Cortical complexity alterations in motor subtypes of Parkinson's disease: A surface‐based morphometry analysis of fractal dimension

Based on motor symptoms, Parkinson's disease (PD) can be classified into tremor dominant (TD) and postural instability gait difficulty (PIGD) subtypes. Few studies have examined cortical complexity differences in PD motor subtypes. This study aimed to investigate differences in cortical complexity and grey matter volume (GMV) between TD and PIGD. We enrolled 36 TD patients, 27 PIGD patients and 66 healthy controls (HC) from the PPMI (Parkinson's Progression Markers Initiative) database. Voxel-based morphometry (VBM) and surface-based morphometry (SBM) were utilized to assess differences in GMV, cortical thickness and cortical complexity. The structural MRI data of participants was analysed using CAT12/SPM12 (p < 0.05, FDR corrected). Additionally, correlations between clinical data and structural changes were examined (p < 0.05, Holm-Bonferroni corrected). In comparison to both HC and TD groups, PIGD patients exhibited a significant fractal dimension (FD) decrease in many cortical regions. A significant negative correlation between age and FD was observed in the left insula for the PIGD patients and in the bilateral insula for the TD patients. However, no significant differences were found in GMV, cortical thickness or other complexity indices. Altered FD in the bilateral insula indicates that postural instability and gait disturbances may result from a failure to integrate information from various structures, whereas parkinsonian rest tremor is not associated with this integration. Also, widespread decreases in cortical FD demonstrate that FD is more sensitive than other complexity measures and can serve as a novel biomarker for identifying subtle changes in cortical morphology in the PIGD subtype.