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A total of 70 early\u2010stage, drug\u2010na\u00efve patients with PD and 70 age\u2010 and sex\u2010matched healthy controls (HCs) were selected from the Parkinson's Progression Markers Initiative database for cross\u2010sectional analysis. Longitudinal data at 4\u2010year follow\u2010up were available for the PD group. Glymphatic function was evaluated using DTI\u2010ALPS, and dopaminergic function using DAT\u2010SBR derived from DAT\u2010SPECT imaging. Clinical motor and non\u2010motor assessments were performed at baseline and follow\u2010up. Correlations between imaging index and clinical variables were analyzed using Spearman correlation and multivariate regression. At baseline, both DTI\u2010ALPS and DAT\u2010SBR index were significantly lower in PD patients compared to HCs. Notably, no significant correlation was observed between ALPS and SBR index. Clinically, the DTI\u2010ALPS index showed negative correlations with body mass index, disease duration, Hoehn and Yahr stage, and UPDRS III scores, and its longitudinal decline correlated with white matter microstructural degeneration. The DAT\u2010SBR index was negatively correlated with Epworth Sleepiness Scale, REM sleep behavior disorder score, and serum urate. Our findings suggest that glymphatic dysfunction and nigrostriatal denervation represent independent, parallel pathological trajectories in early PD. While the ALPS index may serve as a potential imaging marker of structural network integrity linked to motor execution. These indices offer distinct, complementary mechanistic insights into PD pathology.<\/jats:p>","DOI":"10.1002\/hbm.70477","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:04:15Z","timestamp":1772967855000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Longitudinal Neuroimaging Reveals Divergent Clinical Associations of Glymphatic Dysfunction and Dopaminergic Degeneration in Parkinson's Disease"],"prefix":"10.1002","volume":"47","author":[{"given":"Taiyuan","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Medical Imaging Zhengzhou University People's Hospital &amp; Henan Provincial People's Hospital  Zhengzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging Zhengzhou University People's Hospital &amp; Henan Provincial People's 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