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We compared the ability of three commonly used neuroimaging modalities to detect cortical changes in PD patients with mild cognitive impairment (PD-MCI) and dementia (PDD).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>53 cognitively normal PD patients (PD-CN), 32 PD-MCI, and 35 PDD underwent concurrent structural MRI (sMRI), diffusion-weighted MRI (dMRI), and [<jats:sup>18<\/jats:sup>F]FDG PET. We extracted grey matter volumes (sMRI), mean diffusivity (MD, dMRI), and standardized uptake value ratios ([<jats:sup>18<\/jats:sup>F]FDG PET) for 52 cortical regions included in a neuroanatomical atlas. We assessed group differences using ANCOVA models and further applied a cross-validated machine learning approach to identify the modality-specific brain regions that are most indicative of dementia status and assessed their diagnostic accuracy for group separation using receiver operating characteristic analyses.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In sMRI, atrophy of temporal and posterior-parietal areas allowed separating PDD from PD-CN (AUC\u2009=\u20090.77\u2009\u00b1\u20090.07), but diagnostic accuracy was poor for separating PD-MCI from PD-CN (0.57\u2009\u00b1\u20090.10). dMRI showed most pronounced diffusivity changes in the medial temporal lobe, which provided excellent diagnostic performance for PDD (AUC\u2009=\u20090.87\u2009\u00b1\u20090.06), and a more modest but still significant performance for PD-MCI (AUC\u2009=\u20090.71\u2009\u00b1\u20090.09). Finally, [<jats:sup>18<\/jats:sup>F]FDG PET revealed pronounced hypometabolism in posterior-occipital regions, which provided the highest diagnostic accuracies for both PDD (AUC\u2009=\u20090.89\u2009\u00b1\u20090.05) and PD-MCI (AUC\u2009=\u20090.78\u2009\u00b1\u20090.05). In statistical comparisons, both [<jats:sup>18<\/jats:sup>F]FDG PET (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and dMRI (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.031) outperformed sMRI for detecting PDD and PD-MCI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Among the tested modalities, [<jats:sup>18<\/jats:sup>F]FDG PET was most accurate for detecting cortical changes associated with cognitive impairment in PD, especially at early stages. Diffusion measurements may represent a promising MRI-based alternative.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00259-025-07070-z","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T07:49:26Z","timestamp":1738309766000},"page":"2002-2014","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Imaging biomarkers of cortical neurodegeneration underlying cognitive impairment in Parkinson\u2019s disease"],"prefix":"10.1007","volume":"52","author":[{"given":"Jes\u00fas","family":"Silva-Rodr\u00edguez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel \u00c1ngel","family":"Labrador-Espinosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Castro-Labrador","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Mu\u00f1oz-Delgado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Franco-Rosado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Mar\u00eda","family":"Castellano-Guerrero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Mac\u00edas-Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Jes\u00fas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid D.","family":"Adarmes-G\u00f3mez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e1tima","family":"Carrillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Francisco","family":"Mart\u00edn-Rodr\u00edguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Garc\u00eda-Sol\u00eds","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florinda","family":"Rold\u00e1n-Lora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Mir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2600-9022","authenticated-orcid":false,"given":"Michel J.","family":"Grothe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"key":"7070_CR1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jns.2017.01.012","volume":"374","author":"HA Hanagasi","year":"2017","unstructured":"Hanagasi HA, Tufekcioglu Z, Emre M. 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