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Previous studies have suggested that mild behavioral impairment (MBI) should be considered an early marker of cognitive decline. However, the precise neurostructural underpinnings of MBI in early\u2010 to mid\u2010stage PD remain poorly understood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim was to explore the changes in white matter microstructure linked to MBI and mild cognitive impairment (MCI) in early\u2010 to mid\u2010stage PD using diffusion magnetic resonance imaging (dMRI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 91 PD patients and 36 healthy participants were recruited and underwent anatomical MRI and dMRI, a comprehensive neuropsychological battery, and the completion of the Mild Behavioral Impairment\u2010Checklist. Metrics of white matter integrity included tissue fractional anisotropy (FAt) and radial diffusivity (RDt), free water (FW), and fixel\u2010based apparent fiber density (AFD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The connection between the left amygdala and the putamen was disrupted when comparing PD patients with MBI (PD\u2010MBI) to PD\u2010non\u2010MBI, as evidenced by increased RDt (<jats:italic>\u03b7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.09, <jats:italic>P<\/jats:italic>\u2009=\u20090.004) and both decreased AFD (<jats:italic>\u03b7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.05, <jats:italic>P<\/jats:italic>\u2009=\u20090.048) and FAt (<jats:italic>\u03b7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.12, <jats:italic>P<\/jats:italic>\u2009=\u20090.014). Compared to controls, PD patients with both MBI and MCI demonstrated increased FW for the connection between the left orbitofrontal gyrus (OrG) and the hippocampus (<jats:italic>\u03b7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.22, <jats:italic>P<\/jats:italic>\u2009=\u20090.008), augmented RDt between the right OrG and the amygdala (<jats:italic>\u03b7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.14, <jats:italic>P<\/jats:italic>\u2009=\u20090.008), and increased RDt (<jats:italic>\u03b7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.25, <jats:italic>P<\/jats:italic>\u2009=\u20090.028) with decreased AFD (<jats:italic>\u03b7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.10, <jats:italic>P<\/jats:italic>\u2009=\u20090.046) between the right OrG and the caudate nucleus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>MBI is associated with abnormal microstructure of connections involving the orbitofrontal cortex, putamen, and amygdala. To our knowledge, this is the first assessment of the white matter microstructure in PD\u2010MBI using dMRI. \u00a9 2024 The Authors. <jats:italic>Movement Disorders<\/jats:italic> published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mds.29804","type":"journal-article","created":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T09:34:17Z","timestamp":1714037657000},"page":"1026-1036","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["White Matter Microstructural Underpinnings of Mild Behavioral Impairment in Parkinson's Disease"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2148-5409","authenticated-orcid":false,"given":"Oury","family":"Monchi","sequence":"first","affiliation":[{"name":"Centre de recherche de l'Institut universitaire de g\u00e9riatrie de Montr\u00e9al  Montreal Quebec 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