Dr. Richard Camicioli

May 2017

 

Parkinson Association of Alberta (PA): For those who aren’t aware of the work you do, can you tell us a little bit about yourself?


Dr. Richard Camicioli (DRC): I’m a clinical neurologist and also do research. Roughly half time doing clinical, half time research.

I mostly work with movement disorders; half of my clinical work is with people with dementia and other cognitive disorders.

 

(PA): You’re a veteran Parkinson’s researcher. Does anything stand out for you as far as career highlights?

 

(DRC): The focus of my research is prognosis and identifying biomarkers that can predict how patients do and can track how people will do over the course of their having a disease. It aims to identify and track changes in the brain with different imaging, genetic and blood markers.

I’m also interested gait and walking problems and interventions to improve mobility. One project is in collaboration with researchers in Calgary--  AmbuloSono – Dr Bin Hu. It’s an app that helps people walk more smoothly. It uses a piece of hardware that provides feedback while a person is walking. They get music feedback when they take a step and it helps their gait

In the research, we compared music played unrelated to feedback to music played as feedback when walking is normalized. We looked at whether it improved cognitive function. Ultimately we’d like to couple interventions with imaging and fluid-based biomarkers to see if we can identify a profile of responders and markers that we can identify to help optimize treatments.


(PA): You’ve mentioned that quality of life is important for health. Is this something that most people underestimate? How do you define quality of life?

 

(DRC): Quality of life is critical for patients—we think about it in clinic all the time. Motor function contributes to quality of life in people with Parkinson’s, but other aspects, especially non-motor symptoms are equally, if not more important.

Mood and depressive symptoms are also associated with quality of life. There are medications for mood and we work with a psychiatrist here. Movement and activity can both help with mood. Cognitive function affects quality of life. It’s common in Parkinson’s—we’re hoping to prevent cognitive decline and learn to help people cope better with cognitive changes and plan ahead for them.


(PA): Can you tell us more about COMPASS-ND? What are some examples of biomarkers?

 

(DRC): COMPASS-ND is a national study looking at all neurodegenerative diseases: Parkinson’s, Alzheimer’s, and others. It involves trying to learn which measures are different between disease groups, and later to decide which markers predict future changes.

It will be the first study to compare age-related neurodegenerative diseases. We’ll compare brain imaging, blood (and other biofluid) markers, cognitive markers, and others across a number of diseases.

With Parkinson’s and Alzheimer’s, it’s not uncommon for patients to have similar brain changes. We may find that someone with Alzheimer’s to have a Parkinson biomarker profile and vice-versa.

This is really an effort to work nationally to bring patients into study and test biomarkers.

I lead the Lewy Body Dementia team. I’ve organized a number a sites that have expertise in Parkinson’s. We will recruit people who do and don’t have cognitive impairment. We’re learning about the whole spectrum of neurodegenerative diseases, including Lewy Body Dementia.

CCNA (Canadian Consortium on Neurodegeneration in Aging) is the overall project and COMPASS-ND is the assessment within the overall project.


(PA): How can learning more about other neurodegenerative diseases like Alzheimer’s disease help us better understand Parkinson’s?

 

(DRC): One of things not appreciated, is that there are overlapping pathological changes in the brain in older people. People with Parkinson’s who have cognitive decline have changes in their spinal fluid, for example, that are similar to people with Alzheimer’s disease.

IF we had a safe Alzheimer’s treatment, we could apply it to Parkinson’s. We need to have better biomarkers as well, to predict what therapy is best for which patient.

  

(PA): You’ve also studied the use of MRIs in tracking cognitive decline. Do you think we have a good set of tools for tracking and diagnosing PD?

 

(DRC): No, not yet. That’s another challenge that needs more development. With MRIs, they’re used clinically a lot. It would be nice to identify an imaging test for Parkinson’s disease. Other imaging tests are available but they are still not perfect for testing dopamine cell loss.

I’ve collaborated with Dr. Wayne Martin to study changes in the substanstia nigra. We’re trying to advance those methods by looking at the substantia nigra and other brain areas are related to how Parkinson disease progresses.

 

(PA): What’s next for you as far as PD research? Is there anything you’re particularly excited about?

 

(DRC): COMPASS is quite exciting. It’s a nice start because it will show that sites across Canada can recruit patients and work together. It will be useful. We don’t have all the necessary funding yet but it will be nice to have biomarkers in Parkinson’s.

Team members are coming up with projects. One example is looking at impact of non-Lewy body pathology with Dr. David Breen and Dr. Tony Lang in Toronto along with the Lewy body team. More focused research will be a springboard for Parkinson’s research and grant applications.

Dr Hu’s project is completed (Ambulosono) but in future projects we want to take biomarkers and see if/how exercise can improve the biomarker profile and how things like physiotherapy can help.

As part of CCNA, there’s a team looking at  cognitive and exercise interventions in people with mild cognitive impairment. It’s not funded yet but interventions might apply to people with PD.

I’ve collaborated with Dr. Miyasaki  (Movement disorders program director) to examine how people with mild cognitive impairment and Parkinson’s understanding goals of care. This highlights the implications of cognitive impairment for all groups helping care of people with PD, including advocacy organizations.

 

(PA): Are there opportunities for persons with PD to get involved in your studies? How important is it to have people to volunteer for studies?

 

(DRC): For COMPASS we’re recruiting patients from our clinic for now to ensure accurate diagnosis, but we’ll roll out more broadly once we figure out how testing will go. We’ll make sure Parkinson Association of Alberta knows about our projects and can assist in recruitment.

Other projects like literature review projects need support for research staff. People can support research through Parkinson Association of Alberta or other groups.

Our research is tied to our national  and international competitive grants , which are dependent on budgets. Some sustained  and predictable funding such as research chairs are critical to maintain research teams..

For Ambulosono we advertised through Parkinson Association of Alberta and if Parkinson Association of Alberta can spread the word about projects this is appreciated as it is good for research and good for patients. Patients in studies seem to do well and have a more positive outlook.  Many Ambulosono patients are keen to participate in COMPASS. The key is good recruitment and then we’ll get good projects and keep this ball rolling.

 

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