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All patients underwent comprehensive neuropsychiatric assessments. Using spatial independent component analysis, the study identified independent metabolic networks and examined their correlations with clinical features and striatal dopaminergic binding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three distinct metabolic networks were identified in PSP: The first network demonstrated hypometabolism in dorsomedial thalamus (dmT), medial prefrontal cortex (mPFC) and midbrain, termed the dmT\u2010mPFC network, negatively correlating with disease severity, functional disability and duration, and associating with gait\/midline disturbances and ocular dysfunction. The second network displayed posterior cingulate cortex (PCC) and lateral prefrontal hypometabolism (LPFC), named the PCC\u2010LPFC network, linking to disease severity, cognitive impairment, and parkinsonism. The third network exhibited preserved putamen metabolism with ventrolateral thalamus and sensorimotor cortex hypermetabolism, inversely relating to disease duration. Both dmT\u2010mPFC and PCC\u2010LPFC networks strongly correlated with striatal dopaminergic degeneration. The test set showed strong associations between cognitive impairment and the PCC\u2013LPFC network, and between functional disability and the dmT\u2013mPFC network, along with potential trends linking disease severity to these networks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The robust clinical and dopaminergic\u2010related independent metabolic networks offer novel insights into disease pathophysiology, whereas their qualitative weighting offers a potential tool for staging disease severity. \u00a9 2025 International Parkinson and Movement Disorder Society.<\/jats:p>\n                  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