Varenicline for the Treatment of Postural and Gait Dysfunction in Parkinson Disease

α7-Nicotinic Acetylcholine Receptor and Mutated α-Synuclein Interact in Motor Behaviour and Nigrostriatal Dopamine-Findings With Potential Relevance for a Protective Effect of Cigarette Smoking and Parkinson's Disease

Parkinson's disease (PD) occurs less frequently in cigarette smokers than in nonsmokers. Assuming that nicotinic acetylcholine receptors are periodically active by activation through endogenous acetylcholine, we tested whether they act against the effect of α-synuclein, a protein relevant in PD. Transgenic mice with a human α-synuclein containing two mutations that cause familial PD were crossed with mice lacking the nicotinic α7-acetylcholine receptor. Vertical movements determined at 7 and 16 months and nonambulatory movements at 16 months of age were significantly lower in mice with α7-acetylcholine receptor knockout if they express the mutated α-synuclein but not in mice with α-synuclein wild type. Striatal noradrenaline, serotonin and dopamine levels did not differ between the four groups of mice at 21 months; however, striatal dopamine turnover was significantly higher in mice without than with α7-acetylcholine receptor. Stereological counts of nigral cells positive for tyrosine hydroxylase in the left and right hemisphere at 21 months revealed that asymmetry was also significantly higher in mice without than with α7-acetylcholine receptor. In conclusion, up to the age of 16 months, there was no obvious PD behaviour; however, absence of the α7-acetylcholine receptor generally reduced several features of motor behaviour and showed a statistically significant interaction between α7-acetylcholine receptor and mutated α-synuclein. The asymmetry of nigral cell counts and the increased striatal dopamine turnover suggest a stressed nigrostriatal system in mice without α7-acetylcholine receptor and that the neuroprotective effect of smoking might at least partly be mediated by the nicotine in the cigarettes acting via α7-acetylcholine receptors.

Falling Short: The Contribution of Central Insulin Receptors to Gait Dysregulation in Brain Aging

Insulin resistance, which manifests as a reduction of insulin receptor signaling, is known to correlate with pathological changes in peripheral tissues as well as in the brain. Central insulin resistance has been associated with impaired cognitive performance, decreased neuronal health, and reduced brain metabolism; however, the mechanisms underlying central insulin resistance and its impact on brain regions outside of those associated with cognition remain unclear. Falls are a leading cause of both fatal and non-fatal injuries in the older population. Despite this, there is a paucity of work focused on age-dependent alterations in brain regions associated with ambulatory control or potential therapeutic approaches to target these processes. Here, we discuss age-dependent alterations in central modalities that may contribute to gait dysregulation, summarize current data supporting the role of insulin signaling in the brain, and highlight key findings that suggest insulin receptor sensitivity may be preserved in the aged brain. Finally, we present novel results showing that administration of insulin to the somatosensory cortex of aged animals can alter neuronal communication, cerebral blood flow, and the motivation to ambulate, emphasizing the need for further investigations of intranasal insulin as a clinical management strategy in the older population.

Newly Approved and Investigational Drugs for Motor Symptom Control in Parkinson's Disease

Motor symptoms are a core feature of Parkinson's disease (PD) and cause a significant burden on patients' quality of life. Oral levodopa is still the most effective treatment, however, the motor benefits are countered by inherent pharmacologic limitations of the drug. Additionally, with disease progression, chronic levodopa leads to the appearance of motor complications including motor fluctuations and dyskinesia. Furthermore, several motor abnormalities of posture, balance, and gait may become less responsive to levodopa. With these unmet needs and our evolving understanding of the neuroanatomic and pathophysiologic underpinnings of PD, several advances have been made in defining new therapies for motor symptoms. These include newer levodopa formulations and drug delivery systems, refinements in adjunctive medications, and non-dopaminergic treatment strategies. Although some are in early stages of development, these novel treatments potentially widen the available options for the management of motor symptoms allowing clinicians to provide an individually tailored care for PD patients. Here, we review the existing and emerging interventions for PD with focus on newly approved and investigational drugs for motor symptoms, motor fluctuations, dyskinesia, and balance and gait dysfunction.