MRI Study of Brain Activity in Healthy Adults and Individuals With Parkinsonism and Rapid Eye Movement Disorder.

Statistical Mapping of the Brain in Progressive Supranuclear Palsy, Essential Tremor, Parkinson Disease, Parkinsonism, and REM Behavior Disorder

This proposal is focused on developing a reliable, valid, and reproducible imaging techniques and statistical methodology for segregation of various forms of Parkinsonism from healthy adults without Parkinsonism.

Study Overview

• Status: Completed
• Conditions: REM Sleep Behavior Disorder; Movement Disorders (Incl Parkinsonism); Tremor Familial Essential, 1

Detailed Description

This proposal is focused on developing a reliable, valid, and reproducible imaging techniques and statistical methodology for segregation of various forms of Parkinsonism from healthy adults without Parkinsonism. We focus on early diagnosis of Parkinsonism, other tremor disorders, and determine how imaging might be used to improve diagnosis. The purpose of this protocol is to gather a multi-modal dataset to explore and validate the investigator's previous research findings in prior studies.

• Study Type: Observational
• Enrollment (Actual): 50

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States, 35294
      • University of Alabama at Birmingham

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 19 years to 85 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Subjects with PD, MSA-P, ET, or PSP will be recruited based on clinical criteria from the UAB Comprehensive Parkinson Disease and Movement Disorder Clinic located at The Kirklin Clinic at UAB. This center sees over 3,500 patients annually. Individuals with RBD will be recruited from the UAB University Hospital and UAB Highlands Sleep Disorders Center and will be identified through patient contact with a UAB Department of Neurology physician.

Description

Inclusion Criteria:

• Healthy Control • Age 35-85

Parkinson Disease (PD) Age 35-85

Diagnosis of clinically definite PD made by a movement disorders specialist, with evidence of the following features:

• Presence of bradykinesia and 1 or both of the following:

  1. Rest tremor
  2. Rigidity
• Asymmetric Onset
• Progressive motor symptoms
• Levodopa responsive
• Duration at least 1 but not more than 10 years
• Hoehn and Yahr Stage 1-2

Progressive Supranuclear Palsy (PSP) Age 40-85

Diagnosis of clinically definite PSP, with the following features:

• Gradually progressive disorder.
• Onset after age 39
• Supranuclear palsy* and postural instability with falls in the first year of disease onset*.
• No evidence of other disease.

Parkinsonism of Other or Undetermined Cause (POC) Age 35-85

Diagnosis of parkinsonism of undetermined other other cause by a movement disorders specialist, with the following features:

• Signs and symptoms of Parkinsonism including

  1. Bradykinesia
  2. Mixed or resting tremor
  3. Rigidity

  4. Characteristic deficits of gait and balance associated with Parkinsonism

     Essential Tremor (ET) Age 35-85

     Diagnosis of essential tremor, with the following features:

• A 2+ postural tremor of at least 1 arm (a head tremor may also be present, but is not sufficient for diagnosis)

• On examination, there must be

  1. a 2+ kinetic tremor during at least 4 tasks, or;
  2. a 2+ kinetic tremor on 1 task and a 3+ kinetic tremor on a second task; tasks include pouring water, using a spoon to drink water, drinking water, finger-to-nose, and drawing a spiral
• If on examination, the tremor is present in the dominant hand, then by report, it must interfere with at least 1 activity of daily living.

REM Behavior Disorder (RBD) Age 25 - 85

Documented diagnosis of REM sleep behavior disorder (RBD) by a sleep medicine specialist, with the following clinical features:

• Presence of REM sleep without atonia on polysomnography

• At least one of the following conditions:

  1. Sleep-related, behaviors by history (eg, dream enactment behavior)
  2. Abnormal REM sleep behavior documented during PSG monitoring

Exclusion Criteria:

Healthy Control

• Pregnancy
• First-degree blood relative affected by PD
• Neurodegenerative disease
• History of repeated head injury, encephalitis, brain surgery, stroke, dementia, neuroleptic exposure, or serious medical illness that may interfere with participation.

Parkinson Disease (PD)

• Any exclusion criteria that would exclude a healthy control patient
• Atypical features indicative of a Parkinson-Plus disorder

Progressive Supranuclear Palsy (PSP)

• Any exclusion criteria that would exclude a healthy control patient
• Any finding atypical for PSP
• Neuroradiologic evidence of relevant structural abnormality unrelated to appropriate changes known to be associated with PSP

Parkinsonism of Other or Undetermined Cause (POC)

• Any exclusion criteria that would exclude a healthy control patient
• Signs and symptoms suggestive of clear diagnosis of idiopathic Parkinson disease, Progressive Supranuclear Palsy, or Essential Tremor

Essential Tremor (ET)

• Any exclusion criteria that would exclude a healthy control patient
• No other potential etiologic factors for the tremor
• Any first-degree blood relative affected by PD
• History of neurodegenerative disease

REM Behavior Disorder (RBD)

• Any exclusion criteria that would exclude a healthy control patient
• Sleep disorder not better explained by another sleep disorder, medical or neurological disorder, mental disorder, medication use, or substance use disorder

Study Plan

How is the study designed?

Number of groups / cohorts

6

Cohorts and Interventions

Group / Cohort
Parkinson's Disease Cohort; Individuals Diagnosed with Parkinson's Disease
Essential Tremor cohort; Individuals Diagnosed with Essential Tremor
Rapid Eye Movement Disorder Cohort; Individuals Diagnosed with Rapid-Eye Movement Behavior Disorder (RBD). Eligible individuals will have been diagnosed with RBD based on a sleep study prior to entering the study. This study does not pay for or support a sleep study.
Healthy Control group; Individuals are healthy, without a known neurologic disease.
Progressive Supranuclear Palsy Cohort; Individuals diagnosed with Progressive Supranuclear Palsy (PSP).
Parkinsonism - Undifferentiated; Individuals with any form of Parkinsonism, not meeting any of the above cohorts.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
fMRI compared between cohorts	Studying resting brain activity between healthy adults, participants with Parkinson's and participants with REM Behavior Disorder.	one time at initial visit

Collaborators and Investigators

• Sponsor: University of Alabama at Birmingham
• Investigators: Principal Investigator: Frank Skidmore, MD, University of Alabama at Birmingham

Study record dates

Study Major Dates

• Study Start: December 1, 2011
• Primary Completion (ACTUAL): December 31, 2015
• Study Completion (ACTUAL): December 31, 2015

Study Registration Dates

• First Submitted: February 28, 2012
• First Submitted That Met QC Criteria: March 2, 2012
• First Posted (ESTIMATE): March 7, 2012

Study Record Updates

• Last Update Posted (ACTUAL): May 17, 2018
• Last Update Submitted That Met QC Criteria: May 14, 2018
• Last Verified: May 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Sleep Wake Disorders; Neurologic Manifestations; Basal Ganglia Diseases; Dyskinesias; Parasomnias; REM Sleep Parasomnias; Disease; Mental Disorders; Movement Disorders; Parkinsonian Disorders; Tremor; REM Sleep Behavior Disorder
• Other Study ID Numbers: fMRI - Skidmore

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Patient data has now been collated as a de-identified dataset, that can be shared if requested.