Fig. 6: SuStaIn analysis restricted to CNS regions.

a, Two subtypes suggesting when the SuStaIn analysis was restricted to ten CNS regions. The brain-first subtype (54%) was characterized by initiation in the OB and AMY, followed by propagation to the brainstem and limbic structures, and then the cortical regions. The body-first subtype (46%), characterized by initiation in the DMV followed by caudorostral spreading and involvement of the AMY and OB, occurred only after the LC and SN were involved. b, The complete SuStaIn analysis defined one brain-first and two distinct body-first subtypes, as shown here. The arrows in the anatomical figures show simplified theoretical spreading routes as indicated by the SuStaIn positional variance diagrams in the boxes. The diagrams suggest that in parasympathetic-predominant LBD, pathology propagates initially via the vagus (purple arrow), followed slightly later by pathology propagating through the sympathetic connections (blue arrows). In sympathetic-predominant LBD, this order of propagation is reversed. Illustration templates created using BioRender.com.