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Substantia nigra pars compacta (SNc) degeneration underlies motor symptoms of PD. In iRBD and early PD (ePD), we measured diffusion MRI (dMRI) in the caudal motor SNc, which overlaps the nigrosome-1\u2014the earliest-degenerating dopaminergic neurons in PD\u2014and in the striatum. Nineteen iRBD, 26 ePD (1.7\u2009\u00b1\u20090.03 years), and 46 age-matched healthy controls (HCs) were scanned at Western University, and 47 iRBD, 115 ePD (0.9\u2009\u00b1\u20090.01 years), and 56 HCs were scanned through the Parkinson\u2019s Progression Markers Initiative, using 3T MRI. We segmented the SNc and striatum into subregions using automated probabilistic tractography to the cortex. We measured mean diffusivity (MD) and fractional anisotropy (FA) along white-matter bundles and subregional surfaces. We performed group-level and classification analyses. Increased caudal motor SNc surface MD was the only iRBD-HCs and ePD-HCs difference replicating across datasets (<jats:italic>p<\/jats:italic><jats:sub>adj<\/jats:sub>\u2009&lt;\u20090.05). No iRBD-ePD differences emerged. Caudal motor SNc surface MD classified patient groups from HCs at the <jats:italic>single-subject level<\/jats:italic> with good-to-excellent balanced accuracy in an independent sample (0.91 iRBD and 0.86 iRBD and ePD combined), compared to fair performance for <jats:italic>total<\/jats:italic> SNc surface MD (0.72 iRBD and ePD). Caudal motor SNc surface MD correlated significantly with MDS-UPDRS-III scores in ePD patients. Using dMRI and automated segmentation, we detected changes suggesting altered microstructural integrity in iRBD and ePD in the nigrostriatal <jats:italic>sub<\/jats:italic>region known to degenerate first in PD. Surface MD of the caudal motor SNc presents a potential measure for inclusion in neuroimaging biomarkers of iRBD and PD.<\/jats:p>","DOI":"10.1038\/s41531-024-00731-0","type":"journal-article","created":{"date-parts":[[2024,7,1]],"date-time":"2024-07-01T14:04:01Z","timestamp":1719842641000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Increased mean diffusivity of the caudal motor SNc identifies patients with REM sleep behaviour disorder and Parkinson\u2019s disease"],"prefix":"10.1038","volume":"10","author":[{"given":"Erind","family":"Alushaj","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimuthu","family":"Hemachandra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hooman","family":"Ganjavi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken N.","family":"Seergobin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0947-1282","authenticated-orcid":false,"given":"Manas","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4505-2081","authenticated-orcid":false,"given":"Alia","family":"Kashgari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Barr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Reisman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali R.","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1817-2383","authenticated-orcid":false,"given":"Penny A.","family":"MacDonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,29]]},"reference":[{"key":"731_CR1","doi-asserted-by":"publisher","first-page":"1641","DOI":"10.1002\/mds.22643","volume":"24","author":"P Barone","year":"2009","unstructured":"Barone, P. et al. 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