Vice-chair of Innovations, Neurological Institute; Bell Family Endowed Chair, and staff, Department of Biomedical Engineering, Cleveland Clinic

Jay Alberts, PhD

"In general, it’s been a mixed bag in terms of looking for blood biomarkers and other imaging biomarkers. The challenge with many of these is they’re expensive, and their integration into routine clinical care is hard to imagine, at this moment."

Biomarkers serve several purposes for Parkinson disease (PD) treatment, by helping distinguish the disease from other neurodegenerative disorders, monitor progression, and give indications of treatment response to therapeutics. Another main use of biomarkers is to identify underlying prodromal changes in an individual before symptoms arise. There are several main types of biomarkers, including clinical, imaging, biochemical, and genetic, all of which provide varying benefits and insights.

Understanding these prodromal changes was the main theme of research evaluating a virtual reality (VR) shopping platform that was conducted by 

. Instead of observing the typical, sometimes intrusive, biomarkers, the study looked at performance of instrumental activities of daily living to see whether changes could indicate prodromal signs or symptoms of PD. The platform consisted of basic and complex shopping experiences, with additional scenarios that increase the cognitive and motor demands of the task to better represent the continuum of activities associated with real-world shopping.

Alberts, the Edward F. and Barbara A. Bell Endowed Chair at the Cleveland Clinic Lerner Research Institute, recently sat down with 

 to discuss the issues the PD community has with identifying successful, widely acceptable biomarkers for the disease. He also provided insight on the possibility of interventions such as the VR platform to tap into specific regions of the brain that may show abnormal signs over time.

REFERENCE
1. Alberts JL, McGrath M, Koop M, et al. The immersive Cleveland Clinic Virtual Reality Shopping Platform for the assessment of instrumental activities of daily living. 

Videos

The Edward F. and Barbara A. Bell Endowed Chair at Cleveland Clinic discussed the complexities with identifying viable biomarkers for Parkinson disease, as well as interventions geared toward specific regions of the brain. [WATCH TIME: 4 minutes]

Challenges With Assessing Stages of Parkinson Disease and the Lack of Standardized Biomarkers: Jay Alberts, PhD

"What we’re looking to do now is gather the data that will eventually raise a red or yellow flag so that you go to the neurologist because your vitals look a little off. Those are things that we hope to do for sure."

Prodromal Parkinson disease (PD) refers to a stage at which individuals do not fulfill diagnostic criteria for PD but do exhibit signs and symptoms that indicate a higher-than-average risk of developing motor symptoms and a diagnosis of PD in the future. Literature has shown that most prodromal symptoms are nonmotor and have a major impact on quality of life for both patients with prodromal PD and for those whose disease stage has progressed to motor-PD. Hyposmia, constipation, mood disorders, and REM sleep behavior disorder have all been well-characterized as symptoms of prodromal PD.

A new tool called the Cleveland Clinic Virtual Reality Shopping platform is continuing the efforts of diagnosis and treatment of neurological disease, including PD. This virtual reality (VR) approach quantifies performance on instrumental activities of daily living using a shopping experience, to see whether declines may be a sign of prodromal PD. Using an omnidirectional treadmill, patients are asked to complete basic and complex shopping experiences, including walking 150 m and retrieving 5 items.

, provided context on how the platform specifically works toward quantifying these prodromal changes, and how previous research on exercise helped formulate the study that is now underway. Alberts, the Edward F. and Barbara A. Bell Endowed Chair at the 

 Lerner Research Center, also discussed the challenges in this patient population and how this VR platform further expands clinicians’ capabilities.

The Edward F. and Barbara A. Bell Endowed Chair at the Cleveland Clinic detailed how a new virtual reality tool elucidates prodromal symptoms from patients with Parkinson disease. [WATCH TIME: 3 minutes]

Exercise, Virtual Reality, and Exposing Prodromal Symptoms of Parkinson Disease: Jay Alberts, PhD

"There’s a misconception that people with neurological diseases, or even older adults, can’t use technology. That was absolutely untrue. They embraced this system, used it like a champ, and had very good usability scores.”

Treating a disease in its prodromal stages may ultimately lead to better long-term outcomes, but identifying these underlying changes remains a challenge, especially in Parkinson disease (PD). A new approach using virtual reality (VR) is working toward improving this. The Cleveland Clinic Virtual Reality Shopping (CC-VRS) platform places patients in a virtual grocery store setting, where they are asked to complete basic and complex shopping experiences while on an omnidirectional treadmill. The complex experience has additional scenarios that increase the cognitive and motor demands of the task to better represent the continuum of activities associated with real-world shopping.

Previously, issues with incorporating VR into neurology care have stemmed from sensory inconsistencies between the visual and vestibular systems, leading to sickness, or otherwise known as a locomotion problem. In the first research published on the CC-VRS, the platform was shown to effectively address the locomotion problem, with patients across the trial having no issues adapting to the VR setting. Lead investigator 

, believes that this study not only highlights the capabilities of VR but also shuts down the notion that those with PD and/or neurological diseases perform poorly with technology.

Alberts, the Edward F. and Barbara A. Bell Endowed Chair at the 

 Lerner Research Institute, sat down with 

 to discuss the major findings from the study, including the safe profile of the CC-VRS. He also provided context on the some of the specific tasks done during the study and what they tell us about the how PD forms.

REFERENCE
1. Alberts JL, McGrath M, Koop M, et al. The immersive Cleveland Clinic Virtual Reality Shopping Platform for the assessment of instrumental activities of daily living. 

Published online July 28, 2022. doi:10.3791/63978

The Edward F. and Barbara A. Bell Family Endowed Chair at Cleveland Clinic discussed seamless adjustment made by patients with Parkinson disease to virtual reality, and the benefits it may bring to care. [WATCH TIME: 4 minutes]

Incorporating Technology and Virtual Reality in Parkinson Disease and Neurological Disorders: Jay Alberts, PhD

"If we can delay the onset by just 5 years, we can cut the number of people who have Alzheimer’s in half. If we delay it by 10 years, we can basically wipe out the disease. Prevention is sometimes the better way the go than treating someone who already has the disease and then try to reverse the effects.”

Cleveland Clinic was recently awarded a $6.7 million grant to evaluate if high-intensity exercise, using the home-based indoor cycling Peleton bike, can prevent the development of Alzheimer disease (AD). The 5-year study, led by Stephen Rao, PhD, and Jay Alberts, PhD, will assess the effect of this intervention in slowing disease progression in healthy older people at high genetic risk for developing the disease.

If successful, the trial has the potential to provide a scalable, low-cost intervention capable of substantially reducing healthcare costs by modifying the trajectory of the disease. The effects that exercise has on cognition and potentially lowering the risk of AD has been previously observed, but not in this same capacity. A total of 150 healthy, sedentary individuals between ages 65 and 80 years who carry the apolipoprotein E epsilon (APOE4) allele will be enrolled in the study.

Rao, director of the Schey Center for Cogntive Neuroimaging at Cleveland Clinic, and Alberts, The Edward F. and Barbara A. Bell Family Endowed Chair at the Cleveland Clinic Lerner Research Institute, sat down to discuss their study. In this interview, they provide a background of how the study will be conducted, how it differs from other previous exercise-based research projects, and the long-term goals they are looking to complete.

A duo of researchers from Cleveland Clinic outlined their new 5-year study that tests home-based intervention in high-risk individuals for Alzheimer disease.

Jay Alberts, PhD

Articles

Challenges With Assessing Stages of Parkinson Disease and the Lack of Standardized Biomarkers: Jay Alberts, PhD

Exercise, Virtual Reality, and Exposing Prodromal Symptoms of Parkinson Disease: Jay Alberts, PhD

Incorporating Technology and Virtual Reality in Parkinson Disease and Neurological Disorders: Jay Alberts, PhD

Assessing High-Intensity Exercise to Prevent Alzheimer Disease: Stephen Rao, PhD; Jay Alberts, PhD

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