Cortical Motor Hierarchy Disruption Is Associated With Functional Status in Early Amyotrophic Lateral Sclerosis

Background

Amyotrophic lateral sclerosis (ALS) is a devastating neuromuscular disease characterised by progressive muscle wasting and functional decline. Although cortical motor network disruption is a hallmark of ALS, the large-scale functional hierarchy alterations and their underlying molecular mechanisms in the early stage of the disease (ALS-ES) remain poorly understood. We aimed to characterise cortical gradient changes in early-stage ALS and to examine their neurochemical and transcriptomic correlates, as well as their cross-sectional associations with clinical functional status.