The dopaminergic neurons within the substantia nigra pars compacta form five clusters (nigrosomes 1-5 [N1-N5]), and N1 has been considered to be the most affected, followed by N2, N4, N3, and N5 in Parkinson’s disease (PD). Recently, N4 was defined on 3T MRI and found to be involved in late-stage PD compared to N1, suggesting sequential involvement from N1 to N4. We found wider cortical thinning in patients with N4 loss compared to those with N1 loss, similar to the cortical thinning propagation pattern seen with PD progression, which supports the sequential progression hypothesis.
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