Tuesday, November 4, 2008

New Research in Thinking Problems in Parkinson's

I had a great meeting today with a particularly bright research psychologist from Tulane about a new project that we will try to launch at LSU to look at some early aspects of dementia in Parkinson's disease.

In broad terms, it helps to think of the typical progression of Parkinson's disease as two processes, creating three broad phases of the disease. The processes are movement deterioration, and more diffuse cortical deterioration. The classical movement deterioration is more related to the kinds of things you usually see in textbooks about loss of dopamine in the substantia nigra. Roughly, it is more evident in the beginning, and is usually controlled well by medication, as least for a while. This is the first, mild, phase of the disease. In the second, moderate, phase, the movement deterioration becomes more severe, and the amount of medication required to try to control it becomes problematic. This is the phase where we look at surgery, as a treatment that doesn't require more medications. This is where the first cortical problems start to show up as well, but they are usually very mild. In the third phase, the cortex is becomming the main problem, and we see dementia, and deterioration of the reflexes that help to keep us from falling. At this point, surgery is too late.

But, the interesting thing, is that if we could look at the dementia process very early on, we might be able to understand it better and even do something about it. Interestingly, when we do the surgery, we decide where to put the electrode by 'mapping' the subthalamic nucleus with tiny electrodes to listen to the cells, and stimulating them in different places. It turns out, this is an area where we can differentially affect some of the loops in the brain thought to be involved in this mental deterioration. It's not something we normally look at while we are there, but in the next few months, for any patients at LSU that will let us listen in on those processes while we are there anyway, we'll start trying to unravel this mystery with the help of our Tulane colleague.

Here's to teamwork!

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