Diagnosing and treating cognitive deficits with Parkinson’s disease

Sean Udow
Dr. Sean Udow

One of the most difficult aspects of Parkinson’s disease is that although doctors can treat its motor symptoms, they often underestimate the impact of accompanying thinking and reasoning problems.

At Toronto’s Sunnybrook Research Institute, Dr. Sean Udow divides his time during his Clinical Movement Disorders Fellowship by focusing on ways to treat those cognitive problems, and on research to investigate a possible link between memory, judgment and reasoning deficits and blood pressure regulation. His fellowship is funded by Parkinson Society Canada’s National Research Program (NRP.)

Udow, a neurologist, knows that without any confirmed diagnostic tests for Parkinson’s, doctors need keen clinical skills to determine whether and what type of neurodegenerative disorder their patients have. The doctors rely on their experience, patient history, and observation.

“Parkinson’s disease isn’t diagnosed by an MRI or a blood test, so you really have to have a strong clinical acumen,” says Udow. “A lot of what we do is like detective work, or good old-fashioned doctoring.”

That’s why Udow is excited about his fellowship, which allows him to work with and learn from expert clinicians like Dr. Mario Masellis, and also to participate in research studies.

During their research, Udow and his colleagues will use unique Magnetic Resonance Imaging (MRI) techniques to scan the brains of people with Parkinson’s disease and dementia with Lewy bodies, another form of dementia. Some of those people will also have orthostatic hypotension – variable blood pressure, which can cause dizziness and fainting when blood pressure drops abruptly. By comparing any changes in the brain the scans reveal, Udow hopes to find further evidence that suggests the variations in blood pressure may cause the cognitive symptoms people with Parkinson’s and other people with dementia experience.

“Blood pressure fluctuations may cause small silent strokes or transient alterations of brain networks that may worsen cognitive impairment,” says Udow.

If he can confirm the link between orthostatic hypotension, cognitive problems and these two neurodegenerative diseases, Udow hopes the findings will lead to further research to determine if early, aggressive treatment of blood pressure fluctuations can prevent the progression of cognitive symptoms.

Dr. Udow was recently awarded the one-year, $50,000, Garden Centre Group Co-op Corp. Clinical Movement Disorders Fellowship from PSC’s National Research Program. This NRP fellowship program gives new doctors the opportunity to receive training specifically in the diagnosis and management of Parkinson’s disease. By 2031, the Parkinson’s population will double. This fellowship is an important step to ensure more medical specialists are trained in Canada to provide high quality care to the growing number of people living with Parkinson’s.