Standard Optimization of Stem Cells in Parkinson's Disease and Atypical Parkinsonism

Inclusion Criteria

• •Participants aged 40-75 years old with a diagnosis of PD or PPS (DLB, PSP, MSA, CBD with parkinsonism) based upon clinical criteria and standardized testing
• •Participants time of documented PD or PPS is \</= 6 years
• •Participants with an anticipated survival of at least 3 years in the investigator's opinion
• •Participants who are willing and able to give informed consent
• •Participants who can comply with the study protocol over the 18-month duration
• •Stable medical profile for 60 days prior to the initial intake screening
• •Participants can ambulate at least 25m without assistance
• •No known history of heparin-induced thrombocytopenia
• •Idiopathic Parkinson's disease patients who meet the MDS's Clinical Diagnostic Criteria for Parkinson's disease
• •Responsive to levodopa or dopamine agonists defined by \>/= 33% improvement in "Off"/"On" symptoms by MDS-UPDRS-III
• •A modified Hoehn and Yahr stage of \</= 3
• •Neuroimaging findings are consistent with PD and absent of atrophy or other brain pathology inconsistent with PD
• •"Normal" cognition as assessed by Montreal Cognitive Assessment (MoCA), with a value \>/= 26
• •DLB -
• •High probability of cognitive capacity to give informed consent by the Montreal Cognitive Assessment (MoCA), with a value \>/= 23
• •Probable DLB - DLB consortium: Two or more core clinical features are present (including features of parkinsonism for the study), or only one core clinical feature is present, but with one or more indicative biomarkers
• •Core clinical features:
• •* Fluctuating cognition with pronounced variations in attention and alertness
• •* Recurrent visual hallucinations that are typically well-formed and detailed Rapid eye movement (REM) sleep behavior disorder (RBD), which may precede cognitive decline
• •One or more spontaneous cardinal features of parkinsonism: bradykinesia, resting tremor, or rigidity
• •Indicative biomarkers:
• •* Reduced dopamine transporter uptake in basal ganglia demonstrated by SPECT/PET
• •* Abnormal (low uptake) I-MIBG myocardial scintigraphy
• •* Polysomnographic confirmation of REM sleep without atonia
• •PSP -
• •MDS Diagnostic Criteria for probable PSP with predominant parkinsonism (PSP-P)
• •Ocular motor dysfunction: vertical supranuclear gaze palsy or slow velocity of vertical saccades or frequent macro square wave jerks ("eyelid-opening apraxia")
• •Ocular motor dysfunction + akinetic-rigid, axial predominant, levodopa resistant or with tremor and/or asymmetric and/or levodopa responsive (akinesia)
• •"Normal" cognition as assessed by Montreal Cognitive Assessment (MoCA), with a value \>/= 26
• •MSA -
• •MDS Diagnostic Criteria for clinically probable MSA
• •Autonomic dysfunction
• •Parkinsonism
• •Cerebellar syndrome, including at least one of gait ataxia, limb ataxia, cerebellar dysarthria, or oculomotor features
• •"Normal" cognition as assessed by Montreal Cognitive Assessment (MoCA), with a value \>/= 26
• •CBD -
• •Chronic progressive course
• •Asymmetric onset
• •Higher cortical dysfunction: apraxia, speech apraxia, non-fluent aphasia, alien limb phenomena, or cortical sensory loss
• •Movement disorder: rigid/akinetic syndrome and either dystonic limb posturing or focal myoclonus in limb, and levodopa resistant
• •"Normal" cognition as assessed by Montreal Cognitive Assessment (MoCA), with a value \>/= 26