Leading the Canadian arm of the project is Dr. Lena Palaniyappan who is using Artificial Intelligence to help personalize treatment for patients with psychosis. Dr. Palaniyappan is an Associate Scientist at Lawson Health Research Institute, Associate Professor at Schulich Medicine & Dentistry and Scientist at Robarts Research Institute.

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Dr. Lena Palaniyappan who is using AI to help personalize treatment for patients with psychosis.

In collaboration with five European centres, Dr. Palaniyappan and a team at Robarts Research Institute and Lawson Health Research Institute, the research institute of London Health Sciences Centre and St. Joseph’s Health Care London, will be collecting brain scans and genetic information from more than 60,000 patients in order to understand the relationship between genetics and brain development. 

“The study itself involves collecting neuroimaging and genetic information from multiple sites in order to understand the mechanisms of mental illness,” said Dr. Palaniyappan. “The translational portion of this is applying this information to clinic. How genes and brain networks interact to cause mental disorders, and how we can use this information to match patients to specific treatment choices.”

The group is specifically studying a treatment called magnetic stimulation which will be delivered within the mental health care program at St. Parkwood Institute, a part of St. Joseph’s, in collaboration with Dr. Amer Burhan. Dr. Burhan is a Lawson Associate Scientist, Associate Professor at Schulich Medicine & Dentistry and Clinical Physician Lead for Therapeutic Brain Stimulation (ECT and TMS) at Parkwood Institute. 

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Dr. Lena Palaniyappan is collaborating with Dr. Amer Burhan for this study. 

The treatment uses focused magnetic pulses that stimulate a specific group of neurons. Dr. Palaniyappan says the treatment is very effective, but only in one-third of patients.

“We want to know if there are clear markers that show who will respond to this treatment, and who will not. This will help reduce the burden of failed treatment trials for this challenging illness,” said Dr. Palaniyappan.

To enable this, the researchers will look for patterns in a very large amount of imaging and clinical data collected in Europe and Canada. That’s where Artificial Intelligence comes in. In order to understand the patterns that are clinically useful, they use a technique called Machine Learning that trains a computer to recognize expected patterns and then make predictions for new patients.

The data is being collected from six centres, coordinated by Dr. Emanuel Schwarz at the University of Heidelberg, Mannheim, Germany. In addition to the centre here in London, Ontario, other partners include Munich, Germany; Oslo, Norway; Rotterdam, Netherlands; and Montpellier, France.

The research project will also mean that this form of magnetic stimulation treatment will be offered for psychosis patients in London for the first time.

“Magnetic brain stimulation is a safe and well-tolerated treatment that is used currently in London to treat depression, but now we will be able to offer this to patients with psychosis as well,” said Dr. Palaniyappan.

 The project will begin in May 2019 and will continue until the end of 2022.

Feeling emotions based on the interactions we have with other people is a common part of daily life, yet we know very little about how these emotions are experienced in the body.

Chloe Stewart, a PhD candidate at Lawson Health Research Institute (Lawson) and Western University’s Schulich School of Medicine & Dentistry, has been awarded a Lawson Internal Research Fund (IRF) Studentship to conduct the first study to comprehensively explore the physical experience of social emotions. The study will be supervised by Dr. Elizabeth Finger, a Lawson scientist, neurologist at St. Joseph’s Health Care London’s Parkwood Institute, and associate professor at Schulich Medicine & Dentistry.

“We feel social emotions based on our awareness, interpretation or anticipation of the thoughts and feelings of others. For example, we feel embarrassment not only because we have done something potentially embarrassing, but also because we know that another person is aware of it, or could become aware of it. Other social emotions include pride, empathy and guilt,” explains Stewart.

“These are distinct from basic emotions, such as anger and happiness, which only require us to be aware of how we ourselves are feeling and can occur completely independently of other people. Whether it’s your heart beating faster when you’re angry or the lump in your throat when you’re sad, the ways that our bodies experience basic emotions are very well understood. However, we do not have a good understanding of what happens to our bodies when we feel social emotions,” she adds.

Unhealthy levels of certain social emotions are associated with many conditions, including certain kinds of dementia, obsessive compulsive disorder and psychopathy. The results of the study, which will be conducted at Parkwood Institute, could help in developing potential interventions or treatment approaches to restore these emotions to healthy levels.

The first phase of the study will look at the physical experience of social emotion in healthy adults. Noninvasive electrodes will be attached to participants’ torso, hands and throat. The electrodes are connected by wires to receivers, which in turn send signals to a computer. The researchers can assess how the signals change based on the stimulus the participant is looking at. Stewart expects the emotions will influence several different physical responses, including heart rate, swallowing rate and movement of the stomach muscles.

The research team will then extend the study to patients with frontotemporal dementia, which can impair social functioning. They will compare the physical experience of social emotions in these participants to participants with Alzheimer’s disease and dementia with Lewy bodies. Patients with Alzheimer’s disease or dementia with Lewy bodies usually have healthy levels of social emotions, but those who have dementia with Lewy bodies often have impaired physiological functioning while those with Alzheimer’s do not.

Their goal is to compare how social emotions look in healthy adults to what happens in the body when social functioning is impaired.

The IRF is designed to provide Lawson scientists and students the opportunity to obtain start-up funds for new projects with the potential to obtain larger funding, be published in a high-impact journal, or provide a clinical benefit to patients. Funding is provided by the clinical departments of London Health Sciences Centre and St. Joseph’s Health Care London, as well as the hospital foundations (London Health Sciences Foundation and St. Joseph’s Health Care Foundation).

In Ontario alone, an estimated 285,000 individuals currently live with some form of neurodegenerative disorder. This includes Alzheimer’s Disease, Parkinson’s Disease, mild cognitive impairment, dementia and movement disorders. 

The experiences and symptoms for each person vary, but they share a progressive decline in their cognitive and motor function. It can affect their ability to work, socialize and live independently. 

As our population ages, there is an urgent need to understand markers that will predict decline and identify targets for therapy that might improve long-term function and outcomes. 

This is where hospital-based research can make a real difference. 

On June 21, 2018, Lawson Health Research Institute hosted Café Scientifique, a community event highlighting the groundbreaking and specialized research on neurodegenerative diseases happening right here in London. 

Moderated by Lawson researcher Dr. Arlene MacDougall, a panel of three expert Lawson scientists shared their unique perspectives as both clinicians and researchers, and how the knowledge we are gaining is being applied to improve health and health care for people here and around the world. 

Watch the video from the event featuring the three talks from our experts. 

Café Talks

Back to the beginning: Targeting early markers for Alzheimer’s Disease

By Dr. Jennie Wells
Time stamp: 5 minutes

Dr. Wells is the Medical Care Coordinator for Geriatric Rehabilitation at St. Joseph's Health Care London's Parkwood Institute, and Chair of the Division of Geriatric Medicine and associate professor in the Department of Medicine at Western Univeristy’s Schulich School of Medicine. Her clinical and research interests are Alzheimer’s Disease and Geriatric Rehabilitation. She has particular interest in Mild Cognitive Impairment (MCI) and the potential for non-drug interventions, such as exercise and nutrition to slow progression of dementia. She is a principal site investigator in randomized controlled trials of new drugs to treat dementia, MCI, and Subjective Cognitive Impairment (SCI).

Highlights:

• What causes dementia?
• How early do changes happen in the brain before symptoms even appear?
• What is the single best diet approach for a healthy body and mind?
• How does exercise keep your brain healthy? 

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Neuroinflammation and dementia: The old and the new 

By Dr. Elizabeth Finger
Time stamp: 24 minutes

Dr. Finger, a neurologist at St. Joseph's Parkwood Institute, received her MD from Cornell University. She completed an internship in Internal Medicine at Massachusetts General Hospital, followed by residency in Neurology at Massachusetts General Hospital and Brigham and Women's Hospital in Boston. Her research focuses on understanding the cognitive, neural, and genetic substrates of abnormal decision-making, emotion and social behavior. Using a variety of different diagnostic techniques and modalities, the research program investigates the cognitive and neural systems affected in patients with Frontotemporal Dementia, related disorders and their at-risk family members.

Highlights:

• Do anti-inflammatory medications reduce the risk of dementia or slow the rate of decline?
• How do genes related to the immune system increase the risk of developing dementia and Alzheimer’s Disease? 
• What about the effects from dysfunction of the brain’s own immune system?
• Do conditions or events causing systematic inflammation (surgery, infection, auto-immune diseases) also increase neuroinflammation which can lead to dementia?

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New Frontiers in the Treatment of Parkinson’s Disease: Addressing the unmet needs 

By Dr. Mandar Jog
Time stamp: 45 minutes

Dr. Jog is a Lawson researcher, Director of the National Parkinson Foundation Centre of Excellence at LHSC, Director of the Movement Disorders Centre in London and Professor of Neurology at Western University. His research interests include topics such as motor control, neurophysiology and computational modeling, multichannel recording and web-based teaching of movement disorders. Dr. Jog has a passion for clinical and scientific innovation and holds numerous patents that are reaching commercialization with strong collaboration with university technology transfer and industry partners.

Highlights:

• How do clinician researchers take questions from the bedside and solve them at the bench using technology in order to treat movement disorders?
• How can wearable technology be used to detect movement disorders and monitor for optimized treatment – remotely from anywhere in the world?
• How can we use machine-guided sensors for personal diagnostics and therapy for essential tremors and Parkinson’s Disease?
• How can spinal cord stimulators improve movement and gait for patients, including those previously using wheelchairs and scooters?

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Did you miss the event? Add your email address to our Café Scientifique invite list so that you’ll be the first to know when the next event takes place. 
 

Sign up here. 

Go to Lawson’s Facebook page to see photos from the event. 
 

Lawson researchers at Parkwood Institute, part of the St. Joseph’s Health Care London family, work to improve both physical and mental health care based on the understanding that conditions of the body and mind are integrally linked. From studies on mobility after brain and spinal cord injury to treatment-resistant depression, a range of different research areas were highlighted on April 21, 2017 at Parkwood Institute Research’s 2017 Spring Update Half-Day event.

Parkwood Institute Research is a Lawson program that represents inter-disciplinary clinical research. At the second annual Spring Update event celebrating this work, attendees learned about research from across Parkwood Institute’s three core research themes: Cognitive Vitality & Brain Health, Mobility & Activity, and Mental Health Care. New this year was the addition of poster presentations, which provided another opportunity for researchers and trainees to promote and share their work.

Learn more about the work Lawson scientists at Parkwood Institute presented at the event:

Cognitive Vitality & Brain Health

Dr. Stephen Pasternak was one of the presenters in the Cognitive Vitality & Brain Health theme. Dr. Pasternak and his team are conducting a phase 2 randomized controlled trial looking at whether a European over-the-counter cough medicine, Ambroxol, could also treat Parkinson’s Disease Dementia (PDD).

“There are currently no effective treatments for cognitive impairment experienced by PDD patients. Existing treatments only treat the symptoms of Parkinson’s disease, but do not stop the disease process itself,” says Dr. Pasternak.

Parkinson’s disease is believed to be caused by the buildup of a protein called alpha-synuclein in the brain. Ambroxol increases the levels of an enzyme called β-Glucocerebrosidase (GCase), which has been shown to reduce the buildup of alpha-synuclein in animal and cell cultures models, suggesting that this could be used as a treatment for PDD.

This trial is well underway and the first participants have completed the first year of treatment. If successful, this trial will be the first to demonstrate that it is possible to change the underlying cause of PDD.

Mobility & Activity

As part of the Mobility & Activity themed presentations, Dr. Dalton Wolfe discussed an initiative supported by the St. Joseph’s Health Care Foundation and Ontario Neurotrauma Foundation to help improve mobility in patients with acquired brain and spinal cord injuries.

Called the Parkwood Program for Rehabilitation Innovations in Movement Enhancement (PRIME), a key goal of this initiative is to develop and implement a clinical decision support system that integrates approaches to activity-based therapy. Clinicians, researchers, administrators and IT specialists have combined their efforts to initiate development on this system.

“PRIME will provide recommendations for treatment based on patients’ injury level and type, and clinical characteristics,” says Dr. Wolfe. “It will also have suggestions for what to monitor for each patient to challenge them to optimize recovery, as well as to reduce risk of injury or secondary complications.”

This system will also enable electronic tracking of practices and outcomes, moving away from the current paper-based model and creating a practice-based research platform.

Mental Health Care

Dr. Amer Burhan presented his research on Transcranial Magnetic Stimulation (TMS) in the Mental Health Care portion of the presentations. TMS is a non-invasive method that uses magnetic fields to stimulate nerve cells in the brain. An electromagnetic coil is held against the head and short magnetic pulses are administered, causing a change in activity level in specific targeted areas and allowing for a study of the function and interconnectivity of the brain. The method has been approved to treat depression resistant to medications and has potential to be used to treat other mental and neurological disorders.

Dr. Burhan’s talk focused on the effectiveness of a certain type of TMS, bilateral theta-burst stimulation, in treating patients with depression who are not responsive to medication. This is a new method of TMS that is designed to facilitate change in brain activity and connectivity more efficiently. He presented preliminary results on the first 60 patients treated with this method. So far the treatment has resulted in significant improvement in over half of the patients.

“More studies are planned to understand predictors of response and facilitate individualized selection of treatment for patients struggling with this very disabling illness,” says Dr. Burhan.