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This study aimed to identify dynamic, state-dependent neural signatures of cognitive fluctuations in LBD using magnetoencephalography and dynamic functional connectivity based on hidden Markov modelling. Resting-state magnetoencephalography data were acquired from individuals with LBD, Parkinson\u2019s disease without dementia and cognitively normal controls. Hidden Markov modelling was used to identify transient brain states followed by spectral analyses across regions and states. Additionally, associations between regional spectral power and cognitive fluctuations severity, measured by the Clinician Assessment of Fluctuation, were assessed. Patients with LBD exhibited a distinct pattern of brain dynamics, particularly in two states (States 2 and 6), characterized by increased fractional occupancy of State 2 and markedly reduced occupancy of State 6, contrasting with the more distributed state engagement observed in Parkinson\u2019s disease and normal controls. Spectral analyses revealed widespread slowing in LBD, with elevated theta\/beta power ratios in frontal, parietal and visual cortices\u2014most pronounced in States 2 and 6. Region-specific theta\/beta power ratio elevations were identified in the anterior cingulate, medial prefrontal cortex, posterior cingulate, dorsal visual stream and auditory cortex. Critically, Clinician Assessment of Fluctuation scores correlated positively with spectral power in low frequency (\u03b4 and \u03b8) and negatively with power in the high frequency (\u03b1 and \u03b2), particularly in the ventral visual stream, default mode network hubs and sensorimotor regions. These findings reveal dynamic and spatially specific electrophysiological abnormalities in LBD closely linked to cognitive fluctuations severity, suggesting that magnetoencephalography-hidden-Markov-model characteristics hold promise as biomarkers for diagnosis, monitoring and therapeutic targeting in LBD.<\/jats:p>","DOI":"10.1093\/braincomms\/fcag236","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T11:51:41Z","timestamp":1781869901000},"source":"Crossref","is-referenced-by-count":0,"title":["Dynamic, state-dependent characteristics of cognitive fluctuations in Lewy body dementia: a magnetoencephalography study"],"prefix":"10.1093","volume":"8","author":[{"given":"Hojjatollah","family":"Sadeqi","sequence":"first","affiliation":[{"name":"Department of Neurology, University of Florida , Gainesville, FL 32611 ,","place":["USA"]},{"name":"The Norman Fixel Institute of Neurological Diseases, University of Florida Health , Gainesville, FL 32608 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Fixel Institute of Neurological Diseases, University of Florida Health , Gainesville, FL 32608 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa J","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Florida , Gainesville, FL 32611 ,","place":["USA"]},{"name":"The Norman Fixel Institute of Neurological Diseases, University of Florida Health , Gainesville, FL 32608 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbas","family":"Babajani-Feremi","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Florida , Gainesville, FL 32611 ,","place":["USA"]},{"name":"The Norman Fixel Institute of Neurological Diseases, University of Florida Health , Gainesville, FL 32608 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