Originally published by Agência FAPESP

By establishing a new metric, researchers envision advancements in diagnosing and treating a disease that is estimated to affect around 4 million people worldwide.

Maria Fernanda Ziegler | Agência FAPESP – In a study that analyzed brain images from more than 2,500 individuals with Parkinson’s disease across 20 countries, scientists identified neurodegeneration patterns and created metrics for each of the disease’s five clinical stages.

The work, published in NPJ Parkinson’s Disease, represents a breakthrough in understanding Parkinson’s. The analyses and the vast data obtained could lead to significant developments, not only in diagnostic advancements but also in enabling new treatments to be tested and monitored like never before.

Read the article:
Laansma, M.A., Zhao, Y., van Heese, E.M., et al. A worldwide study of subcortical shape as a marker for clinical staging in Parkinson’s disease. npj Parkinson’s Dis. 10, 223 (2024). https://doi.org/10.1038/s41531-024-00825-9

Approximately 4 million people worldwide are estimated to have Parkinson’s disease, a progressive neurological condition affecting brain structures linked to movement. The disease progresses variably among patients, potentially taking up to 20 years to transition through all stages.

In its early stages, initial signs include tremors, muscle stiffness, and slowed movements on one side of the body. Later, symptoms become bilateral. In the final stage, patients may rely on wheelchairs as leg stiffness prevents walking.

“For many years, clinical diagnosis, supported by complementary exams, has been well established. However, for the first time, it was possible to correlate the disease’s progression scale—the five stages of clinical symptoms—with quantitative changes in brain images,” explains Fernando Cendes, lead researcher at the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), a FAPESP Research, Innovation, and Dissemination Center (CEPID) based at the State University of Campinas (Unicamp).

BRAINN is part of the ENIGMA Consortium, an international network of scientists in imaging genomics, neurology, and psychiatry. The group leverages high-resolution MRI, genetic data, and other information to study conditions like epilepsy, Parkinson’s, Alzheimer’s, autism, and schizophrenia.

Cendes explains that Parkinson’s disease involves changes in the brain’s basal ganglia—regions associated with automatic movements. However, the study revealed progressive alterations in other cortical areas, previously thought to be less involved in the disease.

“We observed that as each disease stage advanced, there was increased atrophy or hypertrophy not only in movement-related structures but also in other cortical areas. These combinations of atrophy and hypertrophy correlate with the disease’s stage,” he says.

Additionally, researchers found shape differences in various brain structures. Some thalamic regions, responsible for relaying sensory information to the cortex, thickened, while others, such as the amygdala, responsible for social behavior and emotion regulation, atrophied.

“These changes are not visible to the naked eye,” Cendes explains. “They are submillimetric measurements. However, with programs and AI, it is possible to identify patterns and monitor these changes in the future.”

 

Driving New Treatments

By establishing a metric to quantify brain changes related to Parkinson’s stages, the study could have several implications, beginning with improving diagnosis.

“The morphometric data we obtained are sensitive and reproducible, supporting clinical diagnosis. With the vast amount of data from this study, AI-assisted programs could aid clinicians,” Cendes says.

Further implications lie in treatments. Currently, Parkinson’s is incurable, and treatments only address dopamine deficiency—the neurotransmitter lost in patients, which triggers brain changes and symptoms.

Over time, the disease affects other brain areas, causing non-motor symptoms like depression, anxiety, sleep disorders, cognitive decline, and, eventually, dementia.

“These findings allow new ways to monitor treatments developed in the future. The ultimate goal is to find a treatment that halts neurodegeneration or at least slows its progression. The metrics we identified are essential to evaluating future therapies, ensuring they work comprehensively—not just on movement-related areas but also on others affected by the disease,” he emphasizes.

Another significant impact of the study is in data science. The large dataset includes diverse countries, study groups, disease stages, and data types.

“The innovation lies not only in identifying metrics related to Parkinson’s stages but also in the data analysis methods. These advances pave the way for future AI-driven studies on other diseases,” Cendes concludes.

The article A worldwide study of subcortical shape as a marker for clinical staging in Parkinson’s disease can be read at: https://www.nature.com/articles/s41531-024-00825-9.

Also available on UOL.com.br and Veja.com.br.

April 18th, 2016

by Erik Nardini Medina *

PEOPLE WITH DISABILITIES – A PANORAMA

The “Handbook of Census 2010 – People with Disabilities”, the latest national survey on the topic produced in Brazil, offers a panorama of people with vision, hearing, mobility, mental and intellectual impairments.

The document, published in 2012 by the Brazilian Institute of Geography and Statistics (IBGE), reveals that 23.9% of the population (45,606,048 people) has some kind of disability among the five categories mentioned, and 7% suffer from some form of motor dysfunction.

ASSISTIVE DEVICES – WE NEED MANY MORE

The agents working nowadays with assistive technologies are not few. In addition to the private sector, the very own World Health Organization (WHO) recognizes that “more than one billion assistive products” are needed today, and that the number will rise to “more than two billion in 2050”.

In an important initiative, inspired by the successful “Essential Drugs List”, the organization developed the “Model List of Priority Assistive Products“, open to public responses, which aimed to compose a list of 50 essential products for people with some kind deficiency. Find out more by clicking here.

Give more freedom to those who live in a wheelchair is one of the goals of the research groups.

WHAT ARE THE RESEARCHERS DOING?

A lot, we would say! At first, it may seem that scientific development is progressing slowly, but we must know that there is an active community of researchers working intensively on the development of machines that may radically change the autonomy of people with disabilities.

When such equipment will arrive in the market is still unknown. Science, after all, is also an exercise in patience.

AN AMAZING ROBOTIC WHEELCHAIR

One of the most important assistive projects underway in Brazil takes place in the School of Electrical and Computer Engineering (FEEC) at the State University of Campinas (Unicamp).

A team of researchers, now working with the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), develops a prototype of a robotic wheelchair that can be controlled by head and facial movements.

Model of an assistive wheelchair being developed by the BRAINN team.

“We do research on several fronts, including technologies that respond to facial expressions, other from visual stimuli (eyetracking), driven by voice, and, finally, technologies based on Brain-Computer Interface (BCI), which is able to convert electrical pulses into brain commands, recognizable by computers”, explains Professor Eleri Cardozo, a member of the team. It is so advanced it sound like science fiction.

The researcher reveals that there is no forecast for when the prototype will reach the market, but the ambitions of those involved generate enormous expectations.

“The laboratory tests are essential so that we can produce a comfortable equipment, one that can be used all the time, in a natural way,” said Cardozo.

“Our expectation is not to launch a fully-functional wheelchair, but to put what’s best of all this technology in a module that can be installed in common wheelchairs, that is, something that the person already has”, he continues.

ASSISTIVE AND AFFORDABLE

Researcher Eleri Cardozo, BRAINN. Photo: Antoninho Perri / UNICAMP

Cardozo expects that the module, when released, will be more accessible than other chairs now on the market. Eleri is used to receiving requests from people all over the country looking to buy the technology, so he emphatically explains that there is no forecast of when the product will be released.

In the future, public health policies might subsidize part of the cost (or even the total cost) of such technologies, but this is something that can only be discussed in depth when the assistive wheelchair is, in fact, available.

[1] Bersch e Tonolli

* Journalist graduated from the Pontifical Catholic University of Campinas (PUC-Campinas), student of Science Journalism specialization at the Advanced Studies in Journalism Laboratory (Labjor / Unicamp). Has a MídiaCiência / FAPESP scholarship.