Theme 1: Clinical cohorts
OPDC Discovery, also known as the Oxford Discovery Cohort, was set up in 2010 through the Parkinson’s UK Monument Trust Discovery Award to Oxford. This long-term observational study of Parkinson’s and prodromal Parkinson’s is a world-leading Parkinson’s biomarker cohort. Oxford Discovery provides an unparalleled opportunity to look at how movement and cognition change with normal ageing, through the transition to prodromal Parkinson’s, and subsequent conversion to established Parkinson’s. Key research objectives are to improve understanding of the biology of premotor and early Parkinson’s, and identify predictors of disease onset and progression. In addition to standardised assessments, we are interested in validating novel biomarkers to stratify, predict and measure Parkinson’s motor and cognitive progression, including digital remote sensing devices.
The cohort comprises: (i) 1000 People with Parkinson’s (PwP) within 3.5 years of diagnosis recruited from 2010 to 2016, of whom around 500 remain in active follow-up (ii) 320 age-matched control participants (iii) 285 sleep study-diagnosed REM sleep behaviour disorder (RBD) patients recruited from three specialist sleep clinics and (iv) 110 PD relatives. In addition to longitudinal follow-up at 18 monthly intervals, we also collect biosamples including serum and DNA (all), with plasma, cerebrospinal fluid, peripheral blood mononuclear cells (PBMC’s), skin biopsy, induced pluripotent stem cells (iPSc), MRI (see studies in Brain Vol 141 and Annals of Clinical and Translational Neurology Vol 7) and DaT SPECT scans collected in a cohort subgroup.
The Discovery cohort has provided us with an excellent opportunity to understand more about how Parkinson's develops over time, and how Parkinson’s affects different people in different ways- which doctors call disease stratification. Key cohort findings include the major contribution of age to disease severity and the gender-related motor phenotype seen in Parkinson’s, the major impact of non-motor symptoms on driving poor quality of life, and the effect of concomitant RBD on motor and cognitive function in early Parkinson’s. We have defined baseline predictors of cognitive impairment, motor complications, and impulse control disorders in Parkinson’s and RBD.
Data-driven approaches have been used to stratify PwP, showing 4 baseline subtypes across the Discovery and Tracking cohorts combined (> 2500 PwP), that differ in subsequent motor and cognitive progression. The worst baseline subtype showed pro-inflammatory changes, measured via a simple blood test. Watch Michele Hu’s lecture at the Royal Institution for a discussion on how these subtypes were defined. Discovery has a major focus on prodromal parkinsonism through study of its large RBD cohort, leading to several key findings in this at-risk group for future Parkinson’s (see Sleep Vol 40, European Journal of Neurology Vol 25, Brain Vol 139 Issue 1 and Issue 8, and Neurology Vol 83). Digital approaches, including an 8 minute smartphone app test to measure motor function, and home-based sleep studies among PwP and RBD, are examples of novel technologies we use in our research. Watch the Parkinson’s UK video on YouTube.
Read the Parkinson’s Life article which explains how researchers have created a smartphone test that may be able to predict the development of Parkinson’s symptoms. More information on this research can be found in Neurology Vol 91, Clinical Neurophysiology Vol 130, and Annals of Clinical and Translational Neurology Vol 6.
We are delighted to announce that the Discovery Cohort was awarded a further 5 years of funding from the Parkinson’s UK Cohort Studies Council in 2020. This will fund ongoing cohort follow-up from 2021 to 2026, establishing Discovery as one of the best long-term studied Parkinson’s cohorts worldwide, allowing us to develop a prognostic index that can predict the long-term trajectory of PwP. This will be modelled on an individual basis following diagnosis and used to improve patient care, information and counselling, alongside proactive management of their symptoms.