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Positron emission tomography imaging of the cholinergic system in parkinsonian tremor

Lookup NU author(s): Emeritus Professor David Brooks, Professor Nicola PaveseORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2026 The AuthorsIntroduction: It is believed that anticholinergics alleviate tremor and rigidity in Parkinson's (PD) by counteracting a relative cholinergic overactivity in motor regions, but this remains unclear. This study aimed to investigate possible cholinergic alterations in tremor dominant (TD) PD that may back use of anticholinergics. Methods: Twelve PD patients [six with TD and six with non-tremor dominant (nTD) phenotype] and six healthy controls (HC) underwent cholinergic positron emission tomography with [11C]-donepezil. Participants were assessed with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale. Results: We found no increases of [11C]-donepezil binding in cortical or subcortical areas of either PD group compared with HC. Compared with HC, [11C]-donepezil binding was significantly decreased in the thalamus of nTD patients (p = 0.0463) but not in TD patients. This was confirmed by voxel-wise analyses that found further significant decreases in hippocampus, caudate, parahippocampus, cerebellar vermis, and lower part of mesencephalon of nTD PD patients compared with HC (p = 0.000). However, no significant differences in [11C]-donepezil binding were found in the direct comparison between TD and nTD PD patients. Conclusion: Our study provides evidence that TD PD patients might have relatively preserved cholinergic function in tremor-associated regions. However, anticholinergics should be used with caution when treating parkinsonian tremor due to their side effect profile.

Publication metadata

Author(s): Terkelsen MH, Baun AM, Stokholm MG, Danielsen EH, Moller M, Valdemarsen RN, Moller A, Brooks DJ, Tolosa E, Pavese N

Publication type: Article

Publication status: Published

Journal: Parkinsonism and Related Disorders

Year: 2026

Volume: 144

Online publication date: 26/01/2026

Acceptance date: 26/01/2026

Date deposited: 16/02/2026

ISSN (print): 1353-8020

ISSN (electronic): 1873-5126

Publisher: Elsevier Ltd

URL: https://doi.org/10.1016/j.parkreldis.2026.108212

DOI: 10.1016/j.parkreldis.2026.108212

Data Access Statement: Sharing of data require a formal data sharing agreement approved by the local ethics committees.

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