An Interview with Dr. Paul Thompson of Enigma-PD: Part 2

In case you missed it, check out part 1 of this interview with Dr. Paul Thompson.

Dr. Paul Thompson is the Associate Director of the USC Mark and Mary Stevens Neuroimaging and Informatics Institute at the Keck School of Medicine. He also works as a professor of ophthalmology, neurology, psychiatry and behavioral sciences, and radiology and engineering.

I recently sat down to chat with him about the work that he does, and the Parkinson’s chapter of Enigma.

What is Enigma?

Enigma-PD is a global scientific community that seeks to collect data in order to gain a greater understanding of the Parkinson’s progression and treatment outcomes.

There are currently 20 countries that are participating in the project. This organization has conducted some of the largest neuroimaging studies to date.

Over the course of 5 years, Enigma-PD hopes to make scientific discoveries in relation to the treatment and assessment of Parkinson’s disease. And Dr. Paul Thompson is a key player in the United States chapter of Enigma-PD.

Range of questions

Mary Beth: What kind of questions does the Enigma-PD chapter seek to answer?

Dr. Thompson: They go from simple to difficult like: How does Parkinson’s disease spread in the brain? Does everyone undergo these changes? Which ones are reversible? Other [questions] may be more challenging like: How do Parkinson’s risk factors act on the brain?

What will the data show?

Mary Beth: What types of things are you expecting the Enigma-PD data to show?

Dr. Thompson: One thing that would be a huge benefit is if there was a test that could identify at least a subgroup of Parkinson’s patients who do better on a certain treatment (there is levodopa, and DBS for the motor aspects, there are social and physical interventions, and there are psychiatric medications for depression and agitation).

You could say: How do I know which of those 4 categories of medicine is likely to be of any benefit at all? So, if someone has severe symptoms in one area it makes sense to target one of those areas. There may be a subtle effect of delaying the disease that you need large samples of data to detect.

Addressing different regions

Mary Beth: I read that this study is hoping to draw attention to underdeveloped countries. Are you expecting to find anything different about these regions?

Dr. Thompson: Yes. In the areas where there are very different representations of brain disorders from neurology (like in India and south Africa) there are, in general, less resources to treat patients with these conditions.

The factors that would matter the most for them might be related to resources (i.e. early detection, access to treatment). I don’t want to overgeneralize. In financially better developed countries like Taiwan and New Zealand, there isn’t an enormous difficulty with access health care. But everyone is different. Their education, lifestyle, and the environment that they live in.

Caregiver role

Mary Beth: What role do caregivers have in all of this?

Dr. Thompson: As scientists, I think we need better studies that include things that caregivers notice. If you read a neurology text book, people think of Parkinson’s as a progressive disorder but there is so much fluctuation even from the daily environment that revives some language, speech or even motor function. Identifying the habits and behaviors that are beneficial is really important to study.

Building a picture of PD

Mary Beth: Is there anything else you’d like to share with the PD community?

Dr. Thompson: Just a note of thanks for taking part in research. If we were ill, we wouldn’t necessarily want to be in a research study unless the research could help us.

It doesn’t have to be interventional. It could be one where they’re assessing cognitive behavior, mood state, depression. But all of these things are building a better picture of PD.