King’s College Hospital and King’s College London, Centre of Excellence in Parkinson’s disease care and research desplays its work on an international and national plateform every year. Below are list of posters presented at meetings, congresses, and conferences.

Non-Motor Longitudinal International Study (NILS)

The main EUROPAR project is a longitudinal study in Parkinson’s (NILS: Non-motor Longitudinal International Study), a global study addressing non-motor profiling of Parkinson’s and natural history of non-motor symptoms together with treatment response and clinico-pathological correlations. This project has been adopted by the Department of Health in the UK (NIHR: National Institute of Health Research) and also supported by the Spanish ministry of education and the Biomedical Research Centre (Dementia) at King’s College.

PKG Registry

Traditionally, Parkinson’s disease is managed by asking patients about their own experience and symptoms and using a number of questionnaires and scales, combined with the observations and clinical expertise of the professionals involved. One difficulty of this approach is that as a patient you may not remember all the symptoms you have experienced over the last few months at the time of the appointment. There is a growing interest in having more objective ways of assessing symptoms so these can be better managed in clinical practice and also useful in research.

One new way of doing this is using wearable technology devices that can capture key symptoms while wearing them at home over a number of days. The Parkinson’s KinetiGraph® or PKG is like a little wrist watch wearable device that has the ability to measure some symptoms of Parkinson’s disease in the above mentioned “real-life” settings (e.g. at home). The PKG has been incorporated in routine clinical care in an increasing number of centres worldwide and we think it helps us improve our knowledge and expertise in managing Parkinson’s disease. In addition, objective measurement of symptoms of Parkinson’s disease patients also helps us to address and better understand clinical outcomes of specific interventions.

The anonymised patient data collected will contribute to an international multicentre registry. We aim to use some standard and validated clinical questionnaires in combination with PKG recordings to objectively assess Parkinson’s disease patients. This will provide the clinician with a better understanding of the patient’s response to their therapies and in turn allow for better delivery of care.

Ethnicity

Impact of ethnicity on Parkinson’s symptoms has been poorly investigated although over three million people from different ethnic minorities are living in the UK. Studies of conditions such as diabetes and heart disease as well as multiple sclerosis in communities of black African/Caribbean and South Asian subjects living in London have provided important information in relation to cause and migration in these disorders.

Non motor symptoms (NMS) of Parkinson’s are present from even before diagnosis of Parkinson’s and may affect every aspect of day to day life of patients with Parkinson’s. Previous studies have suggested that the NMS profile may be different within different ethnic groups.

In the current study we expand this initial observation. The effect of ethnicity on the presentation of Parkinson’s as well as the diary habits is also evaluated/audited particularly focusing on non-motor effects, for instance effects on sleep, dribbling of saliva, fatigue, depression, pain and sexual function. This is the first study of its kind ever attempted.

OpiSleep

Sleep disorders are among the commonest non-motor symptoms of Parkinson’s disease (PD). These sleep disorders include nocturnal sleep disturbances such as insomnia, sleep fragmentation, periodic limb movement, REM Sleep Behaviour disorder, and Early Morning Off (EMO). Patient can have various combinations of sleep disorders which affect the daytime alertness and thus reduce the quality of life.

Most of the time, patients may not volunteer the sleep disturbances that they are suffering and this study, through questionnaires and personal KinetiGraph recording (PKG), would enable us to identify and address this issue. In addition, we postulate that this new medication, Opicapone, a long-acting peripheral catecolamine-o-methyltransferase (COMT) inhibitor may also be able to have an effect in nocturnal sleep disturbances and EMO. Hence, this study will help us in exploring the potential role of this medication which is currently used for wearing off phenomenon.

APOMYL

It is now widely acknowledged that PD patients suffer from several non-motor symptoms which significantly decrease their quality of life. The treatment of non-motor symptoms remains challenging and difficult. Up to 80% of patients will develop significant memory problems during the course of the disease. These memory problems are in part associated with the deposit of the protein amyloid-beta. A few studies in PD patients, as well as in rodent models, have shown that in some the level of beta-amyloid in the brain is influenced by Apomorphine (one of the advanced therapies for Parkinson’s).  In PD patients,  a recent post-mortem study showed that some patients treated with Apomorphine had less pronounced beta-amyloid deposition.

The APOMYL study seeks to confirm these preliminary observations by using positron emission tomography (PET) scans to study amyloid-beta deposition in PD patients who are treated with subcutaneous Apomorphine. Amyloid deposition in patients on long-term Apomorphine treatment (over one year) will be compared to patients on conventional therapy and to patients who have only recently been treated with Apomorphine. The aim is to recruit at least 20 patients on Apomorphine
treatment for the study.

SYM-PD

Latest research has focused on the role of the gut in Parkinson’s disease and recent studies have shown that the intestinal microbiota can be abnormal with a deficiency of protective bacteria in people with Parkinson’s. This leads to a “leaky-gut” that can absorb harmful material from the gut to the brain via the vagus nerve (gut-brain axis) and even lead to inflammation as well as abnormal alpha-synuclein formation and deposition.

Recently, in line with other disorders where gut microbiota may be abnormal, faecal transplantation has been proposed as a possible treatment strategy in Parkinson’s; however, the process is difficult and needs many regulatory approvals and safety checks.Symprove is an oral probiotic (food supplement), which unlike other commercial probiotics, can reach the lower gut and improve symptoms in gastrointestinal diseases.

From our experience at the Parkinson’s Centre of Excellence at King’s College Hospital, some people with Parkinson’s showed a considerable improvement in motor and non-motor symptoms after intake of Symprove for a variable period. We believe that the rationale behind this observation is that Symprove regulates the gut microbiota. However, to date, no studies have addressed the possible beneficial effect of Symprove in Parkinson’s.

Consequently, this research project, if successful, can have a major impact on the quality of life for people with Parkinson’s.This is a world-first UK-led randomised, double-blind, placebo-controlled study comparing 60 people with Parkinson’s with constipation to either oral Symprove or placebo for 3 months.

iPrognosis

Intelligent Parkinson early detection guiding novel supportive interventions (iPrognosis).

Eleven partners, academic institutions and companies, from six EU countries, led by Aristotle University of Thessaloniki, Greece, have joined forces for i-PROGNOSIS in order to provide technology-based solutions against Parkinson’s, as well as raise awareness on the disease and self-health management. The i-PROGNOSIS consortium has been established based upon the partners’ a priori shared and common vision of providing solutions to help people in need, including the Parkinson’s disease community.

For more information, visit: iPrognosis

Psychosis Scale

One of the key non-motor symptoms experienced by up to 70% of people with Parkinson’s is psychosis. Encompassing both hallucinations and delusions, psychosis has been shown to have a significantly negative impact on the quality of life and caregiver burden for people with Parkinson’s disease. Recently, the spectrum of psychosis in Parkinson’s disease characterized in extant literature is shown to differ in many ways from the usual symptoms experienced by patients suffering from schizophrenia or other known psychotic disorders.This project aims to help healthcare professionals characterize and measure both hallucinations and delusions (often called psychosis) in a more reliable way. To this end, we are seeking to develop and validate a novel psychosis severity scale, specific for people with Parkinson’s disease, which is clinician-rated and can be completed in less than 10 minutes. We hope that this project will serve as a platform for future research exploring the clinical correlations of psychosis and the effectiveness of its treatment in this specific population.