(Borghammer, 2021 #1484) BODY-FIRST vs BRAIN-FIRST PD, Commissures, Anatomy-Neurological signs / General, motor anatomy table, Reported signs and symptoms

(Borghammer, 2021 #1484)

BODY-FIRST PD	BRAIN-FIRST PD
More autonomic symptoms Prodromal RBD Damage to autonomic systems in prodromal phase Faster progression Faster cognitive decline Motor symptoms more symmetric Dopamine transporter loss more symmetric More hyposmia GBA & SNCA mutation carriers have this phenotype	Fewer autonomic symptoms No prodromal RBD Less damage to autonomic systems in prodromal phase Slower progression Slower cognitive decline Motor symptoms more asymmetric Dopamine transporter loss more asymmetric Less hyposmia LRRK2 mutation carriers have this phenotype

Numbered nodes — BODY-FIRST: 1 = intestine; 2 = stellate / coeliac / heart (multiple); 3, 4, 5 = ascending through brain.

Numbered nodes — BRAIN-FIRST: 1, 2 = SN / LC / DMV / amygdala; 3, 4, 5 = stellate / coeliac / vagus / heart / intestine.

Journal credit: P. Borghammer / Explaining Motor Asymmetry, Non-Motor Phenotypes, and Cognitive Decline / 459

Panel A — Connection diagram

• Telencephalon
  • Connections: strong arrows / weak arrows
  • amygdala
• Mesencephalon — PPN, SN
• Pons — LC
• Medulla Oblongata — DMV
• GI tract

Panel B — Brain first

stages: Prodromal / De novo stage / Later stage. (slower cognitive decline; more asymmetric parkinsonism; RBD negative; no autonomic symptoms)

Panel C — Body first

stages: Prodromal / De novo stage / Later stage. (faster cognitive decline; more symmetric parkinsonism; RBD positive; autonomic symptoms)

Lewy pathology legend: mild / moderate / severe.

Commissures

commissure	content
Corpus callosum
Anterior commissure	interconnects the regions of the two cerebral hemispheres concerned with the olfactory pathway such as the olfactory bulb, the anterior olfactory nucleus, the piriform cortex, the entorhinal area, the anterior perforated substance, and the amygdaloid complex. It also links the caudal part of the orbital frontal cortex, the temporal pole, the rostral superior temporal region, the major part of the inferotemporal area, the parahippocampal gyri and other regions of the two temporal lobes, as well as the frontal lobes of the two hemispheres.
Post commissure
Habenular commissure:
Commissure of fornix

Anatomy-Neurological signs

General

Sagittal brain neurotransmitter-pathway figure legend:

• Cholinergic
• Serotonergic
• Histaminergic
• Dopaminergic
• Noradrenergic

Source labels visible on the figure: Basal forebrain, Pons, Ventral tegmental area, Tuberomammillary nucleus, Hypothalamus, Substantia nigra, Raphe nuclei, Locus coeruleus, Laterodorsal tegmental and pedunculo-pontine nuclei, Nucleus basalis of Meynert.

	tract	upper neuron	pathway		Muscles	Function	Pathologic signs
Pyramidal tract?	Corticospinal tract	Upper motor neurons (pyramidal cells in just below the surface of the cerebral cortex within layer V of the primary motor cortex) in cor-tex	Synapse directly with Lower motor neuron or via interneuron (majority) in the Spinal cord		Muscles		spasticity, weakness, slowing of rapid alternating movements, hyperreflexia, and a Babinski sig (in m SST, ↑ tone & reflex)
	Cortibulbar tract		brainstem		Cranial nerves	Muscles of face & neck	Facial expression, mastication, swallowing
Cerebellum						Muscle coordinating	Ataxia (balance and walking. Speaking, swallowing, eye movement)
						rapid and alternating contraction and relaxation of muscles.	Tremor, in PD the trembling is usually more apparent when the hands are resting on the affected person's lap or when walking. 'Pill rolling' rest tremor is typical

Reported signs and symptoms

Bar chart with three series (Present = red, Absent = blue, Unknown = gray). Visible bars (left → right) and approximate counts:

symptom	Present	Absent	Unknown
Parkinsonism	1000	0
Bradykinesia	484	13	506
Tremor (any or unspecified)	311	27	665
Rigidity	272	21	710
Dystonia	177	94	732
Tremor at rest	226	25	752
Dyskinesia	184	52	767
Postural instability	166	53	784
Motor fluctuations	149	25	829
NMS parkinsonism	130	11	862
Cognitive decline	126	107	870
Hyperreflexia	53	57	893
Postural tremor	168	41	894
Depression	146	54	903
Atypical parkinsonism	132	67	904
Autonomic sign/sympt.	137	53	913
Tremor, action	128	58	916
Sleep benefit	159	22	922
Diurnal fluctuations	152	119	932
Dystonic tremor	4	65	934
Psychotic sign/sympt.	124	32	947
Sleep disorder	139	115	949
Anxiety	178	117	958
Olfactory impairment	116	113	974

Uncertain Spans

location	transcription	uncertainty
Reported signs / Tremor (any or unspecified)	column-to-bar mapping is dense; the Unknown gray bar values rise monotonically from 506 to 974 across the right side.	reads as written; the per-symptom Present / Absent / Unknown values are reconstructed from small bar-end labels and may need image-level review.
Reported signs / Olfactory impairment	Present 116, Absent 113, Unknown 974	reads as written; the bar-end labels are small and may need image-level review.