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The left nigrostriatal system appears more susceptible to early degeneration than the right, and a left\u2010lateralized pattern of early neuropathological changes is also described in several neurodegenerative conditions, including Alzheimer's disease, frontotemporal dementia, and Huntington's disease. In this study, we evaluated hemispheric differences in estimated rates of atrophy in a large, well\u2010characterized cohort of <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content> patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Our cohort included 205 <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content> patients who underwent clinical assessments and T1\u2010weighted brain <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>'s. Patients were classified into Early (<jats:italic>n\u00a0<\/jats:italic>=\u00a0109) and Late stage (<jats:italic>n\u00a0<\/jats:italic>=\u00a096) based on disease duration, defined as greater than or less than 10\u00a0years of motor symptoms. Cortical thickness was determined using FreeSurfer, and a bootstrapped linear regression model was used to estimate differences in rates of atrophy between Early and Late patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our results show that patients classified as Early stage exhibit a greater estimated rate of cortical atrophy in left frontal regions, especially the left insula and olfactory sulcus. This pattern was replicated in left\u2010handed patients, and was not influenced by the degree of motor symptom asymmetry (i.e., left\u2010sided predominant motor symptoms). Patients classified as Late stage exhibited greater atrophy in the bilateral occipital, and right hemisphere\u2010predominant cortical areas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We show that cortical degeneration in <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content> differs between cerebral hemispheres, and findings suggest a pattern of early left, and late right hemisphere with posterior cortical atrophy. Further investigation is warranted to elucidate the underlying mechanisms of this asymmetry and pathologic implications.<\/jats:p><\/jats:sec>","DOI":"10.1002\/brb3.573","type":"journal-article","created":{"date-parts":[[2016,10,13]],"date-time":"2016-10-13T02:34:16Z","timestamp":1476326056000},"source":"Crossref","is-referenced-by-count":115,"title":["Cortical asymmetry in Parkinson's disease: early susceptibility of the left hemisphere"],"prefix":"10.1002","volume":"6","author":[{"given":"Daniel O.","family":"Claassen","sequence":"first","affiliation":[{"name":"Department of Neurology Vanderbilt University  Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine E.","family":"McDonell","sequence":"additional","affiliation":[{"name":"Department of Neurology Vanderbilt University  Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manus","family":"Donahue","sequence":"additional","affiliation":[{"name":"Vanderbilt 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