Progressive iron deposition and widespread neural dysfunction in Parkinson’s disease: a multimodal MRI study

Background: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms, yet its stage-dependent neurobiological mechanisms remain incompletely understood. Multimodal magnetic resonance imaging (MRI) offers a noninvasive approach to investigate both functional and structural alterations across disease stages. Therefore, this study aimed to characterize stage-dependent functional and iron-related brain alterations in PD using multimodal MRI and to explore their associations with motor severity. Methods: We enrolled 104 PD patients, stratified into early-stage (n=49) and advanced-stage (n=55) based on Hoehn and Yahr (H&Y) score, along with 53 age- and sex- matched healthy controls. Quantitative susceptibility mapping (QSM) quantified iron deposition in the substantia nigra (SN) and globus pallidus (GP), while resting-state functional magnetic resonance imaging (rs-fMRI) was used to assess functional alterations using regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuations (fALFF). Group comparisons were conducted using one-way analysis of variance (ANOVA) with post-hoc tests, and voxel-wise analyses were corrected using cluster-level false discovery rate (FDR, P