Neuropathological mechanisms of Parkinson’s disease with GBA1 mutations (GBA-PD) are still unclear. We evaluated the white and gray matter of patients with early-stage GBA-PD using free water (FW) imaging. Patients with GBA-PD showed higher FW-corrected fractional anisotropy and lower FW-corrected mean diffusivity in the anterior thalamic radiation, forceps minor, and uncinate fasciculus, reflecting compensatory reorganization of neural circuits. Meanwhile, neuroinflammation (indexed by higher FW) was detected in the substantia nigra pars compacta (SNpc; Braak stage III), temporal mesocortex (Braak stage IV), forceps major, and cingulum cingulate gyrus. Furthermore, FW in the SNpc was positively correlated with the motor assessment scale.
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