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We investigated OT\u2010related white matter changes and their correlations with scores from a neuropsychological testing battery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Diffusion tensor imaging measures were compared between 14 OT patients and 14 age\u2010 and education\u2010matched healthy controls, using whole\u2010brain\u00a0tract\u2010based spatial statistics analysis. Correlations between altered diffusion metrics and cognitive performance in OT group were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all cognitive domains (attention, executive function, visuospatial ability, verbal memory, visual memory, and language), OT patients\u2019 cognitive performance was significantly worse than that of healthy controls. OT patients demonstrated altered diffusivity metrics not only in the posterior lobe of the cerebellum (left cerebellar lobule VI) and in its efferent cerebellar fibers (left superior cerebellar peduncle), but also in medial lemniscus bilaterally (pontine tegmentum), anterior limb of the internal capsule bilaterally, right posterior limb of the internal capsule, left anterior corona radiata, right insula, and the splenium of corpus callosum. No relationship was found between diffusion measures and disease duration in OT patients. Diffusion white matter changes, mainly those located in right anterior limb of the internal capsule, were correlated with poor performance on tests of executive function, visuospatial ability, verbal memory, and visual memory in OT patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>White matter changes were preferentially located in the cerebellum, its efferent pathways, as well as in the pontine tegmentum and key components of the frontal\u2013thalamic\u2013cerebellar circuit. Further work needs to be done to understand the evolution of these white matter changes and their functional consequences.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.50916","type":"journal-article","created":{"date-parts":[[2019,10,7]],"date-time":"2019-10-07T03:45:00Z","timestamp":1570419900000},"page":"2212-2222","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Diffusion tensor imaging in orthostatic tremor: a tract\u2010based spatial statistics study"],"prefix":"10.1002","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1769-4809","authenticated-orcid":false,"given":"Juli\u00e1n","family":"Benito\u2010Le\u00f3n","sequence":"first","affiliation":[{"name":"Department of Neurology University Hospital \u201c12 de Octubre\u201d Madrid Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Madrid Spain"},{"name":"Department of Medicine 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