Using Varenicline to Reduce Falls in Parkinson's Disease

Reducing Falls With Varenicline in Hypocholinergic Parkinson Disease

This study is testing if the medication Varenicline can help people with Parkinson's disease and mild cognitive issues reduce their risk of falling and improve their ability to walk while doing other tasks.

Quick facts

• Phase: PHASE2
• Study type: Interventional
• Enrollment: 102 (estimated)
• Ages: 45 Years and up
• Sex: All
• Sponsor: University of Michigan (other)
• Drugs / interventions: radiation
• Locations: 1 site (Ann Arbor, Michigan)
• Trial ID: NCT06679374 on ClinicalTrials.gov

What this trial studies

This trial investigates the effectiveness of Varenicline in reducing fall risk and improving multitasking abilities in patients with hypocholinergic Parkinson Disease and Mild Cognitive Impairment. Eligible participants will be randomly assigned to receive either Varenicline or a placebo for one year. The study will involve regular visits, assessments, and imaging to evaluate the impact of the treatment on gait performance and fall risk. The primary goal is to determine if Varenicline can significantly improve dual-task gait performance compared to placebo.

Who should consider this trial

Good fit: Ideal candidates are individuals diagnosed with Parkinson's Disease who exhibit mild cognitive impairment and specific cholinergic denervation.

Not a fit: Patients with atypical Parkinsonian conditions or those on certain dopamine blocking or anticholinergic medications may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could significantly reduce fall risk and enhance mobility in patients with Parkinson's Disease.

How similar studies have performed: While this approach is novel in the context of Parkinson's Disease, similar studies have shown promise in other conditions involving cognitive impairment and fall risk.

Eligibility criteria

Inclusion Criteria:

* Participants with a PD diagnosis based on the Movement Disorders Society Clinical Diagnostic Criteria for Parkinson's Disease at the time of baseline screening/enrollment visit
* Participants with occipital association cortex cholinergic denervation in the lowest tertile of the normal range on F-fluoroethoxybenzovesamicol (FEOBV) Positron Emission Tomography (PET)
* Participants with legally authorized representatives (LARs) able to co-sign documented informed consent or participants that have capacity to provide informed consent upon study enrollment as ascertained by the study-specific University of California, San Diego Brief Assessment of Capacity to Consent (UBACC)
* Mild Cognitive Impairment consistent with Parkinson disease Mild Cognitive Impairment (PD-MCI)

Exclusion Criteria:

* Atypical Parkinsonian conditions other than Parkinson disease (PD)
* Participants initially on certain dopamine blocking drugs (per protocol), specific anticholinergic drugs (trihexyphenidyl, benztropine), or specific cholinesterase inhibitor drugs (per protocol) at the in-person screening visit
* Modified Hoehn and Yahr score of 4.0 or greater at the in-person screening visit
* Current or previous (within last 6 months of in-person screening visit) use of any product or medication containing nicotinic agents, including use of tobacco products such as cigarettes, cigars, pipes, chewing tobacco, etc., e-cigarettes, over the counter (OTC) nicotine patches, chewing gum containing nicotine, or varenicline
* Evidence of a stroke with both cortical and subcortical involvement or occipital lobe mass lesion on structural magnetic brain imaging (MRI) obtained at the in-person screening visit that would preclude co-registration and analysis of FEOBV PET data
* Participants where magnetic resonance imaging (MRI) is contraindicated including, but not limited to, those with a pacemaker, presence of metallic fragments near the eyes or spinal cord, or cochlear implant
* Severe claustrophobia precluding MRI or PET imaging
* Participants limited by participation in research procedures involving ionizing radiation
* Pregnancy (test within 48 hours of the PET imaging session in women of childbearing potential) or breastfeeding at the time of in-person screening visit
* Participants with stage 4 or 5 chronic kidney disease at the time of in-person screening visit (estimated Creatinine Clearance \< 30 milliliters per minute)
* Current, significant mood disorder at the time of in-person screening/enrollment visit defined as follows: persistent (lasting longer than 2 weeks) symptoms of depression or anxiety in the 30 days preceding informed consent, as determined by self-report
* Evidence of active suicidal ideation as defined by an affirmative answer to either question 1 or 2 on the Columbia Suicide Severity Rating Scale (C-SSRS)
* History of a myocardial infarction or unstable angina in the 90 days preceding enrollment visit
* A current or previous history of epilepsy or any epileptic seizures in the 12 months preceding enrollment
* Heavy alcohol use as defined by a score of 8 or greater on the Alcohol Use Disorders Identification Test (AUDIT-self-report version) at the time of screening/enrollment visit
* Participants that are unable to swallow pills
* Participants with a history of allergic reaction to varenicline
* Participants that are actively taking part in another ongoing interventional (i.e., not observational) clinical trial

Where this trial is running

Ann Arbor, Michigan

• University of Michigan — Ann Arbor, Michigan, United States (RECRUITING)

Study contacts

• Principal investigator: Vikas Kotagal, MD — University of Michigan
• Study coordinator: Dawn Keys

Conditions: Parkinson Disease, Mild Cognitive impairment, Multitasking, Reduce falls, Hypocholinergic