Using virtual reality and changes in activities of daily living to detect early signs of Parkinson’s disease

This is the second part of a two-part interview. Click here to view Part 1.

Among the many technological advances that have been incorporated into models of neurology care, virtual reality (VR) remains one of the most underutilized. This integration delay is due in part to the VR-related disease resulting from these approaches, which results from sensory discrepancies between the visual and vestibular systems. Cleveland Clinic’s newly designed Virtual Reality Shopping Platform (CC-VRS) uses an omnidirectional treadmill to alleviate a commonly occurring movement problem.

led Jay Alberts, Ph.D., a recently published study aimed to see if this platform can identify declines in performance of essential activities of daily living (IADLs) as a primary marker of neurodegenerative diseases, specifically Parkinson’s disease (PD). Here, patients completed basic and complex virtual shopping experiences, such as walking 150 meters and retrieving 5 items, and additional scenarios that increase the cognitive and motor requirements for each task.

In an interview with Neurology®, Alberts, Edward F. and Barbara A. Bell Chair in Cleveland ClinicIn this article, discuss the complexities that come with understanding the early signs of PD, and how this virtual reality platform works to achieve this. It provided insight into the difficulties of the current set of biomarkers and tools for assessing early stages of disease, as well as whether technology such as CC-VRS could focus on improving specific functions based on brain region.

Neurology®: How does this tool focus squarely on clarifying the prodromal stages of PD?

Jay Alberts, Ph.D.: You know, I’ve done a lot of work with exercise and Parkinson’s disease. We’ve shown that exercise is great for PD, but that’s kind of a switch. We’re still doing this work, but there’s a bit of a switch in the sense that I think we need to research and try to identify ways of early recognition of the disease. This is not new. This is a new approach in the sense that there is data to suggest that a decrease in active activities of daily living precedes a diagnosis of Alzheimer’s disease and Parkinson’s disease by 5-7 years. precedes clinical diagnosis. This is a significant amount of time that we may be missing somewhat.

The challenge is that we are not doing a good job now evaluating IADLs. There are some surveys out there that are okay, but not great. You could go to an occupational therapist, get evaluated, but that’s not something someone thinks about when they’re 55. And it’s hard, it’s 60 to 80 minutes. Insurance will not pay for it. You need a private space. Again, it is not overly objective or quantitative. If we can build a system and platform that is a proper assessment of the key components of the IADL, maybe we can track that data over time and see, does it regress? And could this be a possible sign of the appropriate sign of disease?

With that in mind, we take the system and put it together at Sheffield Family Health, the Cleveland Clinic’s family health center. Patients 55 or older who just come in for their regular annual visit will be asked if they would like to participate in this project to track them over time to see if there is a possible precursor here? I’m very excited about it, because the people of Sheffield are excited and excited about incorporating this into routine clinical care. This was our primary goal. For integration into routine clinical care. We can get the data, but also make sure that it provides some benefit or value. I want to be clear — we won’t be able to say, “Oh, you have Parkinson’s now or you’re going to have Parkinson’s now.” What we’re looking to do is collect data that will eventually allow us to raise a red or yellow flag to tell someone to go to a neurologist because your ideals seem a little off. These are things we really hope to do for sure.

How did we previously assess the prodromal stages of PD?

There have been some small studies and genetic testing going on. Again, they may have explained about 1% or so of Parkinson’s cases. Perhaps there are a few powerful biomarkers, genetic biomarkers in Alzheimer’s disease. But overall, it was a bit of a mixed bag in terms of looking for blood biomarkers or other biomarkers for imaging. The challenge with many of these is that they are expensive and it’s hard to imagine their integration into routine clinical care at the moment, just because of the cost. As we all know, with healthcare continuing to restrict and trying to constrain costs, these kinds of tests are hard to imagine. we will see. Again, I don’t think this would be a panacea. I think we should clearly look at other biomarkers as well, maybe a combination of something stronger, that we can identify earlier, faster, cheaper. This is where we really look at; How do we measure something, so that it presents value to the person now? Because even when you’re 55 – you’re not there yet, nearby, but you lose your keys, you forget where you parked your car, and you say, “Am I okay?” Perhaps there is something to offer a certain level of assurance to people as well.

Can we use technology like this to specifically target key functions based on a brain region?

We’re with the new Michael J. Fox Foundation study. If you think of the hypothalamic nucleus, it is divided into 3 areas: perceptual, limbic, and sensorimotor. We have developed 3 different additional models or virtual home environments in which patients in the study will go and perform. One of them is anxiety, it’s a worrying paradigm. They’re walking into the kitchen, and they have to go through these double doors. Suddenly, the double doors open right in front of them, and they basically have to walk on a plank to a small platform, turn and go back. You think, oh, maybe that’s not anxiety, but it really reinforces anxiety because people are overwhelmed. feel it. You can see people looking at that plank, they’re walking and their gait changes or their heart rate increases. This is where we will look at neural activity within the limbic region of the STN (the hypothalamic nucleus) to see, does it change? How does it change? How do you respond to this? Similarly, we have a cognitive module where patients do a double task while walking into that kitchen. Again, looking at the cognitive area, the STN. I think we can [target key functions] As long as you develop the model to relate it to the area you are interested in.

Text has been edited for clarity.

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