{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T15:16:51Z","timestamp":1778253411207,"version":"3.51.4"},"reference-count":28,"publisher":"Elsevier BV","issue":"5","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"funder":[{"DOI":"10.13039\/501100004731","name":"Zhejiang Province Natural Science Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004731","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004835","name":"Zhejiang University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004835","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cell.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Med"],"published-print":{"date-parts":[[2026,5]]},"DOI":"10.1016\/j.medj.2026.101071","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T15:19:40Z","timestamp":1774883980000},"page":"101071","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pyramidal signs in Huntington\u2019s disease: An early clinical indicator associated with proximity to disease onset"],"prefix":"10.1016","volume":"7","author":[{"given":"Xiao-Yan","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Feng","family":"Bao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen-Chang","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Dong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2106-572X","authenticated-orcid":false,"given":"Zhi-Ying","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.medj.2026.101071_bib1","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.14336\/AD.2018.0911","article-title":"Clinical and genetic profiles in Chinese patients with Huntington's disease: a ten-year multicenter study in China","volume":"10","author":"Li","year":"2019","journal-title":"Aging Dis."},{"key":"10.1016\/j.medj.2026.101071_bib2","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1093\/brain\/awab367","article-title":"Imbalanced basal ganglia connectivity is associated with motor deficits and apathy in Huntington's disease","volume":"145","author":"Nair","year":"2022","journal-title":"Brain"},{"key":"10.1016\/j.medj.2026.101071_bib3","doi-asserted-by":"crossref","first-page":"4532","DOI":"10.1093\/brain\/awad275","article-title":"Genetic topography and cortical cell loss in Huntington's disease link development and neurodegeneration","volume":"146","author":"Estevez-Fraga","year":"2023","journal-title":"Brain"},{"key":"10.1016\/j.medj.2026.101071_bib4","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.1002\/mds.29228","article-title":"Prevalence and incidence of Huntington's disease: an updated systematic review and meta-analysis","volume":"37","author":"Medina","year":"2022","journal-title":"Mov. Disord."},{"key":"10.1016\/j.medj.2026.101071_bib5","first-page":"43","article-title":"Huntington's disease in Hong Kong Chinese: epidemiology and clinical picture","volume":"31","author":"Chang","year":"1994","journal-title":"Clin. Exp. Neurol."},{"key":"10.1016\/j.medj.2026.101071_bib6","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1159\/000109899","article-title":"Epidemiological and genetic studies of Huntington's disease in the San-in area of Japan","volume":"15","author":"Nakashima","year":"1996","journal-title":"Neuroepidemiology"},{"key":"10.1016\/j.medj.2026.101071_bib7","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1111\/ene.14072","article-title":"Haplotype analysis encompassing HTT gene in Chinese patients with Huntington's disease","volume":"27","author":"Li","year":"2020","journal-title":"Eur. J. Neurol."},{"key":"10.1016\/j.medj.2026.101071_bib8","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1002\/mds.29430","article-title":"Application value of serum neurofilament light protein for disease staging in Huntington's disease","volume":"38","author":"Li","year":"2023","journal-title":"Mov. Disord."},{"key":"10.1016\/j.medj.2026.101071_bib9","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s40035-023-00359-9","article-title":"Perivascular spaces relate to the course and cognition of Huntington's disease","volume":"12","author":"Li","year":"2023","journal-title":"Transl. Neurodegener."},{"key":"10.1016\/j.medj.2026.101071_bib10","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1111\/cns.12844","article-title":"Disrupted striatal neuron inputs and outputs in Huntington's disease","volume":"24","author":"Reiner","year":"2018","journal-title":"CNS Neurosci. Ther."},{"key":"10.1016\/j.medj.2026.101071_bib11","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/j.neuron.2023.12.009","article-title":"Selective vulnerability of layer 5a corticostriatal neurons in Huntington's disease","volume":"112","author":"Pressl","year":"2024","journal-title":"Neuron"},{"key":"10.1016\/j.medj.2026.101071_bib12","first-page":"1464","article-title":"Widespread increased diffusivity reveals early cortical degeneration in Huntington disease","volume":"40","author":"Sampedro","year":"2019","journal-title":"AJNR. Am. J. Neuroradiol."},{"key":"10.1016\/j.medj.2026.101071_bib13","doi-asserted-by":"crossref","DOI":"10.1016\/j.nicl.2019.101913","article-title":"Cortical neurodevelopment in pre-manifest Huntington's disease","volume":"23","author":"Kubera","year":"2019","journal-title":"Neuroimage. Clin."},{"key":"10.1016\/j.medj.2026.101071_bib14","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/S1474-4422(22)00120-X","article-title":"A biological classification of Huntington's disease: the integrated staging system","volume":"21","author":"Tabrizi","year":"2022","journal-title":"Lancet Neurol."},{"key":"10.1016\/j.medj.2026.101071_bib15","doi-asserted-by":"crossref","first-page":"407","DOI":"10.3233\/JHD-220542","article-title":"The Chinese version of UHDRS in Huntington's disease: reliability and validity assessment","volume":"11","author":"Li","year":"2022","journal-title":"J. Huntingtons Dis."},{"key":"10.1016\/j.medj.2026.101071_bib16","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1093\/brain\/awn025","article-title":"Cerebral cortex and the clinical expression of Huntington's disease: complexity and heterogeneity","volume":"131","author":"Rosas","year":"2008","journal-title":"Brain"},{"key":"10.1016\/j.medj.2026.101071_bib17","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.biopsych.2020.11.009","article-title":"Dynamics of cortical degeneration over a decade in Huntington's disease","volume":"89","author":"Johnson","year":"2021","journal-title":"Biol. Psychiatry"},{"key":"10.1016\/j.medj.2026.101071_bib18","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.nrl.2016.04.012","article-title":"Relevance of the pyramidal syndrome in amyotrophic lateral sclerosis","volume":"33","author":"\u00c1lvarez","year":"2018","journal-title":"Neurologia"},{"key":"10.1016\/j.medj.2026.101071_bib19","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1002\/acn3.51576","article-title":"Clinicopathological correlates of pyramidal signs in multiple system atrophy","volume":"9","author":"Lin","year":"2022","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"10.1016\/j.medj.2026.101071_bib20","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s12883-019-1270-1","article-title":"Pyramidal system involvement in progressive supranuclear palsy - a clinicopathological correlation","volume":"19","author":"Stejskalova","year":"2019","journal-title":"BMC Neurol."},{"key":"10.1016\/j.medj.2026.101071_bib21","doi-asserted-by":"crossref","first-page":"317","DOI":"10.3389\/fnhum.2016.00317","article-title":"Corticostriatal dysfunction in Huntington's disease: the basics","volume":"10","author":"Bunner","year":"2016","journal-title":"Front. Hum. Neurosci."},{"key":"10.1016\/j.medj.2026.101071_bib22","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1006\/nbdi.2002.0528","article-title":"Pyramidal cell loss in motor cortices in Huntington's disease","volume":"10","author":"Macdonald","year":"2002","journal-title":"Neurobiol. Dis."},{"key":"10.1016\/j.medj.2026.101071_bib23","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.nbd.2016.08.015","article-title":"Symptom heterogeneity in Huntington's disease correlates with neuronal degeneration in the cerebral cortex","volume":"96","author":"Mehrabi","year":"2016","journal-title":"Neurobiol. Dis."},{"key":"10.1016\/j.medj.2026.101071_bib24","doi-asserted-by":"crossref","first-page":"4440","DOI":"10.1523\/JNEUROSCI.2812-14.2015","article-title":"Cortical efferents lacking mutant huntingtin improve striatal neuronal activity and behavior in a conditional mouse model of Huntington's disease","volume":"35","author":"Estrada-S\u00e1nchez","year":"2015","journal-title":"J. Neurosci."},{"key":"10.1016\/j.medj.2026.101071_bib25","doi-asserted-by":"crossref","first-page":"2670","DOI":"10.1093\/cercor\/bhu065","article-title":"The corticospinal tract in Huntington's disease","volume":"25","author":"Phillips","year":"2015","journal-title":"Cereb. Cortex"},{"key":"10.1016\/j.medj.2026.101071_bib26","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1002\/ajmg.b.30992","article-title":"CAG-repeat length and the age of onset in Huntington disease (HD): a review and validation study of statistical approaches","volume":"153B","author":"Langbehn","year":"2010","journal-title":"Am. J. Med. Genet. B Neuropsychiatr. Genet."},{"key":"10.1016\/j.medj.2026.101071_bib27","doi-asserted-by":"crossref","first-page":"2495","DOI":"10.1212\/WNL.0000000000004743","article-title":"Motor, cognitive, and functional declines contribute to a single progressive factor in early HD","volume":"89","author":"Schobel","year":"2017","journal-title":"Neurology"},{"key":"10.1016\/j.medj.2026.101071_bib28","doi-asserted-by":"crossref","DOI":"10.1016\/j.media.2023.102789","article-title":"Synthseg: segmentation of brain MRI scans of any contrast and resolution without retraining","volume":"86","author":"Billot","year":"2023","journal-title":"Med. Image Anal."}],"container-title":["Med"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2666634026000747?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2666634026000747?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T15:09:08Z","timestamp":1778252948000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2666634026000747"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":28,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["S2666634026000747"],"URL":"https:\/\/doi.org\/10.1016\/j.medj.2026.101071","relation":{},"ISSN":["2666-6340"],"issn-type":[{"value":"2666-6340","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Pyramidal signs in Huntington\u2019s disease: An early clinical indicator associated with proximity to disease onset","name":"articletitle","label":"Article Title"},{"value":"Med","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.medj.2026.101071","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"101071"}}