How a Neurologist is Working to Solve the Problem of Apathy in PD

Apathy can significantly impact quality of life for people with Parkinson’s disease (PD). As many as a third of people with Parkinson’s experience this motivational disorder, often before a diagnosis, making it difficult for them to maintain interest in daily activities. The mechanisms of apathy in PD are poorly understood, as it can be difficult to treat and often becomes more pronounced over course of the disease.

Movement disorder specialist and researcher Alana Kirby, MD, PhD is directing her research work towards understanding, and ultimately solving, the problem of apathy in Parkinson’s.

Based at Rush University Medical Center, a Parkinson’s Foundation Center of Excellence, Dr. Kirby diagnoses and treats people with PD at Rush’s Parkinson’s Disease and Movement Disorders Program clinic.

Using cutting-edge technology, Dr. Kirby is developing an animal model of apathy. By studying rat behavior and motivation, she is categorizing which responses in rats are akin to the condition of apathy in humans. She will later use this information to test what factors in the progression and treatment of PD lead to apathy.

“While there are things you can try clinically to help boost the motivation that is missing with apathy in PD, there is no treatment specifically designed for it,” said Dr. Kirby. “I want to create a benefit for people with PD in my lifetime in areas of greatest need, like solving the issue of apathy. I am focused on the ‘immediate gratification’ of impact I can make in 10 to 20 years,” she said.

At the outset of her career, Dr. Kirby completed specialized movement disorders training from 2018-2020 at Rush. Her training was funded through the Parkinson’s Foundation Movement Disorders Fellowship Program, which supports medical institutions in the two-year training of fellows. The Foundation has funded more than $15 million towards the training of more than 150 movement disorders neurologists since 1980.

The supportive environment that Dr. Kirby’s fellowship offered, as well as the freedom to pursue her own ideas in research during her fellowship, were particularly impactful to her. “I was actively encouraged to go towards my passion during my fellowship, and that opportunity in the research world is very rare,” she said.

During her fellowship, Dr. Kirby pursued a line of research that was not as successful as she would have hoped. However, her self-defined “failure” taught her more than success would have. “That experience to dive into something no one else was working on at the time taught me so much, and led to my current project,” said Dr. Kirby.

The natural flow between clinical work and lab work helps Dr. Kirby approach both with enthusiasm and fresh perspectives. “On a regular basis, I am able to evaluate the most important unmet needs in my patients’ care, which helps me decide which topics are important for me to study,” said Dr. Kirby. “This guides my research and gives me a leg up on those who don’t see people with PD on a regular basis.”

Dr. Kirby is guided by the principal that better Parkinson’s outcomes in and out of the exam room start with the power of observation and connection.

“From my perspective as a doctor, my ability and desire to observe leads to better outcomes for patients. I really like how much of my work is based on looking at patterns and coming to a holistic diagnosis based on my observations. I learn so much from talking to patients, and from critically hearing and understanding their history.” - Dr. Kirby

Talking to people with Parkinson’s teaches Dr. Kirby something new about approaching the complexities of this disease.

"Every patient really is different,” said Dr. Kirby. “You go through the same thought process over and over again in assessing patients, but you still have to do a lot of problem solving. You also create relationships with patients that last for years and decades, and that is very important to me.”

Dr. Kirby is grateful to work within a Parkinson’s Foundation Center of Excellence where her patients have access to a continuum of care resources, and feels strongly that an interdisciplinary approach to treating PD is critical.

“I rely heavily on other modalities in care of patients with PD,” said Dr. Kirby. “Physical therapy, occupational therapy, speech therapy, swallow assessment, behavioral therapies — those modalities all create better outcomes.”

For Dr. Kirby, funding early-career PD research as the Foundation does is critical to making progress towards better treatments and ultimately a cure.

“The Parkinson’s Foundation levels the playing field in the research world,” said Dr. Kirby. “This is especially true for early-stage researchers or people who are mostly clinical but have interesting ideas. Maintaining a pipeline of research, and nurturing crops of young scientists like me, is good for the Parkinson’s community.”

Find a movement disorders specialist in your area at Parkinson.org/Search or call the Parkinson's Foundation Helpline at 1.800.4PD.INFO (1-800-473-4636).