A UF researcher has unlocked a new way to diagnose – and maybe treat – Parkinson’s. But in the O’Dome, a patient is showing him daily basketball drills to relieve the disease’s symptoms.

by Barbara Drake (MFA ’04)

It’s a chilly December morning in Gainesville, and inside the O’Connell Center basketball arena, two men in their 40s – one in a red T-shirt, the other in Gator blue – are playing a game of one-on-one.

Trodding the orange-and-blue floorboards, the two players might not be professional athletes, but they’re fueled by a similar desire to excel.

The player in red, Gary Keating, launches a jump shot, his feet lightly tapping together before he lands. Swish.

Grabbing the rebound, David Vaillancourt, in blue, shows a nice touch on the ball as he goes for one in the paint. Swish.

Back to Keating, who scores some threes from the perimeter.

Just two regular guys shooting around, right?

Not quite. Dr. Vaillancourt, 44, is a renowned professor and researcher in movement disorders at the UF College of Human Health and Performance. His recent laboratory discovery is poised to transform how Parkinson’s disease is diagnosed and monitored – and maybe even cured, one day.

Keating, 48, is a patient and a participant in one of Vaillancourt’s research studies. A former basketball coach from New Jersey who was diagnosed with Parkinson’s at age 38, Keating has managed to slow the disease’s progression – partly, it seems, by practicing his own series of daily basketball drills.

They’re here in the O’Connell Center because – medical research aside – the two discovered a mutual love of the sport.

“Let’s play together,” suggested Vaillancourt. “At the O’Dome,” he added, never one for half measures.

“Great,” Keating e-mailed back, trying not to smash the keys in excitement.

So today’s game of one-on-one skews more “social” than “science.” But now that Vaillancourt’s chasing Keating around the court, now that he’s seeing the unusual facility with which this young-onset Parkinson’s patient moves – his smooth footwork, quick hand movements, crisp passes – it crosses his mind: Maybe I could learn something new from this guy.

Because, to be honest, even for a specialist like Vaillancourt, it’s really hard to see that Keating has any disease at all when he’s on the court.

Working on a Mystery

Parkinson’s is a mystery. First identified more than 200 years ago, scientists still can’t pinpoint what causes the disease. Its symptoms – shaking, stiffness, difficulty with balance, walking and coordination, depression – start gradually, vary widely from patient to patient, and can be easily mistaken for those of other neurodegenerative conditions. In fact, more than a quarter of patients initially diagnosed with Parkinson’s disease (PD) later turn out to have something else.

Medications can control symptoms, but there is no cure – yet.

Those realities make life very hard for people with PD, who number about 1 million in the United States.

“Our ability to move is core to who we are as humans,” says Vaillancourt, a Texas native who began his college career on a basketball scholarship before earning his PhD in kinesiology at Penn State.

“In Parkinson’s disease, your ability to perform the simplest of movements becomes problematic over time,” he explains in calm, measured tones. “So I’m very much attracted to alleviating that issue.

“I think that if we can do that, we’ll have a major impact on society and people’s wellbeing.”

Teaming with Fox Foundation

Until very recently, Parkinson’s researchers lacked an essential tool: biological indicators of the disease, such as proteins in the blood, that can be measured and quantified. Without those biomarkers, as they’re called, specialists have had to rely on patients’ symptoms to diagnose and monitor PD.

(For a comparison, imagine if there were no blood tests for leukemia, and oncologists had to tease out a diagnosis based on a patient’s temperature, fatigue level and weight loss.)

Biomarkers also are needed for new Parkinson’s medication studies. Biomarkers enable scientists to objectively assess how a treatment affects the underlying pathology in the body, revealing if the medication is capable of slowing or even stopping progression of the disease.

The need for reliable PD biomarkers is so urgent that in 2012 the Michael J. Fox Foundation launched the Parkinson’s Progression Markers Initiative (PPMI) to encourage scientists to find these critical missing links for better treatments.

Since Vaillancourt’s days as a post-doc student at the University of Illinois at Chicago, he’s been using neuroimaging to search deep inside the brain for signs of PD and other movement disorders. Now his years of effort have scored a slam dunk for the PPMI.

Vaillancourt examines scans of a patient’s brain with 3T technologist Shane Chatfield, at UF’s Advanced Magnetic Resonance Imaging and Spectroscopy Facility. Through these detailed MRI scans, Vaillancourt can track how Parkinson’s disease affects a part of the brain responsible for movement and dopamine production. (Photo: Aaron Daye, UF Advancement)

In 2014, Vaillancourt and his UF lab made history when they identified the first noninvasive imaging biomarker of PD: structural changes in the substantia nigra, a nucleus in the midbrain that is key to movement and production of dopamine.

The team used diffusion imaging, a type of MRI, to reveal that, over time, Parkinson’s patients lost vital dopamine neurons in the substantia nigra and gained more of a fluid known as free water.

Those initial results – first limited to a study involving 48 patients at UF and the brain scans of 134 patients from the PPMI database – were then validated in a four-year NIH-funded study involving eight sites around the globe.

Importantly, unlike an earlier, costlier brain biomarker for PD, Vaillancourt’s marker can be detected without having to inject patients with radioactive dye. That makes the process noninvasive, faster, safer for subjects and doable on even basic MRI equipment, thus lowering costs for researchers and clinicians.

“Dr. David Vaillancourt’s pioneering research has the potential to improve the way we diagnose and track Parkinson’s disease,” says Mark Frasier, senior vice president of research programs at the Michael J. Fox Foundation, which funded the PPMI landmark study.

Since its debut four years ago, the free water biomarker has passed through every subsequent hurdle for it to be adopted in testing new medications.

“Now all that’s needed is for it to be included in a new clinical trial,” says Vaillancourt.

Volunteering for a Cure

While waiting for that green light, Vaillancourt and his team at the Laboratory for Rehabilitation Neuroscience have been forging ahead with the free-water technique, testing its application in two distinct areas.

In one study, they’re examining the biomarker’s effectiveness at distinguishing PD from other “parkinsonisms,” related disorders that develop more rapidly and aggressively. His lab also is investigating the effects on free water of an existing Parkinson’s medication (Azilect), the first time a PD biomarker has been used in a clinical drug trial.

Both studies rely on the advanced imaging systems at UF’s McKnight Brain Institute. Trial volunteers lie inside futuristic fMRI machines for 40-plus minutes while performing specific motor tasks. On the other side of the glass, a technician captures tens of thousands of images of each patient’s brain, layer by layer, in real time.

It’s a demanding, tedious process, but these test subjects gladly stay put, knowing their data sets can lead to a cure.

Many PD patients share this desire to help others, Vaillancourt has observed.

“People with Parkinson’s are very motivated about improving not only their own health care, but other people’s too,” he says, “so they are very much into research. Getting patients to participate in studies is easy because they’re just such good-hearted, down-to-earth people.”

For Gary Keating, who earned a degree in athletic administration from St. Johns University, taking part in Vaillancourt’s research trials has given him a renewed purpose in life.

“I always knew there was a reason I was given Parkinson’s,” says Keating. “And that reason is, I want to help people.”

“I did it as a coach,” he adds. “Now I’m supposed to continue helping people in a different direction – by doing the trials and giving my results. It’s exciting.”

A Father’s Diagnosis

For an athlete used to beating competitors on the court, Keating views Parkinson’s as the ultimate opponent. He refuses to give in.

“I’ve fought through a lot of this in my life,” he says in his soft Jersey accent. “This is just another one to me.”

His mettle was first tested while his dad, also a basketball coach, was sick with PD. Keating gave up his own dream job coaching basketball at Keystone College, in Pennsylvania, to care for him. Then, six months to the day after his father’s death, in 2009, a neurologist told Keating he had the same disease.

“The news hits you hard,” he admits. “I knew what my father went through. At first, all I could think was, ‘That’s my future.’ It was quite an emotional day.”

But the neurologist told him to stop replaying memories of his elderly father’s 14-year-long demise.

“The first thing the doctor said to me was, ‘Do not compare yourself to your father because what happened to him may not happen to you,’” recalls Keating. “And he explained how individualistic Parkinson’s is. That woke up the fighting spirit in me.

“I said, ‘Okay, there’s a better road.’ I don’t want to end up like my father. I want to stay like this – active.”

Three Coaches

Keating has been on a quest ever since to live well with young-onset Parkinson’s. Over the last decade, he retired from coaching, fought discrimination at work due to his illness and left the northeast to seek better treatment in Florida. A steady regimen of two low-dose PD medications, Requip and Azilect, accompanied him wherever he went.

“The medications have held the disease back,” says Keating. “Sometimes I’ll get the tremor again, but nothing like before, when I wasn’t taking them.”

He also credits his religious faith and a positive attitude for keeping him healthy – as well as an unorthodox Parkinson’s exercise regime: his own series of daily basketball drills.

“I’ve kept on playing basketball in the driveway,” he says, “a half an hour to an hour a day,” using the same drills he used to train his young players.

“On the court, it’s hard to tell he has Parkinson’s disease,” says Vaillancourt of patient Keating, who practices the same daily basketball drills he used to give his players in New Jersey and Pennsylvania. (Photo: Aaron Daye, UF Advancement)

“Dribbles, one hand to the other, stationary, moving,” he says. “It helps.”

Helps is an understatement: People usually look at Keating in surprise when he tells them he has PD.

But the disease is more than just tremors. Many Parkinson’s patients experience non-motor symptoms, such as problems with sleep, mood, vision and even sense of smell. Impaired memory and thinking are also common, says Dr. Rachel Dolhun, a movement disorder specialist and vice president of medical communications at the Michael J. Fox Foundation.

“Cognitive dysfunction can occur at any stage in Parkinson’s disease and can range from mild to severe,” says Dr. Dolhun. “It typically involves activities like multitasking, problem solving, planning or organizing. People can also have problems concentrating or finding their words when speaking.”

Keating, who is an articulate communicator, admits that words sometimes escape him. For him, having the disease is primarily an internal experience.

“There are days I feel lightheaded and weak, and I can’t do much,” he says. “Other days, I’ll look okay, but I might have to reach out and hold onto your arm.”

In his quest for the best care possible, Keating resettled in Gainesville four years ago and sought treatment at UF’s Center for Movement Disorders & Neurorestoration, which encompasses a National Parkinson Foundation Center of Excellence.

It was at UF that Keating volunteered for one of Vaillancourt’s biomarker studies in 2017. Participating in the study spurred Keating to write a short memoir, “Father and Son: A Game and a Battle with Parkinson’s,” published this year by Covenant Books.

“I’m hoping the book will help other people who have it – and maybe other young-onsets,” says the first-time author. “Because I know some young onsets don’t want to say they have Parkinson’s.”

During the 12 months he participated in the UF study, Keating had no idea Vaillancourt coaches two youth basketball teams in Gainesville – yet another connection between the two men.

When Keating found out their shared love of the sport, in November 2018, he was speechless. “Wow!” he said. “What are the odds? Three coaches – him, me and my dad.”

Shooting for a Cure

Back at the O’Dome, Vaillancourt and Keating are winding up their game. They leave the court drenched in sweat, but at a cameraman’s insistence, Keating comes back to demonstrate the daily drills that keep his motor skills up to speed. They’re his own invention, but they’ve got Vaillancourt intrigued.

Before joining the faculty at the College of Health and Human Performance, Vaillancourt contributed to a study that concluded regular resistance training – with a focus on the whole body – helps slow down Parkinson’s. Keating’s drills aren’t anything like those exercises.

“He’s doing a lot of small movements of his hands, ball handling,” says Vaillancourt. “His moves incorporate balance, posture – all the things patients need.

“In many ways, he’s doing something really fresh and out of the box.”

Today’s game has given the two men an appreciation of each other’s skills and taken them outside their everyday routines. Looking forward, what are their hopes for the future of Parkinson’s research?

“My dream is to one day find the cure,” says Keating. “To do anything possible that I can do, to help find it. It’s all for that one day that I can tell my father, ‘We won.’”

And Vaillancourt?

He glances at Keating, smiling a boyish grin: “I cannot have another dream. He’s pretty much summed it all up.”