Shortly after moving to Kelowna in 2015 to establish a movement disorders clinic serving B.C.’s Interior, Dr. Daryl Wile gained critical insights from a focus group of patients living with Parkinson’s disease.
“The Interior is a vast region, and we quickly learned that many of our patients were driving nearly an hour just to reach the clinic,” says Dr. Wile, a neurologist and clinical associate professor with the UBC Faculty of Medicine’s Southern Medical Program (SMP) and Centre for Chronic Disease Prevention and Management.
The rising tide of Parkinson’s disease
Parkinson’s disease is a neurodegenerative condition that affects how people move.
Symptoms start slowly and worsen over time, resulting in tremors, slowed movements, stiffness, balance problems and more. There is no known cure, and better treatments are urgently needed.
In Canada, more than 110,000 people are currently living with Parkinson’s. That number is expected to rise to 150,000 over the next decade, costing patients, care partners and the healthcare system an estimated $4.4 billion annually.
Source: Parkinson Canada
“These are people who already face mobility challenges, and it really got us thinking about how we can enhance access to quality, specialized care for people in rural and remote communities.”
Parkinson’s disease affects approximately 2,700 people in the Interior, and more than 15,000 across B.C. When you factor in the province’s complicated geography and aging population, the urgency of the problem becomes even clearer.
Determined to find innovative solutions, Dr. Wile and a group of SMP students began exploring how technology could bridge the gap. They developed ParkinSMART, a research project that utilizes telehealth appointments and activity trackers to treat people with Parkinson’s disease remotely.
By tracking patient’s wrist and ankle movements throughout the day, the wearable devices collected valuable data on the tremors and involuntary movements that people with Parkinson’s disease often experience. During virtual appointments, Dr. Wile and his team used this data to tailor treatments, making adjustments to medication and care plans with a precision that wasn’t possible before.
“We could actually pinpoint exactly when in a patient’s day symptoms were occurring, an indication that their medication was wearing off, and adjust our treatment plans accordingly,” says Dr. Wile. “Overall, through a series of studies, we found that patients have really positive experiences and health outcomes with telehealth appointments.”
Today, with the success of the ParkinSMART project and a sudden shift to virtual care during the pandemic, telehealth plays a much larger role at Dr. Wile’s clinic, called the Humphreys Family Movement Disorders Clinic at Kelowna General Hospital, making it less stressful and far more accessible and convenient.
Using ParkinSMART, we could actually pinpoint exactly when in a patient’s day symptoms were occurring, an indication that their medication was wearing off, and adjust our treatment plans accordingly.”
– Dr. Daryl Wile
As a clinical researcher, Dr. Wile continues to explore how remote technologies can help people with Parkinson’s disease live fuller, healthier lives. In a series of new research projects, he’s studying how hand bikes and short, targeted exercise programs — delivered virtually through an app — can improve mobility and quality of life.
“There’s a lot of evidence that exercise greatly benefits people with Parkinson’s, but we’re diving deeper to uncover what specific activities are most beneficial,” says Dr. Wile. “Ultimately, we want to develop tailored exercise programs that will help people maintain their dignity and independence while living with this disease.”
Exploring the gut-brain connection
Hundreds of kilometres away at UBC’s Pacific Parkinson’s Research Centre (PPRC) in Vancouver, Dr. Silke Appel-Cresswell is exploring another pathway to better care for Parkinson’s disease — one that starts with the gut.
Dr. Appel-Cresswell, who is PPRC director, studies the connection between diet, the gut microbiome and brain health in people with Parkinson’s disease. Her team is investigating how gastrointestinal changes could be early indicators of the disease, and even a driver of its progression.
“The gut and brain are much more connected than we previously thought,” says Dr. Appel-Cresswell, an associate professor of neurology at the UBC Faculty of Medicine and member of the Djavad Mowafaghian Centre for Brain Health. “We now know that many people with Parkinson’s disease have a disturbed gut microbiome, and that gastrointestinal issues can appear years before motor symptoms, suggesting a possible avenue for earlier detection and treatment.”
“There is emerging evidence to suggest that nutrition could be a key way to prevent or delay and slow the progression of Parkinson’s disease.”
– Dr. Silke Appel-Cresswell
Dr. Appel-Cresswell’s work, in collaboration with other UBC researchers like Dr. Brett Finlay, has shown that this microbiome imbalance may lead to a “leaky gut,” where harmful toxins enter the bloodstream and potentially reach the brain, contributing to progression of the disease.
To address this, Dr. Appel-Cresswell and her team are investigating how dietary changes could restore balance in the gut and slow progression. In one clinical trial, the researchers found that people who follow a Mediterranean or MIND diet — both rich in plant-based foods, healthy fats and fibre — experience a significantly later onset of Parkinson’s disease, up to 17.4 years in women and 8.4 years in men.
“While we currently lack effective medications for Parkinson’s disease, there is a lot of emerging evidence to suggest that nutrition could be a key way to prevent or delay and slow progression,” says Dr. Appel-Cresswell.
At the PPRC, which operates in connection with Vancouver Coastal Health’s Movement Disorder Clinic, research and care are deeply integrated so that B.C. patients have the opportunity to participate in innovative research studies and clinical trials.
The UBC team, which also includes Drs. Jon Stoessl, Martin McKeown and Vesna Sossi, takes a comprehensive approach to Parkinson’s disease research, studying everything from the genetic and molecular mechanisms of the disease, to the development and testing of novel therapeutics, to brain imaging applications for diagnosing and monitoring disease progression.
Another initiative, the BC Brain Wellness Program, integrates the latest evidence to offer people with Parkinson’s and other chronic brain conditions wellness programming in areas like mindfulness, exercise, nutrition, art-based therapies and developing effective coping skills. Prevention is also a major focus, with programming available for individuals interested in healthy aging, as well as care partners.
For Dr. Appel-Cresswell, it all comes down to better quality of life.
“I believe that research is the only way to truly move the needle,” she says. “It has enormous benefits for patients here in B.C., through opportunities to participate in studies, and because we’re able to bring all our learnings back into the clinic to offer better care, supports and programming.” 
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