Clinical manifestations and evolution are very heterogeneous among individuals with Parkinson’s disease (PD). The aims of this study were to investigate the pattern of progressive brain atrophy in PD according to disease stage and to elucidate to what extent cortical thinning and subcortical atrophy are related to clinical motor and non-motor evolution. 154 patients at different PD stages were assessed over time using motor, non-motor and structural MRI evaluations for a maximum of 4 years. Cluster analysis defined clinical subtypes. Cortical thinning and subcortical atrophy were assessed at baseline in patients relative to 60 healthy controls. Longitudinal trends of brain atrophy progression were compared between PD clusters. The contribution of brain atrophy in predicting motor, non-motor, cognitive and mood deterioration was explored. Two main PD clusters were defined: mild (N = 87) and moderate-to-severe (N = 67). Two mild subtypes were further identified: mild motor-predominant (N = 43) and mild-diffuse (N = 44), with the latter group being older and having more severe non-motor and cognitive symptoms. The initial pattern of brain atrophy was more severe in patients with moderate-to-severe PD. Over time, mild-diffuse PD patients had the greatest brain atrophy accumulation in the cortex and the left hippocampus, while less distributed atrophy progression was observed in moderate-to-severe and mild motor-predominant patients. Baseline and 1-year cortical thinning was associated with long-term progression of motor, cognitive, non-motor and mood symptoms. Cortical and subcortical atrophy is accelerated early after the onset of PD and becomes prominent in later stages of disease according to the development of cognitive, non-motor and mood dysfunctions. Structural MRI may be useful for monitoring and predicting disease progression in PD.

在帕金森氏病（PD）的个体中，临床表现和演变非常不同。这项研究的目的是根据疾病阶段调查PD进行性脑萎缩的模式，并阐明皮质变薄和皮质下萎缩在多大程度上与临床运动和非运动进化有关。使用运动，非运动和结构MRI评估对154名处于不同PD阶段的患者进行了长达4年的评估。聚类分析定义了临床亚型。相对于60名健康对照者，在基线时评估了患者的皮质变薄和皮质下萎缩。比较PD簇之间脑萎缩进展的纵向趋势。研究了脑萎缩在预测运动，非运动，认知和情绪下降中的作用。定义了两个主要的PD集群：轻度（N = 87）和中度至重度（N = 67）。进一步确定了两种轻度亚型：轻度以运动为主（N = 43）和轻度弥漫性（N = 44），后一组年龄较大且具有较重的非运动和认知症状。中度至重度PD患者的脑萎缩的初始模式更为严重。随着时间的流逝，轻度弥漫性PD患者在皮质和左海马区的脑萎缩积累最大，而在中度至重度和轻度运动为主的患者中观察到的分布性萎缩进展较少。基线和1年皮层变薄与运动，认知，非运动和情绪症状的长期发展有关。根据认知，非运动和情绪障碍的发展，PD发作后早期皮质和皮质下萎缩会加速，并在疾病的晚期阶段变得突出。结构性MRI对于监测和预测PD的疾病进展可能是有用的。