affiliation(s)
- Johnny Collett
- Centre for Movement, Occupational and Rehabilitation Sciences, OxINMAHR Oxford Brookes University, Oxfordshire, UK
| | - Sophie Lawrie
- Centre for Movement, Occupational and Rehabilitation Sciences, OxINMAHR Oxford Brookes University, Oxfordshire, UK
| | | | | | - Alex Reed
- European Parkinson's Therapy Centre, Brescia, Italy
| | - Natasha Brusco
- School of Primary and Allied Health Care, Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia
| | - Shelly Coe
- Centre for Movement, Occupational and Rehabilitation Sciences, OxINMAHR Oxford Brookes University, Oxfordshire, UK
- Centre for Nutrition and Health, OxINMAHR Oxford Brookes University, Oxfordshire, UK
| | - Jan Coebergh
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
- Department of Neurology, Ashford St Peter's NHS Foundation Trust, Chertsey, UK
| | - Camille Carroll
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Hampshire, UK
| | - Michele T Hu
- Oxford Parkinson's Disease Centre, Division of Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxfordshire, UK
| | - Helen Dawes
- NIHR Exeter BRC, Medical School, University of Exeter, Devon, UK
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Kehagia AA, Chowienczyk S, Helena van Velthoven M, King E, North T, Shenton D, Abraham J, Langley J, Partridge R, Ankeny U, Gorst T, Edwards E, Whipps S, Batup M, Rideout J, Swabey M, Inches J, Bentley S, Gilbert G, Carroll C. Real-World Evaluation of the Feasibility, Acceptability and Safety of a Remote, Self-Management Parkinson's Disease Care Pathway: A Healthcare Improvement Initiative. J Parkinsons Dis 2024; 14:197-208. [PMID: 38250784 PMCID: PMC10836560 DOI: 10.3233/jpd-230205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND There is significant unmet need for effective and efficiently delivered care for people with Parkinson's disease (PwP). We undertook a service improvement initiative to co-develop and implement a new care pathway, Home Based Care (HBC), based on supported self-management, remote monitoring and the ability to trigger a healthcare contact when needed. OBJECTIVE To evaluate feasibility, acceptability and safety of Home Based Care. METHODS We evaluated data from the first 100 patients on HBC for 6 months. Patient monitoring, performed at baseline and 6-monthly, comprised motor (MDS-UPDRS II and accelerometer), non-motor (NMSQ, PDSS-2, HADS) and quality of life (PDQ) measures. Care quality was audited against Parkinson's UK national audit standards. Process measures captured feasibility. Acceptability was assessed using a mixed-methods approach comprising questionnaires and semi-structured interviews. RESULTS Between October 2019 and January 2021, 108 PwP were enrolled onto HBC, with data from 100 being available at 6 months. Over 90% of all questionnaires were returned, 97% were complete or had < 3 missing items. Reporting and communications occurred within agreed timeframes. Compared with baseline, after 6m on HBC, PD symptoms were stable; more PwP felt listened to (90% vs. 79%) and able to seek help (79% vs. 68%). HBC met 93% of national audit criteria. Key themes from the interviews included autonomy and empowerment. CONCLUSIONS We have demonstrated acceptability, feasibility and safety of our novel remotely delivered Parkinson's care pathway. Ensuring scalability will widen its reach and realize its benefits for underserved communities, enabling formal comparisons with standard care and cost-effectiveness evaluation.
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Affiliation(s)
- Angie A. Kehagia
- School of Biomedical Engineering and Imaging Sciences, King’s Technology Evaluation Centre, King’s College London, UK
- University of Plymouth, Plymouth, UK
| | | | | | - Emma King
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | | | | | | | | | | | - Terry Gorst
- South West Academic Health Science Network, Exeter, UK
| | | | | | | | | | - Mat Swabey
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jemma Inches
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Sue Bentley
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Camille Carroll
- University of Plymouth, Plymouth, UK
- University Hospitals Plymouth NHS Trust, Plymouth, UK
- Newcastle University Translational and Clinical Research Institute, Newcastle, UK
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5
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Ewens M, Carroll C, Guenther E. Motivations and barriers to exercise among clinicians. PSYCHOL HEALTH MED 2024; 29:277-285. [PMID: 36576254 DOI: 10.1080/13548506.2022.2162938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
According to Kirk & Rhodes (2011), Nooijen et al. (2018), and Saridi et al. (2019), the motivators and barriers to exercise are influenced by one's occupation, especially among those in the healthcare field. We sought to examine the barriers and motivators to physical activity that are distinctive to clinicians. Community hospital clinicians were surveyed regarding motivators and barriers to exercise that they experience, their burnout levels as described by an adaptation of the Mini-Z single item burnout scale, and average weekly exercise habits. The top barriers and motivators were then correlated to burnout levels, levels of physical activity, and demographics. We received 64 total responses from clinicians. The overall average level of burnout was 2.37 and the median level was 2. Approximately 38% of clinicians reported adhering to American Heart Association (AHA) guidelines of 150 minutes of exercise per week, while 33% of clinicians exercise <75 minutes per week. The top general motivator was for one's own well-being and the top clinician-related motivator was reducing stress. The top two barriers to exercise were COVID-19 concerns at an indoor exercise facility and a lack of time. Higher average levels of burnout were experienced by those who marked being too stressed or too burnt out as barriers to exercise. Because of clinicians' roles in propagating healthy practices in their patients from their own habits, wellness programs should be aimed at capitalizing motivators to combat barriers that this group distinctively experiences. Efforts to improve physical and mental wellness among clinicians will translate into better provider and patient health outcomes.
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Affiliation(s)
- M Ewens
- COMP-NW, Western University of Health Sciences, Lebanon, OR, USA
| | - C Carroll
- Woodland Clinic Medical Group, CommonSpirit Health, Woodland, CA, USA
| | - E Guenther
- COMP-NW, Western University of Health Sciences, Lebanon, OR, USA
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Carroll C, Clarke CE, Grosset D, Rather A, Mohamed B, Parry M, Reddy P, Fackrell R, Chaudhuri KR. Addressing Comorbidities in People with Parkinson's Disease: Considerations From An Expert Panel. J Parkinsons Dis 2024; 14:53-63. [PMID: 38217610 PMCID: PMC10836549 DOI: 10.3233/jpd-230168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
In the UK, guidance exists to aid clinicians and patients deciding when treatment for Parkinson's disease (PD) should be initiated and which therapies to consider. National Institute for Health and Care Excellence (NICE) guidance recommends that before starting PD treatment clinicians should discuss the following: the patient's individual clinical circumstances; lifestyle; preferences; needs and goals; as well as the potential benefits and harms of the different drug classes. Individualization of medicines and management in PD significantly improves patients' outcomes and quality of life. This article aims to provide simple and practical guidance to help clinicians address common, but often overlooked, co-morbidities. A multi-disciplinary group of PD experts discussed areas where clinical care can be improved by addressing commonly found co-morbidities in people with Parkinson's (PwP) based on clinical experience and existing literature, in a roundtable meeting organized and funded by Bial Pharma UK Ltd. The experts identified four core areas (bone health, cardiovascular risk, anticholinergic burden, and sleep quality) that, if further standardized may improve treatment outcomes for PwP patients. Focusing on anticholinergic burden, cardiac risk, sleep, and bone health could offer a significant contribution to personalizing regimes for PwP and improving overall patient outcomes. Within this opinion-based paper, the experts offer a list of guiding factors to help practitioners in the management of PwP.
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Affiliation(s)
- Camille Carroll
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
- University of Plymouth and University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Carl E Clarke
- University of Birmingham and City Hospital, Birmingham, UK
| | | | | | - Biju Mohamed
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Miriam Parry
- Parkinson Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - Kallol Ray Chaudhuri
- Parkinson Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
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7
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Aldred J, Freire-Alvarez E, Amelin AV, Antonini A, Bergmans B, Bergquist F, Bouchard M, Budur K, Carroll C, Chaudhuri KR, Criswell SR, Danielsen EH, Gandor F, Jia J, Kimber TE, Mochizuki H, Robieson WZ, Spiegel AM, Standaert DG, Talapala S, Facheris MF, Fung VSC. Continuous Subcutaneous Foslevodopa/Foscarbidopa in Parkinson's Disease: Safety and Efficacy Results From a 12-Month, Single-Arm, Open-Label, Phase 3 Study. Neurol Ther 2023; 12:1937-1958. [PMID: 37632656 PMCID: PMC10630297 DOI: 10.1007/s40120-023-00533-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/07/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION Foslevodopa/foscarbidopa, a soluble formulation of levodopa/carbidopa (LD/CD) prodrugs for the treatment of Parkinson's disease (PD), is administered as a 24-hour/day continuous subcutaneous infusion (CSCI) with a single infusion site. The efficacy and safety of foslevodopa/foscarbidopa versus oral immediate-release LD/CD was previously demonstrated in patients with PD in a 12-week, randomized, double-blind, phase 3 trial (NCT04380142). We report the results of a separate 52-week, open-label, phase 3 registrational trial (NCT03781167) that evaluated the safety/tolerability and efficacy of 24-hour/day foslevodopa/foscarbidopa CSCI in patients with advanced PD. METHODS Male and female patients with levodopa-responsive PD and ≥ 2.5 hours of "Off" time/day received 24-hour/day foslevodopa/foscarbidopa CSCI at individually optimized therapeutic doses (approximately 700-4250 mg of LD per 24 hours) for 52 weeks. The primary endpoint was safety/tolerability. Secondary endpoints included changes from baseline in normalized "Off" and "On" time, percentage of patients reporting morning akinesia, Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Parkinson's Disease Sleep Scale-2 (PDSS-2), 39-item Parkinson's Disease Questionnaire (PDQ-39), and EuroQol 5-dimension questionnaire (EQ-5D-5L). RESULTS Of 244 enrolled patients, 107 discontinued, and 137 completed treatment. Infusion site events were the most common adverse events (AEs). AEs were mostly nonserious (25.8% of patients reported serious AEs) and mild/moderate in severity. At week 52, "On" time without troublesome dyskinesia and "Off" time were improved from baseline (mean [standard deviation (SD)] change in normalized "On" time without troublesome dyskinesia, 3.8 [3.3] hours; normalized "Off" time, -3.5 [3.1] hours). The percentage of patients experiencing morning akinesia dropped from 77.7% at baseline to 27.8% at week 52. Sleep quality (PDSS-2) and quality of life (PDQ-39 and EQ-5D-5L) also improved. CONCLUSION Foslevodopa/foscarbidopa has the potential to provide a safe and efficacious, individualized, 24-hour/day, nonsurgical alternative for patients with PD. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT03781167.
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Affiliation(s)
- Jason Aldred
- Selkirk Neurology and Inland Northwest Research, 610 S Sherman St, Spokane, WA, 99202, USA.
| | - Eric Freire-Alvarez
- Neurology Department, University General Hospital of Elche, Carrer Almazara, 11, 03203, Elche, Spain
| | - Alexander V Amelin
- Department of Neurology and Neurosurgery, Pavlov First Saint Petersburg State Medical University, Ulitsa L'va Tolstogo, 6-8, St. Petersburg, 197022, Russia
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neuroscience, Padua University, Via VIII Febbraio, 2, 35122, Padua, Italy
| | - Bruno Bergmans
- Department of Neurology, AZ St-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Filip Bergquist
- Department of Pharmacology, University of Gothenburg, Universitetsplatsen 1, 405 30, Gothenburg, Sweden
| | - Manon Bouchard
- Clinique Neuro-Lévis, 1190 A Rue de Courchevel #301, Lévis, QC, G6W 0M5, Canada
| | - Kumar Budur
- AbbVie Inc., 1 N. Waukegan Road, North Chicago, IL, 60064, USA
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - K Ray Chaudhuri
- Parkinson's Foundation International Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
- King's College Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Susan R Criswell
- Department of Neurology, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Erik H Danielsen
- Department of Neurology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Florin Gandor
- Movement Disorders Hospital, Straße Nach Fichtenwalde 16, 14547, Beelitz-Heilstätten, Germany
- Department of Neurology, Otto-Von-Guericke University Magdeburg, Universitätspl. 2, 39106, Magdeburg, Germany
| | - Jia Jia
- AbbVie Inc., 1 N. Waukegan Road, North Chicago, IL, 60064, USA
| | - Thomas E Kimber
- Department of Neurology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- Department of Medicine, University of Adelaide, 4 North Terrace, Adelaide, SA, 5000, Australia
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | | | - Amy M Spiegel
- AbbVie Inc., 1 N. Waukegan Road, North Chicago, IL, 60064, USA
| | - David G Standaert
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL, 35233, USA
| | | | | | - Victor S C Fung
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury Road and Darcy Rd, Westmead, NSW, 2145, Australia
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
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Aldred J, Freire-Alvarez E, Amelin AV, Antonini A, Bergmans B, Bergquist F, Bouchard M, Budur K, Carroll C, Chaudhuri KR, Criswell SR, Danielsen EH, Gandor F, Jia J, Kimber TE, Mochizuki H, Robieson WZ, Spiegel AM, Standaert DG, Talapala S, Facheris MF, Fung VSC. Correction: Continuous Subcutaneous Foslevodopa/Foscarbidopa in Parkinson's Disease: Safety and Efficacy Results From a 12-Month, Single-Arm, Open-Label, Phase 3 Study. Neurol Ther 2023; 12:1959-1960. [PMID: 37817017 PMCID: PMC10630263 DOI: 10.1007/s40120-023-00554-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Affiliation(s)
- Jason Aldred
- Selkirk Neurology and Inland Northwest Research, 610 S Sherman St, Spokane, WA, 99202, USA.
| | - Eric Freire-Alvarez
- Neurology Department, University General Hospital of Elche, Carrer Almazara, 11, 03203, Elche, Spain
| | - Alexander V Amelin
- Department of Neurology and Neurosurgery, Pavlov First Saint Petersburg State Medical University, Ulitsa L'va Tolstogo, 6-8, St. Petersburg, 197022, Russia
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neuroscience, Padua University, Via VIII Febbraio, 2, 35122, Padua, Italy
| | - Bruno Bergmans
- Department of Neurology, AZ St-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Filip Bergquist
- Department of Pharmacology, University of Gothenburg, Universitetsplatsen 1, 405 30, Gothenburg, Sweden
| | - Manon Bouchard
- Clinique Neuro-Lévis, 1190 A Rue de Courchevel #301, Lévis, QC, G6W 0M5, Canada
| | - Kumar Budur
- AbbVie Inc., 1 N. Waukegan Road, North Chicago, IL, 60064, USA
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - K Ray Chaudhuri
- Parkinson's Foundation International Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
- King's College Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Susan R Criswell
- Department of Neurology, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Erik H Danielsen
- Department of Neurology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Florin Gandor
- Movement Disorders Hospital, Straße Nach Fichtenwalde 16, 14547, Beelitz-Heilstätten, Germany
- Department of Neurology, Otto-Von-Guericke University Magdeburg, Universitätspl. 2, 39106, Magdeburg, Germany
| | - Jia Jia
- AbbVie Inc., 1 N. Waukegan Road, North Chicago, IL, 60064, USA
| | - Thomas E Kimber
- Department of Neurology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- Department of Medicine, University of Adelaide, 4 North Terrace, Adelaide, SA, 5000, Australia
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | | | - Amy M Spiegel
- AbbVie Inc., 1 N. Waukegan Road, North Chicago, IL, 60064, USA
| | - David G Standaert
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL, 35233, USA
| | | | | | - Victor S C Fung
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury Road and Darcy Rd, Westmead, NSW, 2145, Australia
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
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Kelly J, Moyeed R, Carroll C, Luo S, Li X. Blood biomarker-based classification study for neurodegenerative diseases. Sci Rep 2023; 13:17191. [PMID: 37821485 PMCID: PMC10567903 DOI: 10.1038/s41598-023-43956-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023] Open
Abstract
As the population ages, neurodegenerative diseases are becoming more prevalent, making it crucial to comprehend the underlying disease mechanisms and identify biomarkers to allow for early diagnosis and effective screening for clinical trials. Thanks to advancements in gene expression profiling, it is now possible to search for disease biomarkers on an unprecedented scale.Here we applied a selection of five machine learning (ML) approaches to identify blood-based biomarkers for Alzheimer's (AD) and Parkinson's disease (PD) with the application of multiple feature selection methods. Based on ROC AUC performance, one optimal random forest (RF) model was discovered for AD with 159 gene markers (ROC-AUC = 0.886), while one optimal RF model was discovered for PD (ROC-AUC = 0.743). Additionally, in comparison to traditional ML approaches, deep learning approaches were applied to evaluate their potential applications in future works. We demonstrated that convolutional neural networks perform consistently well across both the Alzheimer's (ROC AUC = 0.810) and Parkinson's (ROC AUC = 0.715) datasets, suggesting its potential in gene expression biomarker detection with increased tuning of their architecture.
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Affiliation(s)
- Jack Kelly
- Faculty of Medicine, Biology and Health, Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK.
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BU, UK.
| | - Rana Moyeed
- Faculty of Science and Engineering, University of Plymouth, Plymouth, PL6 8BU, UK
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BU, UK
| | - Shouqing Luo
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BU, UK
| | - Xinzhong Li
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BX, UK.
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Martínez Carrasco A, Real R, Lawton M, Hertfelder Reynolds R, Tan M, Wu L, Williams N, Carroll C, Corvol JC, Hu M, Grosset D, Hardy J, Ryten M, Ben-Shlomo Y, Shoai M, Morris HR. Genome-wide Analysis of Motor Progression in Parkinson Disease. Neurol Genet 2023; 9:e200092. [PMID: 37560120 PMCID: PMC10409573 DOI: 10.1212/nxg.0000000000200092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/08/2023] [Indexed: 08/11/2023]
Abstract
Background and Objectives The genetic basis of Parkinson disease (PD) motor progression is largely unknown. Previous studies of the genetics of PD progression have included small cohorts and shown a limited overlap with genetic PD risk factors from case-control studies. Here, we have studied genomic variation associated with PD motor severity and early-stage progression in large longitudinal cohorts to help to define the biology of PD progression and potential new drug targets. Methods We performed a GWAS meta-analysis of early PD motor severity and progression up to 3 years from study entry. We used linear mixed-effect models with additive effects, corrected for age at diagnosis, sex, and the first 5 genetic principal components to assess variability in axial, limb, and total Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III scores. Results We included 3,572 unrelated European ancestry patients with PD from 5 observational cohorts and 1 drug trial. The average AAO was 62.6 years (SD = 9.83), and 63% of participants were male. We found an average increase in the total MDS-UPDRS III score of 2.3 points/year. We identified an association between PD axial motor progression and variation at the GJA5 locus at 1q12 (β = -0.25, SE = 0.04, p = 3.4e-10). Exploration of the regulation of gene expression in the region (cis-expression quantitative trait loci [eQTL] analysis) showed that the lead variant was associated with expression of ACP6, a lysophosphatidic acid phosphatase that regulates mitochondrial lipid biosynthesis (cis-eQTL p-values in blood and brain RNA expression data sets: <10-14 in eQTLGen and 10-7 in PsychEncode). Discussion Our study highlights the potential role of mitochondrial lipid homeostasis in the progression of PD, which may be important in establishing new drug targets that might modify disease progression.
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Affiliation(s)
- Alejandro Martínez Carrasco
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Raquel Real
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Michael Lawton
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Regina Hertfelder Reynolds
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Manuela Tan
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Lesley Wu
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Nigel Williams
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Camille Carroll
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Jean-Christophe Corvol
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Michele Hu
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Donald Grosset
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - John Hardy
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Mina Ryten
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Yoav Ben-Shlomo
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Maryam Shoai
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
| | - Huw R Morris
- From the Department of Clinical and Movement Neurosciences (A.M.C., R.R., L.W., H.R.M.), UCL Queen Square Institute of Neurology; UCL Movement Disorders Centre (A.M.C., R.R., L.W., H.R.M.), University College London, United Kingdom; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network (A.M.C., R.R., R.H.R. L.W., M.R., M.S. J.H., H.R.M.), Chevy Chase, MD; Population Health Sciences (M.L., Y.B.-S.), Bristol Medical School, University of Bristol; Genetics and Genomic Medicine (R.H.R., M.R.), UCL Great Ormond Street Institute of Child Health, University College London, United Kingdom; Department of Neurology (M.T.), Oslo University Hospital, Norway; Institute of Psychological Medicine and Clinical Neurosciences (N.W.), MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University; Faculty of Health (C.C.), University of Plymouth, United Kingdom; Sorbonne Université (J.-C.C.), Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS; Assistance Publique Hôpitaux de Paris (J.-C.C.), Department of Neurology, Hôpital Pitié-Salpêtrière, France; Division of Clinical Neurology (M.H.), Nuffield Department of Clinical Neurosciences; Oxford Parkinson's Disease Centre (M.H.), University of Oxford; School of Neuroscience and Psychology (D.G.), University of Glasgow; Department of Neurodegenerative Diseases (J.H., M.S.), UCL Queen Square Institute of Neurology; UK Dementia Research Institute (J.H., M.S.), University College London; Reta Lila Weston Institute (J.H., M.S.), UCL Queen Square Institute of Neurology; National Institute for Health Research (NIHR), University College London Hospitals Biomedical Research Centre (J.H.); Institute for Advanced Study (J.H.), The Hong Kong University of Science and Technology, Hong Kong SAR, China; and NIHR Great Ormond Street Hospital Biomedical Research Centre (M.R.), University College London, United Kingdom
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Martinez-Carrasco A, Real R, Lawton M, Iwaki H, Tan MMX, Wu L, Williams NM, Carroll C, Hu MTM, Grosset DG, Hardy J, Ryten M, Foltynie T, Ben-Shlomo Y, Shoai M, Morris HR. Genetic meta-analysis of levodopa induced dyskinesia in Parkinson's disease. NPJ Parkinsons Dis 2023; 9:128. [PMID: 37652906 PMCID: PMC10471743 DOI: 10.1038/s41531-023-00573-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
The genetic basis of levodopa-induced-dyskinesia (LiD) is poorly understood, and there have been few well-powered genome-wide studies. We performed a genome-wide survival meta-analyses to study the effect of genetic variation on the development of LiD in five separate longitudinal cohorts, and meta-analysed the results. We included 2784 PD patients, of whom 14.6% developed LiD. We found female sex (HR = 1.35, SE = 0.11, P = 0.007) and younger age at onset (HR = 1.8, SE = 0.14, P = 2 × 10-5) increased the probability of developing LiD. We identified three genetic loci significantly associated with time-to-LiD onset. rs72673189 on chromosome 1 (HR = 2.77, SE = 0.18, P = 1.53 × 10-8) located at the LRP8 locus, rs189093213 on chromosome 4 (HR = 3.06, SE = 0.19, P = 2.81 × 10-9) in the non-coding RNA LINC02353 locus, and rs180924818 on chromosome 16 (HR = 3.13, SE = 0.20, P = 6.27 × 10-9) in the XYLT1 locus. Based on a functional annotation analysis on chromosome 1, we determined that changes in DNAJB4 gene expression, close to LRP8, are an additional potential cause of increased susceptibility to LiD. Baseline anxiety status was significantly associated with LiD (OR = 1.14, SE = 0.03, P = 7.4 × 10-5). Finally, we performed a candidate variant analysis of previously reported loci, and found that genetic variability in ANKK1 (rs1800497, HR = 1.27, SE = 0.09, P = 8.89 × 10-3) and BDNF (rs6265, HR = 1.21, SE = 0.10, P = 4.95 × 10-2) loci were significantly associated with time to LiD in our large meta-analysis.
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Affiliation(s)
- Alejandro Martinez-Carrasco
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK.
- UCL Movement Disorders Centre, University College London, London, UK.
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA.
| | - Raquel Real
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA
| | - Michael Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hirotaka Iwaki
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Data Tecnica International, Glen Echo, MD, USA
| | - Manuela M X Tan
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Lesley Wu
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA
| | - Nigel M Williams
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Plymouth, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Michele T M Hu
- Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
| | - Donald G Grosset
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - John Hardy
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA
- Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
- UK Dementia Research Institute, University College London, London, UK
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, London, UK
- Institute for Advanced Study, The Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Mina Ryten
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
| | - Tom Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maryam Shoai
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA
- Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
- UK Dementia Research Institute, University College London, London, UK
| | - Huw R Morris
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK.
- UCL Movement Disorders Centre, University College London, London, UK.
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA.
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Sorrell L, Leta V, Barnett A, Stevens K, King A, Inches J, Kobylecki C, Walker R, Chaudhuri KR, Martin H, Rideout J, Sneyd JR, Campbell S, Carroll C. Clinical features and outcomes of hospitalised patients with COVID-19 and Parkinsonian disorders: A multicentre UK-based study. PLoS One 2023; 18:e0285349. [PMID: 37523365 PMCID: PMC10389727 DOI: 10.1371/journal.pone.0285349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Parkinson's disease has been identified as a risk factor for severe Coronavirus disease 2019 (COVID-19) outcomes. However, whether the significant high risk of death from COVID-19 in people with Parkinson's disease is specific to the disease itself or driven by other concomitant and known risk factors such as comorbidities, age, and frailty remains unclear. OBJECTIVE To investigate clinical profiles and outcomes of people with Parkinson's disease and atypical parkinsonian syndromes who tested positive for COVID-19 in the hospital setting in a multicentre UK-based study. METHODS A retrospective cohort study of Parkinson's disease patients with a positive SARS-CoV-2 test admitted to hospital between February 2020 and July 2021. An online survey was used to collect data from clinical care records, recording patient, Parkinson's disease and COVID-19 characteristics. Associations with time-to-mortality and severe outcomes were analysed using either the Cox proportional hazards model or logistic regression models, as appropriate. RESULTS Data from 552 admissions were collected: 365 (66%) male; median (inter-quartile range) age 80 (74-85) years. The 34-day all-cause mortality rate was 38.4%; male sex, increased age and frailty, Parkinson's dementia syndrome, requirement for respiratory support and no vaccination were associated with increased mortality risk. Community-acquired COVID-19 and co-morbid chronic neurological disorder were associated with increased odds of requiring respiratory support. Hospital-acquired COVID-19 and delirium were associated with requiring an increase in care level post-discharge. CONCLUSIONS This first, multicentre, UK-based study on people with Parkinson's disease or atypical parkinsonian syndromes, hospitalised with COVID-19, adds and expands previous findings on clinical profiles and outcomes in this population.
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Affiliation(s)
- Lexy Sorrell
- University of Plymouth, Plymouth, United Kingdom
| | - Valentina Leta
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | | | - Kara Stevens
- Exploristics Ltd, Belfast, Northern Ireland, United Kingdom
| | - Angela King
- University of Plymouth, Plymouth, United Kingdom
| | - Jemma Inches
- University of Plymouth, Plymouth, United Kingdom
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Christopher Kobylecki
- Division of Neuroscience and Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Richard Walker
- Department of Medicine, North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom
- Population Health Science Institute, Newcastle University, Newcastle, United Kingdom
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Hannah Martin
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | | | | | | | - Camille Carroll
- University of Plymouth, Plymouth, United Kingdom
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
- Newcastle University, Newcastle, United Kingdom
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Foltynie T, Gandhi S, Gonzalez-Robles C, Zeissler ML, Mills G, Barker R, Carpenter J, Schrag A, Schapira A, Bandmann O, Mullin S, Duffen J, McFarthing K, Chataway J, Parmar M, Carroll C. Towards a multi-arm multi-stage platform trial of disease modifying approaches in Parkinson's disease. Brain 2023; 146:2717-2722. [PMID: 36856727 PMCID: PMC10316775 DOI: 10.1093/brain/awad063] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 12/20/2022] [Accepted: 01/08/2023] [Indexed: 03/02/2023] Open
Abstract
An increase in the efficiency of clinical trial conduct has been successfully demonstrated in the oncology field, by the use of multi-arm, multi-stage trials allowing the evaluation of multiple therapeutic candidates simultaneously, and seamless recruitment to phase 3 for those candidates passing an interim signal of efficacy. Replicating this complex innovative trial design in diseases such as Parkinson's disease is appealing, but in addition to the challenges associated with any trial assessing a single potentially disease modifying intervention in Parkinson's disease, a multi-arm platform trial must also specifically consider the heterogeneous nature of the disease, alongside the desire to potentially test multiple treatments with different mechanisms of action. In a multi-arm trial, there is a need to appropriately stratify treatment arms to ensure each are comparable with a shared placebo/standard of care arm; however, in Parkinson's disease there may be a preference to enrich an arm with a subgroup of patients that may be most likely to respond to a specific treatment approach. The solution to this conundrum lies in having clearly defined criteria for inclusion in each treatment arm as well as an analysis plan that takes account of predefined subgroups of interest, alongside evaluating the impact of each treatment on the broader population of Parkinson's disease patients. Beyond this, there must be robust processes of treatment selection, and consensus derived measures to confirm target engagement and interim assessments of efficacy, as well as consideration of the infrastructure needed to support recruitment, and the long-term funding and sustainability of the platform. This has to incorporate the diverse priorities of clinicians, triallists, regulatory authorities and above all the views of people with Parkinson's disease.
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Affiliation(s)
- Tom Foltynie
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Sonia Gandhi
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Cristina Gonzalez-Robles
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | | | - Georgia Mills
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Roger Barker
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0PY, UK
| | | | - Anette Schrag
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Anthony Schapira
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Oliver Bandmann
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield S10 2HQ, UK
| | - Stephen Mullin
- Faculty of Health, University of Plymouth, Plymouth PL4 9AA, UK
| | - Joy Duffen
- MRC Clinical Trials Unit at UCL, London WC1V 6LJ, UK
| | | | - Jeremy Chataway
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, London WC1V 6LJ, UK
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Plymouth PL4 9AA, UK
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Martinez-Carrasco A, Real R, Lawton M, Iwaki H, Tan MMX, Wu L, Williams NM, Carroll C, Hu MT, Grosset DG, Hardy J, Ryten M, Foltynie T, Ben-Shlomo Y, Shoai M, Morris HR. Genetic meta-analysis of levodopa induced dyskinesia in Parkinson's disease. medRxiv 2023:2023.05.24.23290362. [PMID: 37425912 PMCID: PMC10327264 DOI: 10.1101/2023.05.24.23290362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Importance Forty percent of Parkinson's disease patients develop levodopa-induced-dyskinesia (LiD) within 4 years of starting levodopa. The genetic basis of LiD remains poorly understood, and there have been few well powered studies. Objective To discover common genetic variants in the PD population that increase the probability of developing LiD. Design setting and Participants We performed survival analyses to study the development of LiD in 5 separate longitudinal cohorts. We performed a meta-analysis to combine the results of genetic association from each study based on a fixed effects model weighting the effect sizes by the inverse of their standard error. The selection criteria was specific to each cohort. We studied individuals that were genotyped from each cohort and that passed our analysis specific inclusion criteria. Main Outcomes and Measures We measured the time for PD patients on levodopa treatment to develop LiD as defined by reaching a score higher or equal than 2 from the MDS-UPDRS part IV, item 1, which is equivalent to a range of 26%-50% of the waking time with dyskinesia. We carried out a genome-wide analysis of the hazard ratio and the association of genome-wide SNPs with the probability of developing LiD using cox proportional hazard models (CPH). Results This study included 2,784 PD patients of European ancestry, of whom 14.6% developed LiD. Consistent with previous studies, we found female gender (HR = 1.35, SE = 0.11, P = 0.007) and younger age at onset (HR = 1.8, SE = 0.14, P = 2 × 10 -5 ) to increase the probability of developing LiD. We identified three loci significantly associated with time-to-LiD onset. rs72673189 on chromosome 1 (HR = 2.77, SE = 0.18, P = 1.53 × 10 -8 ) located in the LRP8 locus, rs189093213 on chromosome 4 (HR = 3.06,, SE = 0.19, P = 2.81 × 10 -9 ) in the non-coding RNA LINC02353 locus, and rs180924818 on chromosome 16 (HR = 3.13, SE = 0.20, P = 6.27 × 10 -9 ) in the XYLT1 locus. Subsequent colocalization analyses on chromosome 1 identified DNAJB4 as a candidate gene associated with LiD through a change in gene expression. We computed a PRS based on our GWAS meta-analysis and found high accuracy to stratify between PD-LID and PD (AUC 83.9). We also performed a stepwise regression analysis for baseline features selection associated with LiD status. We found baseline anxiety status to be significantly associated with LiD (OR = 1.14, SE = 0.03, P = 7.4 × 10 -5 ). Finally, we performed a candidate variant analysis and found that genetic variability in ANKK1 ( rs1800497 , Beta = 0.24, SE = 0.09, P = 8.89 × 10 -3 ) and BDNF ( rs6265 , Beta = 0.19, SE = 0.10, P = 4.95 × 10 -2 ) loci were significantly associated with time to LiD in our large meta-analysis. Conclusion In this association study, we have found three novel genetic variants associated with LiD, as well as confirming reports that variability in ANKK1 and BDNF loci were significantly associated with LiD probability. A PRS nominated from our time-to-LiD meta-analysis significantly differentiated between PD-LiD and PD. In addition, we have found female gender, young PD onset and anxiety to be significantly associated with LiD.
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Affiliation(s)
- Alejandro Martinez-Carrasco
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, UK
- UCL Movement Disorders Centre, University College London, London, UK
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815
| | - Raquel Real
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, UK
- UCL Movement Disorders Centre, University College London, London, UK
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815
| | - Michael Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hirotaka Iwaki
- Center for Alzheimer’s and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Data Tecnica International, Glen Echo, Maryland, USA
| | | | - Lesley Wu
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, UK
- UCL Movement Disorders Centre, University College London, London, UK
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815
| | - Nigel M. Williams
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Plymouth, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Michele T.M. Hu
- Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Oxford Parkinson’s Disease Centre, University of Oxford, Oxford, UK
| | - Donald G. Grosset
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - John Hardy
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815
- Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
- UK Dementia Research Institute, University College London, London, UK
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, London, UK
- Institute for Advanced Study, The Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Mina Ryten
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
| | - Tom Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maryam Shoai
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815
- Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
- UK Dementia Research Institute, University College London, London, UK
| | - Huw R. Morris
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, UK
- UCL Movement Disorders Centre, University College London, London, UK
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815
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Bounsall KL, Milne-Ives M, Hall A, Carroll C, Meinert E. Artificial Intelligence Applications for Assessment, Monitoring and Management of Parkinson’s Disease Symptoms: A Systematic Review Protocol (Preprint). JMIR Res Protoc 2023. [DOI: 10.2196/46581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
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Schrag A, Carroll C, Duncan G, Molloy S, Grover L, Hunter R, Brown R, Freemantle N, Whipps J, Serfaty MA, Lewis G. Antidepressants Trial in Parkinson's Disease (ADepT-PD): protocol for a randomised placebo-controlled trial on the effectiveness of escitalopram and nortriptyline on depressive symptoms in Parkinson's disease. BMC Neurol 2022; 22:474. [PMID: 36510237 PMCID: PMC9743717 DOI: 10.1186/s12883-022-02988-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Depressive symptoms are common in patients with Parkinson's disease and depression is a significant predictor of functional impairment, reduced quality of life and general well-being in Parkinson's disease. Despite the high prevalence of depression, evidence on the effectiveness and tolerability of antidepressants in this population is limited. The primary aim of this trial is to establish the clinical and cost effectiveness of escitalopram and nortriptyline for the treatment of depression in Parkinson's disease. METHODS This is a multi-centre, double-blind, randomised placebo-controlled trial in 408 people with Parkinson's disease with subsyndromal depression, major depressive disorder or persistent depressive disorder and a Beck Depression Inventory-II (BDI-II) score of 14 or above. Participants will be randomised into one of three groups, receiving either escitalopram, nortriptyline or placebo for 12 months. Trial participation is face-to-face, hybrid or remote. The primary outcome measure is the BDI-II score following 8 weeks of treatment. Secondary outcomes will be collected at baseline, 8, 26 and 52 weeks and following withdrawal, including severity of anxiety and depression scores as well as Parkinson's disease motor severity, and ratings of non-motor symptoms, cognitive function, health-related quality of life, levodopa-equivalence dose, changes in medication, overall clinical effectiveness, capability, health and social care resource use, carer health-related quality of life, adverse effects and number of dropouts. DISCUSSION This trial aims to determine the effectiveness of escitalopram and nortriptyline for reducing depressive symptoms in Parkinson's disease over 8 weeks, to provide information on the effect of these medications on anxiety and other non-motor symptoms in PD and on impact on patients and caregivers, and to examine their effect on change in motor severity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03652870 Date of registration - 29th August 2018.
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Affiliation(s)
- A Schrag
- grid.83440.3b0000000121901201Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK ,grid.437485.90000 0001 0439 3380Department of Neurology, Royal Free London NHS Foundation Trust, London, UK
| | - C Carroll
- grid.11201.330000 0001 2219 0747Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - G Duncan
- grid.39489.3f0000 0001 0388 0742NHS Lothian, Edinburgh, UK
| | - S Molloy
- grid.417895.60000 0001 0693 2181Department of Neurosciences, Imperial College Healthcare NHS Trust, London, UK
| | - L Grover
- grid.83440.3b0000000121901201Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - R Hunter
- grid.83440.3b0000000121901201Research Department of Primary Care and Population Health, University College London, London, UK
| | - R Brown
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - N Freemantle
- grid.83440.3b0000000121901201Comprehensive Clinical Trials Unit, University College London, London, UK
| | - J Whipps
- PPI Representative, Plymouth, UK
| | - M. A Serfaty
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, London, UK ,Priory Hospital North London, London, UK
| | - G Lewis
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, London, UK
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Stevens KN, Creanor S, Jeffery A, Whone A, Zajicek J, Foggo A, Jones B, Chapman R, Cocking L, Wilks J, Webb D, Carroll C, Inches J, Underwood D, Frost J, James A, Schofield C, James R, O’Reilly C, Sheridan R, Statton S, Goff A, Russell T, Whitcher A, Craw S, Lewis A, Sophia R, Amar K, Hernandez R, Pitcher A, Carvey S, Hamlin R, Lyell V, Aubry L, Carey G, Coebergh J, Mojela I, Molloy S, Berceruelo Bergaz Y, Camera B, Campbell P, Morris H, Samakomva T, Schrag A, Fuller S, Misbahuddin A, Parker L, Visentin E, Gallehawk S, Rudd J, Singh S, Wilson S, Creven J, Croucher Y, Tluk S, Watts P, Hargreaves S, Johnson D, Worboys L, Worth P, Brooke J, Kobylecki C, Parker V, Johnson L, Joseph R, Melville J, Raw J, Birt J, Hare M, Shaik S, Alty J, Cosgrove J, Burn D, Green A, McNichol A, Pavese N, Pilkington H, Price M, Walker K, Chaudhuri R, Podlewska A, Reddy P, Trivedi D, Bandmann O, Clegg R, Cole G, Emery A, Dostal V, Graham J, Keshet-Price J, Mamutse G, Miller-Fik A, Wiltshire A, Wright C, Dixon K, Abdelhafiz A, Rose J. Evaluation of Simvastatin as a Disease-Modifying Treatment for Patients With Parkinson Disease: A Randomized Clinical Trial. JAMA Neurol 2022; 79:1232-1241. [PMID: 36315128 PMCID: PMC9623477 DOI: 10.1001/jamaneurol.2022.3718] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Importance Current treatments manage symptoms of Parkinson disease (PD), but no known treatment slows disease progression. Preclinical and epidemiological studies support the potential use of statins as disease-modifying therapy. Objective To determine whether simvastatin has potential as a disease-modifying treatment for patients with moderate PD. Design, Setting, and Participants This randomized clinical trial, a double-blind, parallel-group, placebo-controlled futility trial, was conducted between March 2016 and May 2020 within 23 National Health Service Trusts in England. Participants aged 40 to 90 years with a diagnosis of idiopathic PD, with a modified Hoehn and Yahr stage of 3.0 or less while taking medication, and taking dopaminergic medication with wearing-off phenomenon were included. Data were analyzed from May 2020 to September 2020, with additional analysis in February 2021. Interventions Participants were allocated 1:1 to simvastatin or matched placebo via a computer-generated random sequence, stratified by site and Hoehn and Yahr stage. In the simvastatin arm, participants entered a 1-month phase of simvastatin, 40 mg daily, followed by 23 months of simvastatin, 80 mg daily, before a 2-month washout period. Main Outcomes and Measures The prespecified primary outcome was 24-month change in Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) part III score measured while not taking medication (high scores indicate worse outcome). The primary futility analysis included participants who commenced the 80-mg phase and had valid primary outcome data. The safety analysis included all participants who commenced trial treatment and is reported by dose at time of event. Results Of 332 patients assessed for eligibility, 32 declined and 65 were ineligible. Of 235 recruited participants, 97 (41%) were female, 233 (99%) were White, and the mean (SD) age was 65.4 (9.4) years. A total of 216 patients progressed to the 80-mg dose. Primary outcome analysis (n = 178) indicated the simvastatin group had an additional deterioration in MDS-UPDRS III score while not taking medication at 24 months compared with the placebo group (1.52 points; 2-sided 80% CI, -0.77 to 3.80; 1-sided futility test P = .006). A total of 37 serious adverse events (AEs), including 3 deaths, and 171 AEs were reported for participants receiving 0-mg simvastatin; 37 serious AEs and 150 AEs were reported for participants taking 40 mg or 80 mg of simvastatin. Four participants withdrew from the trial because of an AE. Conclusions and Relevance In this randomized clinical trial, simvastatin was futile as a disease-modifying therapy in patients with PD of moderate severity, providing no evidence to support proceeding to a phase 3 trial. Trial Registration ISRCTN Identifier: 16108482.
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Affiliation(s)
- Kara N. Stevens
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom,Exploristics Ltd, Belfast, United Kingdom
| | - Siobhan Creanor
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Alison Jeffery
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Alan Whone
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - John Zajicek
- School of Medicine, Medical and Biological Sciences, University of St Andrews, St Andrews, United Kingdom
| | - Andy Foggo
- School of Biological and Marine Sciences, Faculty of Science and Engineering, University of Plymouth, Plymouth, United Kingdom
| | - Ben Jones
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Rebecca Chapman
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Laura Cocking
- NIHR BioResource, University of Cambridge, Cambridge, United Kingdom
| | - Jonny Wilks
- MAC Clinical Research, Blackpool, United Kingdom
| | - Doug Webb
- Bristol Trials Centre, University of Bristol, Bristol, United Kingdom
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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Rousham EK, Goudet S, Markey O, Griffiths P, Boxer B, Carroll C, Petherick ES, Pradeilles R. Unhealthy Food and Beverage Consumption in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-Analysis. Adv Nutr 2022; 13:1669-1696. [PMID: 35362512 PMCID: PMC9526862 DOI: 10.1093/advances/nmac032] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/25/2022] [Accepted: 03/25/2022] [Indexed: 01/28/2023] Open
Abstract
This WHO-commissioned review contributed to the update of complementary feeding recommendations, synthesizing evidence on effects of unhealthy food and beverage consumption in children on overweight and obesity. We searched PubMed (Medline), Cochrane CENTRAL, and Embase for articles, irrespective of language or geography. Inclusion criteria were: 1) randomized controlled trials (RCTs), non-RCTs, cohort studies, and pre/post studies with control; 2) participants aged ≤10.9 y at exposure; 3) studies reporting greater consumption of unhealthy foods/beverages compared with no or low consumption; 4) studies assessing anthropometric and/or body composition; and 5) publication date ≥1971. Unhealthy foods and beverages were defined using nutrient- and food-based approaches. Risk of bias was assessed using the ROBINS-I (risk of bias in nonrandomized studies of interventions version I) and RoB2 [Cochrane RoB (version 2)] tools for nonrandomized and randomized studies, respectively. Narrative synthesis was complemented by meta-analyses where appropriate. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Of 26,542 identified citations, 60 studies from 71 articles were included. Most studies were observational (59/60), and no included studies were from low-income countries. The evidence base was low quality, as assessed by ROBINS-I and RoB2 tools. Evidence synthesis was limited by the different interventions and comparators across studies. Evidence indicated that consumption of sugar-sweetened beverages (SSBs) and unhealthy foods in childhood may increase BMI/BMI z-score, percentage body fat, or odds of overweight/obesity (low certainty of evidence). Artificially sweetened beverages and 100% fruit juice consumption make little/no difference to BMI, percentage body fat, or overweight/obesity outcomes (low certainty of evidence). Meta-analyses of a subset of studies indicated a positive association between SSB intake and percentage body fat, but no association with change in BMI and BMI z-score. High-quality epidemiological studies that are designed to assess the effects of unhealthy food consumption during childhood on risk of overweight/obesity are needed to contribute to a more robust evidence base upon which to design policy recommendations. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO as CRD42020218109.
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Affiliation(s)
- E K Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - S Goudet
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - O Markey
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - P Griffiths
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - B Boxer
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - C Carroll
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - E S Petherick
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, United Kingdom
| | - R Pradeilles
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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Zeissler ML, McFarthing K, Gonzalez-Robles C, Chapman R, Mills G, Foltynie T, Carroll C. 109 Embedding patient voice in trial design: the EJS ACT-PD experience. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatient-centred trials address patient relevant questions, have protocols that maximise recruitment and retention, as well as effective communication strategies. Involving patients and carers in trial design and oversight is essential for patient-centred research. In the Edmond J Safra ACT-PD ini- tiative we are developing the first multi-arm multi-stage (MAMS) trial for disease modifying Parkinson’s treatments. Here we present our patient-centred approach.MethodsSeven people with Parkinson’s (PwP) and three care partners (CP) (3 male, 7 female) were recruited nationally and two allocated to each of 5 working groups (WG) developing the trial. Together they form a Patient and Public Involvement and Engagement (PPIE) WG chaired by PwP (KMcF). The group iteratively developed processes for supporting their input into WG decisions with an impact evalu- ation plan involving semi-structured interviews and a revised Patient Engagement in Research Scale).ResultsThe PPIE team meets every six weeks online. Standard Reporting Forms facilitate communication between WGs and PPIE members, supporting group input into issues arising. PPIE feedback is an agenda item at all WG meetings. Post-WG PPIE debriefs with the WG chairs ensure a shared understanding of discussions. Monthly PPIE forums provide opportunity for informal education and themed discussions with PwP/CP. A PwP/CP WhatsApp group creates a safe space for sharing experiences and ideas.ConclusionWe have developed a process by which PwP/CP can meaningfully co-design our MAMS trial, ensuring it is truly patient-centred.
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Sorrell L, King A, Inches J, Rideout J, Sneyd R, Kobylecki C, Chaudhuri R, Walker R, Martin H, Carroll C. 110 Outcome and mortality of hospital admission with COVID-19 for individuals with parkinsonian syndromes. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectiveTo evaluate features of Parkinson’s disease (PD) and atypical Parkinson’s syndromes (APS) associated with poor outcome and mortality in people with COVID-19 in a hospital setting.BackgroundPrevious studies have demonstrated increased mortality of COVID-19 in people with PD. However, it is not known whether this is associated with disease-related factors (eg autonomic dysfunc- tion, dysphagia).MethodsAn online survey tool captured anonymised patient data from hospital admission records of people with PD and APS who tested positive for COVID-19 between February 2020 and July 2021. We will use Cox proportional hazards and linear regression models to evaluate which characteristics are associ- ated with mortality, increased care requirement and more severe COVID-19 infection. Models will be adjusted for known associations with poor outcome, such as co-morbidities, age and sex.ResultsData were collected from 556 admissions from 21 UK sites: 66.2% male; median (IQR) age 80 (11) years; median disease duration 5 (7) years. 19.2% were asymptomatic, 28.8% had mild symptoms and 52.5% required respiratory support. 38.3% died within 4 weeks of a positive COVID-19 test. Preliminary Kaplan-Meier curves suggest that co-existing dementia, marked motor fluctuations and more advanced Hoehn and Yahr stage may be associated with 28-day mortality. Full statistical analysis is in progress.ConclusionsIdentification of Parkinson’s features associated with poor in-hospital COVID-19 outcome will allow a more informed discussion relating to individual COVID-19 risk.
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Day JO, Smith S, Noyce AJ, Alty J, Jeffery A, Chapman R, Carroll C. Challenges of Incorporating Digital Health Technology Outcomes in a Clinical Trial: Experiences from PD STAT. J Parkinsons Dis 2022; 12:1605-1609. [PMID: 35466954 PMCID: PMC9398088 DOI: 10.3233/jpd-223162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Digital health technologies (DHTs) have great potential for use as clinical trial outcomes; however, practical issues need to be addressed in order to maximise their benefit. We describe our experience of incorporating two DHTs as secondary/exploratory outcome measures in PD STAT, a randomised clinical trial of simvastatin in people with Parkinson's disease. We found much higher rates of missing data in the DHTs than the traditional outcome measures, in particular due to technical and software difficulties. We discuss methods to address these obstacles in terms of protocol design, workforce training and data management.
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Affiliation(s)
- Jacob O. Day
- Faculty of Health, University of Plymouth, Plymouth, UK,Correspondence to: Jacob Day, Faculty of Health, University of Plymouth, Plymouth, PL4 8AA, UK. Tel.: +01752 432028; E-mail:
| | - Stephen Smith
- Department of Electronic Engineering, University of York, York, UK
| | - Alastair J. Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, UK,Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, London, UK
| | - Jane Alty
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Australia,Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alison Jeffery
- Peninsula Clinical Trials Unit, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Rebecca Chapman
- Peninsula Clinical Trials Unit, Faculty of Health, University of Plymouth, Plymouth, UK
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Kehagia AA, North TK, Grose J, Jeffery AN, Cocking L, Chapman R, Carroll C. Enhancing Trial Delivery in Parkinson’s Disease: Qualitative Insights from PD STAT. JPD 2022; 12:1591-1604. [PMID: 35466952 PMCID: PMC9398073 DOI: 10.3233/jpd-212987] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Recruitment and retention of participants in clinical trials for Parkinson’s disease (PD) is challenging. A qualitative study embedded in the PD STAT multi-centre randomised controlled trial of simvastatin for neuroprotection in PD explored the motivators, barriers and challenges of participants, care partners and research staff. Objective: To outline a set of considerations informing a patient-centred approach to trial recruitment, retention, and delivery. Method: We performed semi-structured interviews and focus groups with a subset of trial participants and their care partners. Quantitative and qualitative data were obtained through surveys circulated among the 235 participants across 23 UK sites at the beginning, middle and end of the 2-year trial. We also interviewed and surveyed research staff at trial closure. Results: Twenty-seven people with PD, 6 care partners and 9 researchers participated in interviews and focus groups. A total of 463 trial participant survey datasets were obtained across three timepoints, and 53 staff survey datasets at trial closure. Trial participants discussed the physical and psychological challenges they faced, especially in the context of OFF state assessments, relationships, and communication with research staff. Care partners shared their insights into OFF state challenges, and the value of being heard by research teams. Research staff echoed many concerns with suggestions on flexible, person-centred approaches to maximising convenience, comfort, and privacy. Conclusion: These considerations, in favour of person-centred research protocols informed by the variable needs of participants, care partners and staff, could be developed into a set of recommendations for future trials.
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Affiliation(s)
- Angie A. Kehagia
- University College Hospital, University London Hospitals NHS Trust, London, UK
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
| | - Tracie K. North
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
| | - Jane Grose
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
| | | | - Laura Cocking
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
| | - Rebecca Chapman
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
| | - Camille Carroll
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
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Rochester L, Carroll C. Implications of research that excludes under-served populations. Nat Rev Neurol 2022; 18:449-450. [PMID: 35768654 DOI: 10.1038/s41582-022-00688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lynn Rochester
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK. .,Newcastle Hospitals University Foundation Trust, Newcastle, UK.
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Plymouth, UK.,University Hospitals Plymouth NHS Trust, Plymouth, UK
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Meinert E, Milne-Ives M, Chaudhuri KR, Harding T, Whipps J, Whipps S, Carroll C. The impact of a digital artificial intelligence system on the monitoring and self-management of non-motor symptoms in People with Parkinson’s: Proposal for a Phase 1 implementation study (Preprint). JMIR Res Protoc 2022; 11:e40317. [PMID: 36155396 PMCID: PMC9555326 DOI: 10.2196/40317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Nonmotor symptoms of Parkinson disease are a major factor of disease burden but are often underreported in clinical appointments. A digital tool has been developed to support the monitoring and management of nonmotor symptoms. Objective The aim of this study is to establish evidence of the impact of the system on patient confidence, knowledge, and skills for self-management of nonmotor symptoms, symptom burden, and quality of life of people with Parkinson and their care partners. It will also evaluate the usability, acceptability, and potential for adoption of the system for people with Parkinson, care partners, and health care professionals. Methods A mixed methods implementation and feasibility study based on the nonadoption, abandonment, scale-up, spread, and sustainability framework will be conducted with 60 person with Parkinson–care partner dyads and their associated health care professionals. Participants will be recruited from outpatient clinics at the University Hospitals Plymouth NHS Trust Parkinson service. The primary outcome, patient activation, will be measured over the 12-month intervention period; secondary outcomes include the system’s impact on health and well-being outcomes, safety, usability, acceptability, engagement, and costs. Semistructured interviews with a subset of participants will gather a more in-depth understanding of user perspectives and experiences with the system. Repeated measures analysis of variance will analyze change over time and thematic analysis will be conducted on qualitative data. The study was peer reviewed by the Parkinson’s UK Non-Drug Approaches grant board and is pending ethical approval. Results The study won funding in August 2021; data collection is expected to begin in December 2022. Conclusions The study’s success criteria will be affirming evidence regarding the system’s feasibility, usability and acceptability, no serious safety risks identified, and an observed positive impact on patient activation. Results will be disseminated in academic peer-reviewed journals and in platforms and formats that are accessible to the general public, guided by patient and public collaborators. Trial Registration ClinicalTrials.gov NCT05414071; https://clinicaltrials.gov/ct2/show/NCT05414071 International Registered Report Identifier (IRRID) PRR1-10.2196/40317
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Affiliation(s)
- Edward Meinert
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Madison Milne-Ives
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom
| | - Tracey Harding
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - John Whipps
- University of Plymouth, Plymouth, United Kingdom
| | - Susan Whipps
- University of Plymouth, Plymouth, United Kingdom
| | - Camille Carroll
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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Milne-Ives M, Carroll C, Meinert E. Self-management interventions for people with Parkinson’s Disease: A scoping review (Preprint). J Med Internet Res 2022; 24:e40181. [PMID: 35930315 PMCID: PMC9391969 DOI: 10.2196/40181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/07/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Madison Milne-Ives
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Camille Carroll
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Edward Meinert
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States
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King E, Inches J, Edwards E, Rideout J, Whipps S, Holley M, Gorst T, Carroll C. 023 Evaluating a home-based care pathway for people with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundCurrent care pathways for people with Parkinson’s (PwP) are not tailored to need. In line with the NHS Long Term Plan, together with PwP, we have co-developed, piloted and evaluated an innovative care pathway, ‘Home Based Care (HBC)’, based on supported self-management, triggered contacts and digitally-enabled remote monitoring.MethodEvaluation was performed at baseline and 6-monthly of motor (UPDRS II and accelerometer) and non-motor (NMSQ, PDSS2, HADS) symptoms, acceptability and self-management efficacy. Care was audited using Parkinson’s UK national audit standards. Process measures captured feasibility.ResultsData are available for 93 patients at baseline and 38 at 6m. Compared with baseline, after 6m on HBC, fewer PwP had uncontrolled bradykinesia (55.3% vs 63.4%), severe non-motor symptom burden (32.4% vs 50.6%), depression (2.9% vs 15.9%) and anxiety (17.1% vs 23.2%); median UPDRS II improved from 12.0 to 9.0; PwP felt more involved in care (70% vs 42%), listened to (72% vs 48%) and treated as an individual (81% vs 58%), as well as having increased PD understanding (57% vs 38%) and ability to self- manage (45% vs 34%). HBC met 93% of national audit criteria.ConclusionsWe have demonstrated acceptability, feasibility and effectiveness of our novel Parkinson’s care pathway.e.king6@nhs.net|NIHR Bursary
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Edwards E, Triscott K, Ankeny U, Langley J, Partridge R, Swabey M, Rideout J, Whipps S, Whipps J, Carroll C. 237 Designing and implementing a home based care pathway for people with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Healthcare for people with Parkinson’s (PwP) can vary across the UK. With the prediction that numbers will increase by a fifth by 2025, the Parkinson’s specialist team in Plymouth recognised an opportunity to meet the challenge with a service re-design that incorporated patient initiated contact and digital technology.Following a series of workshops facilitated by healthcare design engineers, and attended by PwP, their family, Parkinson’s practitioners, and digital health representatives, various supportive and educational materials were devised to support patient self-management supported by home based monitoring.The main structure and associated materials of the pathway incorporated 3 main themes:Education and support (which includes an initial teaching session, information booklets, symptom tracking cards, and an online social media group for peer support);Clear information on how to initiate a healthcare contact via a dedicated email and telephone hotline;Motor and non-motor symptoms monitored from home via the Parkinson’s KinetigraphTM (PKG) watch and regular completion of validated questionnaires.The first phase of this Health Foundation Innovation project was implemented in Oct 2019 with 10 PwP from Plymouth taking part. A wider roll out of the pathway involving people in East Cornwall, West Devon and Plymouth is taking place in 2020, involving 150 patients. Embedded processes for evaluation and feedback inform continued development and refinement of the pathway.camille.carroll@plymouth.ac.uk
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Zeissler ML, Dominey T, Morris H, Bandmann O, Schrag A, Foltynie T, Carroll C. 233 Working towards an adaptive trial platform for Parkinson’s disease. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundNo intervention for Parkinson’s disease (PD) has been unequivocally proven to be neuro- protective. Setting up phase 2 and 3 clinical trials in isolation is costly, time consuming and inefficient. An adaptive trial design may allow streamlining clinical evaluation, with interim analyses allowing for early detection and replacement of ineffective arms. We were interested to explore the practicalities of developing an adaptive trial for PD.MethodWe consulted with experts in disease areas where adaptive trials have been initiated and sought support from national and international Parkinson’s experts, charities, and input from patient advocates.ResultsFollowing consultation, we have adapted the process successfully employed by the multiple sclerosis (MS) Society in the development of the STOP MS initiative. Initial steps involve a review of recent trial methodologies and a Delphi study involving multi-organisational stakeholders, including patients and international experts. These results will inform the function of working groups responsible for drug selection, trial design, outcome measure selection and infrastructure.ConclusionsDeveloping a adaptive trial for PD is challenging. However, we now have a process to take this forward, building on the success of similar initiatives in other neurodegenerative diseases.marie-louise.zeissler@plymouth.ac.uk
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Affiliation(s)
- C Carroll
- Klamath Center for Conservation Research, Orleans, CA 95556, USA
| | - R F Noss
- Florida Institute for Conservation Science, Melrose, FL 32666, USA
| | - Bruce A Stein
- National Wildlife Federation, Washington, DC 20005, USA
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Schofield C, Chaudhuri KR, Carroll C, Sharma JC, Pavese N, Evans J, Foltynie T, Reichmann H, Zurowska L, Soares-da-Silva P, Lees A. Opicapone in UK clinical practice: effectiveness, safety and cost analysis in patients with Parkinson's disease. Neurodegener Dis Manag 2022; 12:77-91. [PMID: 35313124 DOI: 10.2217/nmt-2021-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This subanalysis of the OPTIPARK study aimed to confirm the effectiveness and safety of opicapone in patients with Parkinson's disease and motor fluctuations in clinical practice specifically in the UK and to assess the impact of opicapone on treatment costs. Methods: Patients received opicapone added to levodopa for 6 months. Clinical outcomes were assessed at 3 and 6 months and treatment costs at 6 months. Results: Most patients' general condition improved at 3 months, with sustained improvements reported at 6 months. Opicapone improved motor and non-motor symptoms at both timepoints, was generally well tolerated and reduced total treatment costs by GBP 3719. Conclusion: Opicapone added to levodopa resulted in clinical improvements and reduced treatment costs across UK clinical practice.
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Affiliation(s)
- Christine Schofield
- Research & Development Unit (Neurology), Royal Cornwall Hospitals Trust, Truro, Cornwall, TR1 3HD, UK
| | - K Ray Chaudhuri
- Parkinson's Foundation Centre of Excellence, King's College Hospital & NIHR Biomedical Research Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, WC2R 2LS, UK
| | - Camille Carroll
- University of Plymouth, Faculty of Health, Plymouth, Devon, PL6 8BX, UK
| | - Jagdish C Sharma
- Lincoln County Hospital, University of Lincoln, Lincoln, LN2 5QY, UK
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK
| | - Jonathan Evans
- Department of Neurology, Nottingham University NHS Trust, Nottingham, NG7 2UH, UK
| | - Thomas Foltynie
- Unit of Functional Neurosurgery, National Hospital for Neurology & Neurosurgery, London, WC1N 3BG, UK
| | - Heinz Reichmann
- Department of Neurology, University of Dresden, 01069, Dresden, Germany
| | - Laura Zurowska
- Medical Affairs Department, BIAL - Pharma UK Ltd, Windsor, SL4 3BL, UK
| | - Patrício Soares-da-Silva
- BIAL - Portela & Ca S.A., 4745-457 Coronado (S. Romão e S. Mamede), Portugal.,MedInUP, Center for Drug Discovery & Innovative Medicines, University of Porto, 4099-002 Porto, Portugal
| | - Andrew Lees
- University College London, Reta Lila Weston Institute & The National Hospital, Queen Square, London, WC1N 1PJ, UK
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White P, Boland M, O’Sullivan M, Bambury N, Deignan P, Dean J, Carroll C, Doyle S, Barrett P. Transmission of SARS-CoV-2 arising from international flights arriving in Ireland in December 2020: a descriptive analysis using national surveillance data. Public Health 2022; 204:49-53. [PMID: 35172222 PMCID: PMC8747967 DOI: 10.1016/j.puhe.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/05/2022] [Indexed: 10/25/2022]
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Masoli JAH, Down K, Nestor G, Hudson S, O'Brien JT, Williamson JD, Young CA, Carroll C. A report from the NIHR UK working group on remote trial delivery for the COVID-19 pandemic and beyond. Trials 2021; 22:911. [PMID: 34895305 PMCID: PMC8665850 DOI: 10.1186/s13063-021-05880-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Prior to the COVID-19 pandemic, the majority of clinical trial activity took place face to face within clinical or research units. The COVID-19 pandemic resulted in a significant shift towards trial delivery without in-person face-to-face contact or “Remote Trial Delivery”. The National Institute of Health Research (NIHR) assembled a Remote Trial Delivery Working Group to consider challenges and enablers to this major change in clinical trial delivery and to provide a toolkit for researchers to support the transition to remote delivery. Methods The NIHR Remote Trial Delivery Working Group evaluated five key domains of the trial delivery pathway: participant factors, recruitment, intervention delivery, outcome measurement and quality assurance. Independent surveys were disseminated to research professionals, and patients and carers, to ascertain benefits, challenges, pitfalls, enablers and examples of good practice in Remote Trial Delivery. A toolkit was constructed to support researchers, funders and governance structures in moving towards Remote Trial Delivery. The toolkit comprises a website encompassing the key principles of Remote Trial Delivery, and a repository of best practice examples and questions to guide research teams. Results The patient and carer survey received 47 respondents, 34 of whom were patients and 13 of whom were carers. The professional survey had 115 examples of remote trial delivery practice entered from across England. Key potential benefits included broader reach and inclusivity, the ability for standardisation and centralisation, and increased efficiency and patient/carer convenience. Challenges included the potential exclusion of participants lacking connectivity or digital skills, the lack of digitally skilled workforce and appropriate infrastructure, and validation requirements. Five key principles of Remote Trial Delivery were proposed: national research standards, inclusivity, validity, cost-effectiveness and evaluation of new methodologies. Conclusions The rapid changes towards Remote Trial Delivery catalysed by the COVID-19 pandemic could lead to sustained change in clinical trial delivery. The NIHR Remote Trial Delivery Working Group provide a toolkit for researchers recommending five key principles of Remote Trial Delivery and providing examples of enablers. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05880-8.
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Affiliation(s)
- Jane A H Masoli
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK. .,College of Medicine and Health, University of Exeter, Exeter, UK.
| | - Kim Down
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, UK
| | - Gary Nestor
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, UK
| | - Sharon Hudson
- Cornwall Partnership NHS Foundation Trust, Bodmin, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Carolyn A Young
- Walton Centre NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
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Walsh K, Carroll C, Scharf T, O’Donovan D. 257 POSITIVE HEALTH AND AGING FOR OLDER IRISH TRAVELLERS AND OLDER PEOPLE WHO HAVE EXPERIENCED HOMELESSNESS: LIFE-COURSE MEANINGS AND DETERMINANTS. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
The position of marginalized groups of older people remains neglected in positive health and aging (PHA) agendas, whether they concern healthy, active or positive aging. Questions exist around the meaning of such constructs, and the factors that enable disadvantaged populations to achieve equitable later-life experiences. In focusing on two such groups, this study investigates the constituent dimensions of PHA for older Irish Travellers and older people who have experienced homelessness, and the role of life-course and structural determinants in constructing PHA trajectories for these groups.
Methods
The study involves a multi-method qualitative, participatory voice-led methodology, but the analysis draws primarily on 49 in-depth life-course interviews with the populations.
Results
In addition to five interconnected dimensions of PHA, four determinants related to life-course experiences and structural factors are identified: social relations; material and accommodation circumstances; formal supports and systems; and critical transitions and resilience.
Conclusion
While illustrating the validity of PHA agendas for these groups when understood through their lived experiences, the findings highlight the significant deprivations and risks to rights that must be accounted for to secure meaningful gains in PHA for the groups.
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Affiliation(s)
- K Walsh
- Irish Centre for Social Gerontology, National University of Ireland Galway , Galway, Ireland
| | - C Carroll
- Irish Centre for Social Gerontology, National University of Ireland Galway , Galway, Ireland
| | - T Scharf
- Newcastle University , Newcastle, United Kingdom
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Carroll C, Lees A, Ferreira J, Fonseca M, Magalhães D, Rocha J, Soares-Da-Silva P. Impact of 3-month earlier versus later initiation of opicapone versus entacapone in levodopa-treated patients with Parkinson's disease and motor fluctuations. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Carroll C, Lees A, Reichmann H, Martins D, Magalhães D, Rocha J, Soares-Da-Silva P. Influence of levodopa daily dose on the effectiveness of opicapone in Parkinson's disease patients with motor fluctuations: Findings from the real-world OPTIPARK study. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Peach DAH, Carroll C, Meraj S, Gomes S, Galloway E, Balcita A, Coatsworth H, Young N, Uriel Y, Gries R, Lowenberger C, Moore M, Gries G. Correction to: Nectar-dwelling microbes of common tansy are attractive to its mosquito pollinator, Culex pipiens L. BMC Ecol Evol 2021; 21:37. [PMID: 33685389 PMCID: PMC7941694 DOI: 10.1186/s12862-021-01769-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- D A H Peach
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada. .,The University of British Columbia, 2329 West Mall, Vancouver, BC, Canada.
| | - C Carroll
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - S Meraj
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - S Gomes
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - E Galloway
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - A Balcita
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.,University of Saskatchewan, 129-72 Campus Drive, Saskatoon, SK, Canada
| | - H Coatsworth
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.,Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, USA
| | - N Young
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - Y Uriel
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - R Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - C Lowenberger
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - M Moore
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - G Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
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Affiliation(s)
- C Carroll
- Salford Royal NHS Foundation Trust, Salford, UK
| | - F Young
- Salford Royal NHS Foundation Trust, Salford, UK
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Peach DAH, Carroll C, Meraj S, Gomes S, Galloway E, Balcita A, Coatsworth H, Young N, Uriel Y, Gries R, Lowenberger C, Moore M, Gries G. Nectar-dwelling microbes of common tansy are attractive to its mosquito pollinator, Culex pipiens L. BMC Ecol Evol 2021; 21:29. [PMID: 33593286 PMCID: PMC7885224 DOI: 10.1186/s12862-021-01761-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/08/2021] [Indexed: 11/14/2022] Open
Abstract
Background There is widespread interkingdom signalling between insects and microbes. For example, microbes found in floral nectar may modify its nutritional composition and produce odorants that alter the floral odor bouquet which may attract insect pollinators. Mosquitoes consume nectar and can pollinate flowers. We identified microbes isolated from nectar of common tansy, Tanacetum vulgare, elucidated the microbial odorants, and tested their ability to attract the common house mosquito, Culex pipiens. Results We collected 19 microbial isolates from T. vulgare nectar, representing at least 12 different taxa which we identified with 16S or 26S rDNA sequencing as well as by biochemical and physiological tests. Three microorganisms (Lachancea thermotolerans, Micrococcus lactis, Micrococcus luteus) were grown on culture medium and tested in bioassays. Only the yeast L. thermotolerans grown on nectar, malt extract agar, or in synthetic nectar broth significantly attracted Cx. pipiens females. The odorant profile produced by L. thermotolerans varied with the nutritional composition of the culture medium. All three microbes grown separately, but presented concurrently, attracted fewer Cx. pipiens females than L. thermotolerans by itself. Conclusions Floral nectar of T. vulgare contains various microbes whose odorants contribute to the odor profile of inflorescences. In addition, L. thermotolerans produced odorants that attract Cx. pipiens females. As the odor profile of L. thermotolerans varied with the composition of the culture medium, we hypothesize that microbe odorants inform nectar-foraging mosquitoes about the availability of certain macro-nutrients which, in turn, affect foraging decisions by mosquitoes.
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Affiliation(s)
- D A H Peach
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada. .,The University of British Columbia, 2329 West Mall, Vancouver, BC, Canada.
| | - C Carroll
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - S Meraj
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - S Gomes
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - E Galloway
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - A Balcita
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.,University of Saskatchewan, 129-72 Campus Drive, Saskatoon, SK, Canada
| | - H Coatsworth
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.,Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, USA
| | - N Young
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - Y Uriel
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - R Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - C Lowenberger
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - M Moore
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - G Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
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Eke CS, Jammeh E, Li X, Carroll C, Pearson S, Ifeachor E. Early Detection of Alzheimer's Disease with Blood Plasma Proteins Using Support Vector Machines. IEEE J Biomed Health Inform 2021; 25:218-226. [PMID: 32340968 DOI: 10.1109/jbhi.2020.2984355] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The successful development of amyloid-based biomarkers and tests for Alzheimer's disease (AD) represents an important milestone in AD diagnosis. However, two major limitations remain. Amyloid-based diagnostic biomarkers and tests provide limited information about the disease process and they are unable to identify individuals with the disease before significant amyloid-beta accumulation in the brain develops. The objective in this study is to develop a method to identify potential blood-based non-amyloid biomarkers for early AD detection. The use of blood is attractive because it is accessible and relatively inexpensive. Our method is mainly based on machine learning (ML) techniques (support vector machines in particular) because of their ability to create multivariable models by learning patterns from complex data. Using novel feature selection and evaluation modalities, we identified 5 novel panels of non-amyloid proteins with the potential to serve as biomarkers of early AD. In particular, we found that the combination of A2M, ApoE, BNP, Eot3, RAGE and SGOT may be a key biomarker profile of early disease. Disease detection models based on the identified panels achieved sensitivity (SN) > 80%, specificity (SP) > 70%, and area under receiver operating curve (AUC) of at least 0.80 at prodromal stage (with higher performance at later stages) of the disease. Existing ML models performed poorly in comparison at this stage of the disease, suggesting that the underlying protein panels may not be suitable for early disease detection. Our results demonstrate the feasibility of early detection of AD using non-amyloid based biomarkers.
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Carroll C, Conway R, O'Donnell D, Norton C, Hogan E, Browne M, Buckley CM, Kavanagh P, Martin J, Doyle S. Routine testing of close contacts of confirmed COVID-19 cases - National COVID-19 Contact Management Programme, Ireland, May to August 2020. Public Health 2020; 190:147-151. [PMID: 33386140 PMCID: PMC7577651 DOI: 10.1016/j.puhe.2020.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/10/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The objective of this study was to inform public health practitioners who are designing, adapting and implementing testing and tracing strategies for Coronavirus disease (COVID-19) control. STUDY DESIGN The study design is monitoring and evaluation of a national public health protection programme. METHODS All close contacts of laboratory-confirmed cases of COVID-19 identified between the 19th May and 2nd August were included; secondary attack rates and numbers needed to test were estimated. RESULTS Four thousand five hundred eighty six of 7272 (63%) close contacts of cases were tested with at least one test. The secondary attack rate in close contacts who were tested was 7% (95% Confidence Interval [CI]: 6.3 - 7.8%). At the 'day 0' test, 14.6% (95% CI: 11.6-17.6%) of symptomatic close contacts tested positive compared with 5.2% (95% CI: 4.4-5.9%) of asymptomatic close contacts. CONCLUSIONS The application of additional symptom-based criteria for testing in this high-incidence population (close contacts) is of limited utility because of the low negative predictive value of absence of symptoms.
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Affiliation(s)
- C Carroll
- Joint First Author; COVID-19 Contact Management Programme, Health Service Executive, Ireland
| | - R Conway
- Joint First Author; COVID-19 Contact Management Programme, Health Service Executive, Ireland.
| | - D O'Donnell
- COVID-19 Contact Management Programme, Health Service Executive, Ireland
| | - C Norton
- COVID-19 Contact Management Programme, Health Service Executive, Ireland
| | - E Hogan
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; National Quality Improvement Team, Health Service Executive, Ireland
| | - M Browne
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; National Quality Improvement Team, Health Service Executive, Ireland
| | - C M Buckley
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; School of Public Health, University College Cork, Cork, Ireland
| | - P Kavanagh
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; Health Intelligence Unit Strategic Planning and Transformation, Dublin, Ireland; Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Martin
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; National Quality Improvement Team, Health Service Executive, Ireland
| | - S Doyle
- COVID-19 Contact Management Programme, Health Service Executive, Ireland
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Dominey T, Kehagia AA, Gorst T, Pearson E, Murphy F, King E, Carroll C. Introducing the Parkinson's KinetiGraph into Routine Parkinson's Disease Care: A 3-Year Single Centre Experience. J Parkinsons Dis 2020; 10:1827-1832. [PMID: 33016893 PMCID: PMC7683053 DOI: 10.3233/jpd-202101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In an effort to provide timely clinical input for people with Parkinson's disease (PD) in the face of increasing demand and resource limitation in our UK based service, we introduced remote management in place of clinic appointment, including the use of the Parkinson's KinetiGraph (PKG™), a wrist-worn device that provides a continuous measure of movement. We evaluated our reporting methods and findings, the nature of unmet need we identified, our treatment recommendations and the degree of their implementation in our patients whose feedback guided our service developments. Our evaluation highlighted opportunities and challenges associated with incorporating digital data into care traditionally delivered via in-person contact.
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Affiliation(s)
- Thea Dominey
- Applied Parkinson's Research Group, University of Plymouth, Faculty of Health, Plymouth, Devon, United Kingdom
| | - Angie A Kehagia
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Terry Gorst
- Applied Parkinson's Research Group, University of Plymouth, Faculty of Health, Plymouth, Devon, United Kingdom
| | - Emma Pearson
- University Hospitals Plymouth NHS Trust, Plymouth, Devon, United Kingdom
| | - Fiona Murphy
- University Hospitals Plymouth NHS Trust, Plymouth, Devon, United Kingdom
| | - Emma King
- Applied Parkinson's Research Group, University of Plymouth, Faculty of Health, Plymouth, Devon, United Kingdom
| | - Camille Carroll
- Applied Parkinson's Research Group, University of Plymouth, Faculty of Health, Plymouth, Devon, United Kingdom.,University Hospitals Plymouth NHS Trust, Plymouth, Devon, United Kingdom
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Witham MD, Anderson E, Carroll C, Dark PM, Down K, Hall AS, Knee J, Maier RH, Mountain GA, Nestor G, Oliva L, Prowse SR, Tortice A, Wason J, Rochester L. Developing a roadmap to improve trial delivery for under-served groups: results from a UK multi-stakeholder process. Trials 2020; 21:694. [PMID: 32738919 PMCID: PMC7395975 DOI: 10.1186/s13063-020-04613-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 07/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background Participants in clinical research studies often do not reflect the populations for which healthcare interventions are needed or will be used. Enhancing representation of under-served groups in clinical research is important to ensure that research findings are widely applicable. We describe a multicomponent workstream project to improve representation of under-served groups in clinical trials. Methods The project comprised three main strands: (1) a targeted scoping review of literature to identify previous work characterising under-served groups and barriers to inclusion, (2) surveys of professional stakeholders and participant representative groups involved in research delivery to refine these initial findings and identify examples of innovation and good practice and (3) a series of workshops bringing together key stakeholders from funding, design, delivery and participant groups to reach consensus on definitions, barriers and a strategic roadmap for future work. The work was commissioned by the UK National Institute for Health Research Clinical Research Network. Output from these strands was integrated by a steering committee to generate a series of goals, workstream plans and a strategic roadmap for future development work in this area. Results ‘Under-served groups’ was identified and agreed by the stakeholder group as the preferred term. Three-quarters of stakeholders felt that a clear definition of under-served groups did not currently exist; definition was challenging and context-specific, but exemplar groups (e.g. those with language barriers or mental illness) were identified as under-served. Barriers to successful inclusion of under-served groups could be clustered into communication between research teams and participant groups; how trials are designed and delivered, differing agendas of research teams and participant groups; and lack of trust in the research process. Four key goals for future work were identified: building long-term relationships with under-served groups, developing training resources to improve design and delivery of trials for under-served groups, developing infrastructure and systems to support this work and working with funders, regulators and other stakeholders to remove barriers to inclusion. Conclusions The work of the INCLUDE group over the next 12 months will build on these findings by generating resources customised for different under-served groups to improve the representativeness of trial populations.
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Affiliation(s)
- Miles D Witham
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Trust, Newcastle, UK
| | - Eleanor Anderson
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK
| | - Camille Carroll
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
| | - Paul M Dark
- NIHR Manchester Biomedical Research Centre, University of Manchester and Northern Care Alliance NHS Group, Manchester, UK
| | - Kim Down
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK
| | - Alistair S Hall
- Cardiology Department, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Joanna Knee
- NIHR Clinical Research Network Coordinating Centre, 21 Queen Street, Leeds, LS1 2TW, UK
| | - Rebecca H Maier
- Newcastle Clinical Trials Unit, 1-4 Claremont Terrace, Newcastle University, Newcastle upon Tyne, NE2 4AE, UK
| | - Gail A Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Gary Nestor
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK
| | - Laurie Oliva
- NIHR Clinical Research Network Coordinating Centre, London, UK
| | - Sarah R Prowse
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Amanda Tortice
- NIHR Yorkshire and Humber Local Clinical Research Network, Yorkshire and Humber, UK
| | - James Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Lynn Rochester
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK. .,Translational Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
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Edwards E, Carroll C. In reply to: Helmich and Bloem (2020) "The Impact of the COVID-19 Pandemic on Parkinson's Disease: Hidden Sorrows and Emerging Opportunities". J Parkinsons Dis 2020; 10:1267-1268. [PMID: 32597820 PMCID: PMC7458502 DOI: 10.3233/jpd-202169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Camille Carroll
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
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Chiu WC, Powers DB, Hirshon JM, Shackelford SA, Hu PF, Chen SY, Chen HH, Mackenzie CF, Miller CH, DuBose JJ, Carroll C, Fang R, Scalea TM. Impact of trauma centre capacity and volume on the mortality risk of incoming new admissions. BMJ Mil Health 2020; 168:212-217. [PMID: 32474436 DOI: 10.1136/bmjmilitary-2020-001483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Trauma centre capacity and surge volume may affect decisions on where to transport a critically injured patient and whether to bypass the closest facility. Our hypothesis was that overcrowding and high patient acuity would contribute to increase the mortality risk for incoming admissions. METHODS For a 6-year period, we merged and cross-correlated our institutional trauma registry with a database on Trauma Resuscitation Unit (TRU) patient admissions, movement and discharges, with average capacity of 12 trauma bays. The outcomes of overall hospital and 24 hours mortality for new trauma admissions (NEW) were assessed by multivariate logistic regression. RESULTS There were 42 003 (mean=7000/year) admissions having complete data sets, with 36 354 (87%) patients who were primary trauma admissions, age ≥18 and survival ≥15 min. In the logistic regression model for the entire cohort, NEW admission hospital mortality was only associated with NEW admission age and prehospital Glasgow Coma Scale (GCS) and Shock Index (SI) (all p<0.05). When TRU occupancy reached ≥16 patients, the factors associated with increased NEW admission hospital mortality were existing patients (TRU >1 hour) with SI ≥0.9, recent admissions (TRU ≤1 hour) with age ≥65, NEW admission age and prehospital GCS and SI (all p<0.05). CONCLUSION The mortality of incoming patients is not impacted by routine trauma centre overcapacity. In conditions of severe overcrowding, the number of admitted patients with shock physiology and a recent surge of elderly/debilitated patients may influence the mortality risk of a new trauma admission.
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Affiliation(s)
- William C Chiu
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
| | - D B Powers
- Director, Craniomaxillofacial Trauma Program, Duke University Hospital, Durham, North Carolina, USA
| | - J M Hirshon
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - P F Hu
- University of Maryland Medical Center, Baltimore, Maryland, USA
| | - S Y Chen
- National Yunlin University of Science and Technology, Douliou, Taiwan
| | - H H Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - C F Mackenzie
- Shock Trauma and Anesthesiology Research - Organized Research Center (STAR-ORC), University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - C H Miller
- US Air Force Materiel Command, Wright-Patterson AFB, Ohio, USA
| | - J J DuBose
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.,Center for Sustainment of Trauma and Readiness Skills - Baltimore, US Air Force Medical Service, Baltimore, Maryland, USA
| | | | - R Fang
- Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - T M Scalea
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
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Mc Loughlin L, Carroll C. Vaccination - A Vital Protection. Ir Med J 2020; 113:73. [PMID: 32603569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- L Mc Loughlin
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin 2
| | - C Carroll
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin 2
- National Clinical Programme in Surgery
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Abstract
Parkinson’s disease (PD) and Alzheimer’s disease (AD) are the most common neurodegenerative diseases and there is increasing evidence that they share common physiological and pathological links. Here we have conducted the largest network analysis of PD and AD based on their gene expressions in blood to date. We identified modules that were not preserved between disease and healthy control (HC) networks, and important hub genes and transcription factors (TFs) in these modules. We highlighted that the PD module not preserved in HCs was associated with insulin resistance, and HDAC6 was identified as a hub gene in this module which may have the role of influencing tau phosphorylation and autophagic flux in neurodegenerative disease. The AD module associated with regulation of lipolysis in adipocytes and neuroactive ligand-receptor interaction was not preserved in healthy and mild cognitive impairment networks and the key hubs TRPC5 and BRAP identified as potential targets for therapeutic treatments of AD. Our study demonstrated that PD and AD share common disrupted genetics and identified novel pathways, hub genes and TFs that may be new areas for mechanistic study and important targets in both diseases.
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Affiliation(s)
- Jack Kelly
- Faculty of Health: Medicine, Dentistry and Human Sciences, Plymouth University, Plymouth PL6 8BU, UK
| | - Rana Moyeed
- Faculty of Science and Engineering, Plymouth University, Plymouth PL6 8BU, UK
| | - Camille Carroll
- Faculty of Health: Medicine, Dentistry and Human Sciences, Plymouth University, Plymouth PL6 8BU, UK
| | - Shouqing Luo
- Faculty of Health: Medicine, Dentistry and Human Sciences, Plymouth University, Plymouth PL6 8BU, UK
| | - Xinzhong Li
- School of Science, Engineering and Design, Teesside University, Middlesbrough TS1 3BX, UK
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Williams NM, Hubbard L, Sandor C, Webber C, Hendry H, Lawton M, Carroll C, Chaudhuri KR, Morris H, Hu MT, Grosset DG, Kobylecki C, Silverdale M. Genome-Wide Association Study of Pain in Parkinson's Disease Implicates TRPM8 as a Risk Factor. Mov Disord 2020; 35:705-707. [PMID: 32078185 PMCID: PMC7277058 DOI: 10.1002/mds.28001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/08/2020] [Accepted: 01/27/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Nigel M Williams
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Leon Hubbard
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Cynthia Sandor
- Division of Neurology, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
| | - Caleb Webber
- Division of Neurology, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
| | - Hannah Hendry
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Michael Lawton
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Camille Carroll
- University of Plymouth and University Hospitals Plymouth National Health Service Trust, Plymouth, United Kingdom
| | - K Ray Chaudhuri
- Department Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King's College and King's College Hospital, London, United Kingdom
| | - Huw Morris
- Department of Clinical Neuroscience, University College London, Institute of Neurology, London, United Kingdom
| | - Michele T Hu
- Division of Neurology, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
| | - Donald G Grosset
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Christopher Kobylecki
- Department of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Monty Silverdale
- Department of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Barker RA, Björklund A, Gash DM, Whone A, Van Laar A, Kordower JH, Bankiewicz K, Kieburtz K, Saarma M, Booms S, Huttunen HJ, Kells AP, Fiandaca MS, Stoessl AJ, Eidelberg D, Federoff H, Voutilainen MH, Dexter DT, Eberling J, Brundin P, Isaacs L, Mursaleen L, Bresolin E, Carroll C, Coles A, Fiske B, Matthews H, Lungu C, Wyse RK, Stott S, Lang AE. GDNF and Parkinson's Disease: Where Next? A Summary from a Recent Workshop. J Parkinsons Dis 2020; 10:875-891. [PMID: 32508331 PMCID: PMC7458523 DOI: 10.3233/jpd-202004] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 12/22/2022]
Abstract
The concept of repairing the brain with growth factors has been pursued for many years in a variety of neurodegenerative diseases including primarily Parkinson's disease (PD) using glial cell line-derived neurotrophic factor (GDNF). This neurotrophic factor was discovered in 1993 and shown to have selective effects on promoting survival and regeneration of certain populations of neurons including the dopaminergic nigrostriatal pathway. These observations led to a series of clinical trials in PD patients including using infusions or gene delivery of GDNF or the related growth factor, neurturin (NRTN). Initial studies, some of which were open label, suggested that this approach could be of value in PD when the agent was injected into the putamen rather than the cerebral ventricles. In subsequent double-blind, placebo-controlled trials, the most recent reporting in 2019, treatment with GDNF did not achieve its primary end point. As a result, there has been uncertainty as to whether GDNF (and by extrapolation, related GDNF family neurotrophic factors) has merit in the future treatment of PD. To critically appraise the existing work and its future, a special workshop was held to discuss and debate this issue. This paper is a summary of that meeting with recommendations on whether there is a future for this therapeutic approach and also what any future PD trial involving GDNF and other GDNF family neurotrophic factors should consider in its design.
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Affiliation(s)
- Roger A. Barker
- Cambridge Centre for Brain Repair, Department of Clinical Neuroscience and WT-MRC Cambridge Stem Cell Institute, Cambridge, UK
| | | | - Don M. Gash
- Professor Emeritus of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Alan Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol and Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | | | - Jeffrey H. Kordower
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Krystof Bankiewicz
- Neurological Surgery, Gilbert and Kathryn Mitchell Endowed Chair, Director, Brain Health and Performance Center, The Ohio State University, Department of Neurological Surgery, Columbus, OH, USA
| | - Karl Kieburtz
- Center for Health & Technology, and the Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Mart Saarma
- Institute of Biotechnology, HiLIFE, University of Helsinki, Helsinki, Finland
| | | | - Henri J. Huttunen
- Herantis Pharma Plc, Finland
- Neuroscience Center, HiLIFE, University of Helsinki, Finland
| | | | | | - A. Jon Stoessl
- Pacific Parkinson’s Research Centre & Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Howard Federoff
- School of Medicine, Susan and Henry College of Health Sciences, University of California, Irvine and CEO, Aspen Neuroscience, San Diego, CA, USA
| | | | | | - Jamie Eberling
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | - Patrik Brundin
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | | | - Leah Mursaleen
- The Cure Parkinson’s Trust, London, UK
- School of Life Sciences, University of Westminster, UK and School of Pharmacy, University College London, UK
| | | | | | - Alasdair Coles
- Department of Clinical Neuroscience, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Brian Fiske
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | | | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Rockville, MD, USA
| | | | | | - Anthony E. Lang
- The Edmond J Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, and the Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Eke CS, Jammeh E, Li X, Carroll C, Pearson S, Ifeachor E. Identification of Optimum Panel of Blood-based Biomarkers for Alzheimer's Disease Diagnosis Using Machine Learning. Annu Int Conf IEEE Eng Med Biol Soc 2019; 2018:3991-3994. [PMID: 30441233 DOI: 10.1109/embc.2018.8513293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With the increasing number of people living with Alzheimer's disease (AD), there is a need for low-cost and easy to use methods to detect AD early to facilitate access to appropriate care pathways. Neuroimaging biomarkers (such as those based on PET and MRI) and biochemical biomarkers (such as those based on CSF) are recommended by international guidelines to facilitate diagnosis. However, neuroimaging is expensive and may not be widely available and CSF testing is invasive. Bloodbased biomarkers offer the potential for the development of a low-cost and more time efficient tool to detect AD to complement CSF and neuroimaging as blood is much easier to obtain. Although no single blood biomarker is yet able to detect AD, combinations of biomarkers (also called panels) have shown good results. However, a large number of biomarkers are often needed to achieve a satisfactory detection performance. In addition, it is difficult to reproduce reported results within and across different study cohorts because of data overfitting and lack of access to the datasets used in the studies. In this study, our focus is to identify an optimum panel (in terms of the least number of blood biomarkers to meet the specified diagnostic performance of 80% sensitivity and specificity) based on a widely accessible data set, and to demonstrate a testing methodology that reinforces reproducibility of results. Realizing a panel with reduced number of markers will have significant impact on the complexity and cost of diagnosis and potential development of cost-effective point of care devices.
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50
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Carroll C, Dickson R, Boland A, Houten R, Walton M. Decision-making by the NICE Interventional Procedures Advisory Committee. Br J Surg 2019; 106:1769-1774. [PMID: 31654418 DOI: 10.1002/bjs.11334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/21/2019] [Accepted: 07/16/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study explored the evidence base for recommendations by the National Institute of Health and Care Excellence (NICE) Interventional Procedures Advisory Committee, the only NICE committee not to consider cost. The four potential recommendations are: Standard Arrangements (can be performed as routine practice in the NHS); Special Arrangements (can be done under certain conditions); Research Only; and Do Not Do. METHODS Quantitative content analysis of data extracted from all published Interventional Procedure Guidance (IPG) for 2003-2018 (n = 496) was undertaken. All data were extracted independently by two researchers; disagreements were clarified by consensus. Data were tabulated, descriptive statistics produced, and regression analyses performed. RESULTS The proportion of IPGs by recommendation was: 50·0 per cent Standard Arrangements; 37·2 per cent Special Arrangements; 11·1 per cent Research Only; and 1·6 per cent Do Not Do. There was a clear trend over time: the proportion of recommendations for Standard Arrangements decreased, whereas the evidence threshold increased. Adjusted mean numbers of patients in the evidence base by recommendation type were: Standard, 4867; Special, 709; Research Only, 386. Regression analyses confirmed that the year of recommendation, numbers of patients and levels of evidence all affected the likely recommendation. CONCLUSION This study suggests that the likelihood of achieving the most positive recommendation (Standard Arrangements) is decreasing, and that this is most likely due to evidential requirements becoming more demanding. These findings are distinct from those reported for other NICE committees, for which the cost and statistical superiority of new therapies are among the drivers of recommendations.
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Affiliation(s)
- C Carroll
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - R Dickson
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - A Boland
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - R Houten
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - M Walton
- Centre for Reviews and Dissemination, University of York, York, UK
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