Functional MRI gradients reveal cortical-cerebellar hierarchy disruption in Parkinson disease, aiding distinction from essential tremor

Functional MRI gradient analysis differentiated Parkinson disease from essential tremor with AUCs 0.960 (PD) and 0.889 (ET) in a small study; healthy controls AUC 1.000. Cortical and cerebellar hierarchy disruption was more extensive in PD.

• Patients with PD showed widespread abnormalities in cortical and cerebellar Gradient 1 and 2, while ET had fewer cortical changes and no significant cerebellar gradient abnormalities.
• Network-level analyses revealed hierarchical redistribution between sensorimotor and associative systems in PD, but limited alterations in ET.

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