{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:50:59Z","timestamp":1791294659841,"version":"4.1.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Parkinson\u2019s disease (PD) is a common movement disorder with heterogeneous clinical manifestations, and its tremor-predominant presentations may overlap with essential tremor (ET), complicating clinical differentiation in some patients. Functional gradient analysis provides a continuous framework for characterizing macroscale brain hierarchical organization and may offer candidate imaging features for disease characterization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We first investigated surface-based resting-state functional measures and cerebral perfusion in 50 patients with idiopathic PD and 33 healthy controls. We subsequently incorporated functional MRI data from 17 patients with ET to examine alterations in cortical and cerebellar functional gradients in PD and ET and to evaluate their potential utility for distinguishing the two disorders. Group comparisons, gradient range and variance analyses, network-level analyses, and multiclass support vector machine classification were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with PD showed widespread abnormalities in both cortical and cerebellar Gradient 1 and Gradient 2, whereas patients with ET exhibited fewer cortical alterations and no significant cerebellar gradient abnormalities. At the group level, both PD and ET showed broader cortical gradient ranges; however, only PD demonstrated significantly increased individual-level gradient range and variance. Network-level analyses further revealed pronounced hierarchical redistribution between sensorimotor and higher-order associative systems in PD, while ET displayed relatively limited alterations. The combined use of cortical and cerebellar Gradient 1 and Gradient 2 features showed discriminatory performance within the present dataset, with area under the receiver operating characteristic curve values of 1.000 for healthy controls, 0.960 for PD, and 0.889 for ET. Shapley additive explanations (SHAP) analysis indicated that both cerebral and cerebellar gradient features contributed to classification, with broader feature involvement in PD than in ET.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These findings suggest that PD is characterized by extensive disruption of cortical-cerebellar functional hierarchy, exceeding the relatively limited alterations observed in ET. Functional gradients may therefore provide candidate imaging features for characterizing PD-related hierarchical reorganization and for exploratory differentiation of PD from ET.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1942024","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:50:56Z","timestamp":1791291056000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hierarchical reorganization of cortical and cerebellar functional gradients in Parkinson\u2019s disease"],"prefix":"10.3389","volume":"17","author":[{"given":"Qiang","family":"Liu","sequence":"first","affiliation":[{"name":"Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zezhong","family":"Zheng","sequence":"additional","affiliation":[{"name":"Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moxuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Shandong First Medical University Cancer Hospital","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qichao","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Radiology, Qilu Hospital of Shandong University","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luhao","family":"Cui","sequence":"additional","affiliation":[{"name":"Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanshan","family":"Mei","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruihua","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton","place":["Southampton, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Qilu Hospital of Shandong University","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilei","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Liaocheng People's Hospital","place":["Liaocheng, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangang","family":"Meng","sequence":"additional","affiliation":[{"name":"Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1002\/ana.27302","article-title":"The relationship between rest tremor and underlying Lewy pathology in essential tremor: a clinical-pathological study of 201 cases","volume":"98","author":"Louis","year":"2025","journal-title":"Ann Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1136\/jnnp.2008.147223","article-title":"Risk of incident Parkinson's disease and parkinsonism in essential tremor: a population based 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