Diffusion tensor imaging (DTI) characterizes microstructural changes in the basal ganglia in relation to idiopathic Parkinson's disease (PD). However, inconsistent results due to short-interval longitudinal studies with heterogeneous neuropathology across PD stages have been reported. We elucidated microstructural changes in the deep gray nuclei throughout the disease course in a large, prospective, three time-point case-control DTI study in PD over twelve years, with six-year interval gaps. Increased mean striatal diffusivity reflected progressive neurodegeneration, whereas factional anisotropy changes suggested effects of abnormal iron accumulation followed by neuronal loss in the putamen and thalamus as the disease progresses into the late stages.
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