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Mechanistic Diversity in Maladaptive Decision-Making Among Parkinson’s Patients in East London

Code: BC-DTP_2026_01

Primary Supervisor: Prof. Abhishek Banerjee
Email: abhishek.banerjee@qmul.ac.uk
Institute: Blizard Institute

Secondary Supervisor: Prof. Charles Marshall
Email: charles.marshall@qmul.ac.uk
Institute: Wolfson Institute of Population Health

Lay Summary:

Parkinson’s disease (PD) is one of the fastest-growing neurological conditions worldwide (1). Alongside its well-known motor symptoms, many people with PD experience difficulties with decision-making, including altered cognitive flexibility—the ability to adapt to changing situations. This can severely affect everyday tasks, independence, and quality of life. PD often occurs alongside Type 2 diabetes (T2D); people with T2D have a 32% higher risk of developing PD (2). South Asian communities (Indian and Bangladeshi) are at particularly high risk of T2D (3), yet remain underrepresented in PD research. Because maladaptive decision-making in PD may develop through a range of mechanisms, it is crucial to examine whether PD affects the brain differently across ethnic groups and T2D-like metabolic backgrounds, particularly in diverse regions such as East London.

This project will study how people with PD from different ethnic backgrounds make decisions, and whether these differences relate to biological factors such as genetics or diabetes-related markers. Participants will complete a reversal learning task while wearing an EEG cap, recording neural activity across the cortex. We will relate this data to blood markers linked to diabetes and analyse genetic variation. By combining brain activity, behaviour, and biological data, we aim to discover whether distinct “pathways” in the body and brain lead to similar decision-making impairments in PD. Findings could help explain why symptoms vary across individuals and communities. In the long term, this research could guide more personalised PD treatments, ensure therapies are effective for diverse populations, and help reduce health inequalities in East London.

Aims and Objectives:

Aim 1: Identify ethnicity-related biomarkers of decision-making flexibility in PD.

Determine behavioural and neural markers of flexible decision-making in PD across ethnic groups, focusing on South Asian vs. White British patients who are ideally matched for age, disease duration, and socio-economic background.

Aim 2: Derive EEG-based neural biomarkers of decision-making. Extract cortical biomarkers from EEG during a tactile probabilistic reversal learning task, with emphasis on the fronto-parietal network, a key circuit for cognitive flexibility.

Aim 3: Link neural biomarkers to genetic and metabolic factors.

Investigate how EEG-derived biomarkers relate to genetic data (e.g., Single Nucleotide Polymorphisms (SNPs)), metabolic markers, and liver function indicators associated with T2D. Assess whether these biological factors help explain the neural differences observed between ethnic groups. This aim is informed by recent advances in modelling PD risk and early disease markers, which emphasise the value of integrating genetic, metabolic, and behavioural predictors into unified mechanistic frameworks.

References:

  1. Klanker M, Feenstra M, Denys D. (2013). Dopaminergic control of cognitive flexibility in humans and animals. Front Neurosci.
  2. de Pablo-Fernandez E, Goldacre R, Pakpoor J, Noyce AJ, Warner TT. (2018). Association between diabetes and subsequent Parkinson disease: A record-linkage cohort study. Neurology.
  3. Di Luca DG, et al. (2020). Minority Enrollment in Parkinson's Disease Clinical Trials: Meta-Analysis and Systematic Review of Studies Evaluating Treatment of Neuropsychiatric Symptoms. J Parkinsons Dis.
  4. Ben-Joseph, A., Marshall, C. R., Lees, A. J., Noyce, A. J. (2020). Ethnic Variation in the Manifestation of Parkinson’s Disease: A Narrative Review. Journal of Parkinson’s Disease.
  5. Zirra, A., Dey, K.C., Camboe, E. et al. (2025). The East London Parkinson’s disease project – a case-control study of Parkinson’s Disease in a diverse population. npj Parkinsons Dis.
  6. Wang B. A., Veismann M., Banerjee, A., Pleger B. (2023). Human orbitofrontal cortex signals decision outcomes to sensory cortex during behavioral adaptations. Nature Communications.

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