'which would mean their acetylcholine could be high and anticholinergic activity disabled and not working.'

Paula,
My understanding is that acetylcholine levels do not go higher, instead an imbalance occurs between acetycholine and dopamine, in other words it is high relative to dopamine. On the other hand thinking about the way that the body works all the time to maintain the right balance of chemicals of all kinds it seems logical that dopamine replacement therapies would stress any balancing mechanisms due to both fluctuating levels in blood and brain, and the breakdown of excess ldopa. This could account for both the low levels in early PD (where the body is trying to keep itself balanced) and the imbalance in late stages (where the whole system is unable to 'understand' how to balance itself due to disregulation from both lack of natural dopamine and replacement drugs).

Ron's statement about one pushes and one pulls is right, and from past reading I believe it it this imbalance that causes tremor - hence increased tremor for some patients who take anti-cholinergic drugs that give benefits for other symptoms, especially if they have not fine-tuned the medication they are taking. And you are, I think, right about it sounding like dystonia too. another manifestation of imbalance between the two.

If this IS a significant piece of research, then there are more than a few issues that arise from it, especially if it can be determined that 'basal forebrain cholinergic system degeneration appears early in PD '. It actually changes the picture of PD and the SN........., weren't early treatments often this class of drug? If so then did doctors then have an understanding of PD that is now not fashionable, but could still be relevant?

My guess is that anti-cholinergic treatments, and their effects probably need to be monitored with as much care as ldopa, so that fragile balancing acts within the brain are not further impaired. And right from the start, by involving the patient early on in being vigilant about their treatment, and encouraging people to observe body response to medication and working with their doctors.

I know the science is your thing, the end result of that science is mine!! So apologies for coming in from a different angle.......
Thanks for opening up a different line of thinking,

Lindy