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-----Original Message-----
From: Parkinson's Information Exchange Network
[mailto:[log in to unmask]] On Behalf Of mschild
Sent: Thursday, December 17, 2009 10:00 AM
To: [log in to unmask]
Subject: Falls in PD Correlate with Cholinergic, not Dopaminergic,
Dysfunction

 

Loss of cholinergic function predicts falling in Parkinson's disease, 
according to a new study, independent of dopaminergic denervation.

Seventeen PD patients with a history of falls, 27 PD patients without such 
history, and 15 controls underwent radioimaging with tracers for cholinergic

and dopaminergic activity. Both PD groups had reduced dopaminergic function 
compared to controls, but were not significantly different from each other. 
Compared to controls, combined cortical and thalamic cholinergic function
was 
reduced in PD non-fallers (-6.6%) and was even worse in fallers (-12.3%).
The 
same pattern held true for cortical function alone. In contrast, thalamic 
cholinergic function was reduced compared to controls only in fallers. 

"Thalamic acetylcholinesterase activity derives mainly from terminals of 
brainstem pedunculopontine nucleus neurons that play a role in the
generation 
of movement," the authors state, "and loss of AChE is likely to reflect PPN 
neuron dysfunction or degeneration. Our results are consistent with a key
role 
for the PPN in the maintenance of balance in humans and with PPN 
dysfunction/degeneration as a cause of impaired postural control and gait in

PD." They suggest that cholinergic therapy may have a role to play in 
treatment of gait disorder in PD, but "it is uncertain whether the current 
generation of cholinesterase inhibitors have sufficient brain penetrance to 
produce meaningful clinical benefits."

History of falls in Parkinson disease is associated with reduced cholinergic

activity
NI Bohnen, MLTM Muller, RA Koeppe, SA studenski, MA Kilbourn, KA Frey, RL 
Albin
Neurology 2009;73:1670-1676

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