James Parkinson
Jean Martin Charcot
Lou Gehrig
Neuroepidemiolgy in a nutshell
Christina Wolfson
Me?
What is neuroepidemiology?
Domains of inquiry?
Selected topics
Funding opps
Me?
• MSc in Mathematical Statistics
– “Measures of agreement for quantitative data”
• PhD in Epidemiology and Biostatistics
– “Probabilistic models for the natural history of
Multiple Sclerosis”
• Neurodegenerative diseases and aging
• Director of the Neuroepidemiology Research
Unit (RI MUHC)
Neuroepidemiology
• Simply
– that branch of epi dealing with the study of neurological
disease
• Term coined by Milton Alter, Len Kurland and John
Kurtzke in 1967
• Journal NEUROEPIDEMIOLOGY (founded in 1982)
• VERY few neuroepidemiologists in Canada
• People doing research in neuro diseases in EBOH
– Myself, R Fuhrer, N Mayo, E Strumpf, J McCusker, B.
Richards – there are most definitely others
What?
• Epidemiology of
Neurodegenerative
disorders
– Distribution
– Identification
– Determinants/Etiology
• Prevention
– Design
– Prognosis
• Natural history
• Treatment
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Multiple Sclerosis
Amyotrophic Lateral Sclerosis
Parkinson’s Disease
Alzheimer’s disease
Epilepsy
Stroke
Cerebral Palsy
Creutzfeldt Jakob Disease
...........
With whom?
Neurologists, Neuropsychologists,
Economists, Statisticians, Physiotherapists,
Nutritionists, Family Docs, Sociologists,
Ethicists, Lawyers, Engineers,
Kinesiologists, Clinical biochemists,
Immunologists, Virologists, Geneticists, ......
How?
Whatever is needed!
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Case control
Cohort
Case crossover
Clinical Trial
Prevalence
Statistical methods
• Capture recapture
• Markov/semi Markov models
• Disease mapping methods
Spill over into research in aging
• Systematic reviews
• Databases/registries
• Face to face interviews
• Structured
• Qualitative
• Telephone interviews
• Self administered
questionnaires
• Physical assessments
• Biological samples
• Focus Groups
• Harmonization
Some pending questions
•
What is the prevalence of
– MS in Canada?
– ALS in Canada?
– Parkinson’s disease in Canada?
– Epilepsy in Canada?
•
Is the incidence of MS really increasing in women but not in men? If so, why and what
etiological clues might it provide? Could such an observation be due to bias?
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Is the incidence of ALS really increased in deployed Gulf War Veterans? How can we study
such a rare disease? What is the optimal comparison group?
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What do we know about survival with neurological disorders? Has survival with MS increased
over the past 50 years?
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Are sleep disorders early signs of Parkinson’s disease?
Are olfactory makers early signs of neurodegenerative diseases? (Sniff test!)
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Controversial area: Is Chronic Cerebrospinal Venous Insufficiency (CCSVI) a cause of MS? A
consequence of MS? Does the “liberation” procedure to improve cerebral blood flow have
any value?
Some Methods Questions
• How do we identify neurological conditions in population based studies
without a full neuro assessment?
•
Validation of disease ascertainment algorithms in epi studies
• Has the presence of length bias in prevalent cohorts with follow up
resulted in biased estimation of survival with neurological disorders?
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See article in JCE 2012
• What is the best tool to identify cognitive impairment in a population
based study?
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How do we identify participants who do not have the capacity to consent to research?
What do we do when we identify them?
• What are our best strategies to conduct risk factor studies on ALS, a rare,
rapidly fatal disease?
Selected Projects
• International case control study of MS risk factors
(Norway, Italy, Sweden, Serbia, and Canada)
• 4,000 cases – 16,000 controls
• Physician preferences for the care of individuals
with MS – do GPs see MS patients?
• Provincial survey of neurologists, ophthalmologists and GPs.
• The Epidemiology & Impact of Comorbidity on
Multiple Sclerosis in Canada
• Systematic review of incidence and prevalence of
MS worldwide
continued
• Transition of Care for Adolescents with Neurological
Disorders
• Program in Epidemiology Targeting Amyotrophic
Lateral Sclerosis (PETALS)
• Validation of diagnostic algorithms for Parkinson’s
disease, epilepsy for use in population based studies
• Canadian Longitudinal Study on Aging – Neurological
Conditions Initiative
Selected Trainee Topics in Neuroepi
completed and ongoing
•
MSc (EBOH and Math/Stat)
– Misclassified exposure to infectious agents in
case-control studies of MS – impact on Odds
Ratios
– Measures of change in cognition in
Alzheimer’s Disease
– Seasonal variation in Parkinson’s disease risk
– Successful health care transition in young
adults with chronic neurological disorders
– Methods to study the natural history of MS
(Math/Stat)
– A new capture-recapture model selection
criteria with an application to MS
(Math/Stat)
– Validity of the Markov assumption in
economic studies of AD medications
(Math/Stat)
– Active/passive smoking as risk factors for MS
– Validation of an epilepsy algorithm in a
population based study
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PhD students (EBOH)
– Spatial statistics & their application to
neuroimaging studies of MS patients
(Biostatistics)
– Fully Bayesian mapping models to identify
high risk areas with an application to MS in
Sardinia (Biostatistics)
– Physican & caregiver preferences for
treatment options in AD (EBOH)
– Developing a tool kit of epidemiological
resources for etiological research in
pediatric MS (EBOH)
Selected Postdoc projects
• Postdocs
– Mental incapacity & long
term participation in
observational research
– Satisfaction with assistive
technologies in MS
– Delirium in elderly post
surgical patients
– Sleep disturbances as a
marker for Parkinson’s
disease
• Neurology residents/clinical
fellows
– Prevalence of MS in Canada
– Epstein Barr Virus and MS
– Quality of Life in MS
– Prevalence of MS in the
Middle East
– Lead exposure and ALS
– Canine Distemper Virus & MS
– Surgical resection of brain
tumours and survival
Some of what is going on in
Canada
– In 2009 the NHCC Successfully lobbied the government to commit
$15million to epidemiological research into neurological disorders
• The Canadian Multiple Sclerosis Monitoring System (CMSMS)
• The Canadian Longitudinal Study of Aging (Research Platform)
– 50,000 participants
• CIHR International Collaborative Research Strategy for
Alzheimer's Disease
Funding Opportunities
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Supervisor (of course!)
McGill “Graduate and Fellowships and Awards” - GPS website
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CIHR, FRSQ (check the individual réseau for studentships) , disease specific societies (MS, PD, ALS,
Heart and Stroke, etc)
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CIHR Neuroinflammation Training Grant (McGill- U de M – Laval consortium)
www.neuroinflammation.com
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Multiple Sclerosis; Spinal Cord Injury; Neuropathic Pain; Schizophrenia; Mental Illness; Maternal Infections;
Brain Ischemia; CNS Inflammation; Brain Tumours; Neurodegenerative Disease
EndMS Research and Training Network www.endMSnetwork.ca
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$20 million initiative to recruit, retain and train student/researchers interested in MS related research
Annual summer school, SPRINT (Scholar Program for Researchers IN Training); undergraduate summer
studentships
Others (less well known)
L'Oréal Canada For Women in Science Research Excellence Fellowships (Postdoc)
Scottish Rite Charitable Foundation (may be discontinued –check the website)
Research Institute – MUHC Studentships (matching funds from supervisor)
Questions?
christina.wolfson@mcgill.ca