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Recent findings suggest an inability to efficaciously utilize vestibular information during static posturography among people with Parkinson\u2019s disease who exhibit freezing of gait, with associated changes in cholinergic system integrity as assessed by vesicular acetylcholine transporter PET. There is a lack of adequate understanding of how postural control varies as a function of available sensory information in patients with Parkinson\u2019s disease with freezing of gait. The goal of this cross-sectional study was to examine cerebral cholinergic system changes that associate with inter-sensory postural control processing features as assessed by dynamic computerized posturography and acetylcholinesterase PET.<\/jats:p>\n                  <jats:p>Seventy-five participants with Parkinson\u2019s disease, 16 of whom exhibited freezing of gait, underwent computerized posturography on the NeuroCom\u00a9 Equitest sensory organization test platform, striatal dopamine, and acetylcholinesterase PET scanning. Findings demonstrated that patients with Parkinson\u2019s disease with freezing of gait have greater difficulty maintaining balance in the absence of reliable proprioceptive cues as compared to those without freezing of gait [\u03b2 = 0.28 (0.021, 0.54), P = 0.034], an effect that was independent of disease severity [\u03b2 = 0.16 (0.062, 0.26), P &amp;lt; 0.01] and age [\u03b2 = 0.092 (\u22120.005, 0.19), P = 0.062]. Exploratory voxel-based analysis revealed an association between postural control and right hemispheric cholinergic network related to visual-vestibular integration and self-motion perception. High anti-cholinergic burden predicted postural control impairment in a manner dependent on right hemispheric cortical cholinergic integrity [\u03b2 = 0.34 (0.065, 0.61), P &amp;lt; 0.01].<\/jats:p>\n                  <jats:p>Our findings advance the perspective that cortical cholinergic system might play a role in supporting postural control after nigro-striatal dopaminergic losses in Parkinson\u2019s disease. Failure of cortex-dependent visual-vestibular integration may impair detection of postural instability in absence of reliable proprioceptive cues. Better understanding of how the cholinergic system plays a role in this process may augur novel treatments and therapeutic interventions to ameliorate debilitating symptoms in patients with advanced Parkinson\u2019s disease.<\/jats:p>","DOI":"10.1093\/brain\/awad134","type":"journal-article","created":{"date-parts":[[2023,4,22]],"date-time":"2023-04-22T16:27:28Z","timestamp":1682180848000},"page":"3243-3257","source":"Crossref","is-referenced-by-count":35,"title":["Cholinergic system correlates of postural control changes in Parkinson\u2019s disease freezers"],"prefix":"10.1093","volume":"146","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8823-3287","authenticated-orcid":false,"given":"Stiven","family":"Roytman","sequence":"first","affiliation":[{"name":"Department of Radiology, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"Paalanen","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Griggs","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]},{"name":"Parkinson\u2019s Foundation Research Center of Excellence, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"David","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chatkaew","family":"Pongmala","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]},{"name":"Morris K. Udall Center of Excellence for Parkinson\u2019s Disease Research, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A","family":"Koeppe","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]},{"name":"Morris K. Udall Center of Excellence for Parkinson\u2019s Disease Research, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J H","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uros","family":"Marusic","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]},{"name":"Institute for Kinesiology Research, Science and Research Centre Koper , 6000 Koper ,","place":["Slovenia"]},{"name":"Department of Health Sciences, Alma Mater Europaea\u2014ECM , 2000 Maribor ,","place":["Slovenia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1418-2960","authenticated-orcid":false,"given":"Prabesh","family":"Kanel","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]},{"name":"Parkinson\u2019s Foundation Research Center of Excellence, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]},{"name":"Morris K. Udall Center of Excellence for Parkinson\u2019s Disease Research, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0352-6414","authenticated-orcid":false,"given":"Nicolaas I","family":"Bohnen","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]},{"name":"Department of Neurology, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]},{"name":"Parkinson\u2019s Foundation Research Center of Excellence, University of Michigan , Ann Arbor, MI 48109 ,","place":["USA"]},{"name":"Morris K. 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