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. 2024 Aug 15;10:155. doi: 10.1038/s41531-024-00766-3

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© The Author(s) 2024

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Fig. 2 — a Detailed distribution of the frequency of AS accumulation layer by layer in the intestinal wall of patients with PD. The frequency of Lewy pathology is the highest in the muscular layer, mostly found in the myenteric plexus. The concordance of AS accumulation in the proximal and distal blocks in patients with PD is moderate (κ = 0.541, p-value < 0.001). In the control group, the concordance is excellent (κ = 0.927, p-value < 0.001) because most of the controls have AS−. b Distribution of the frequency of AS accumulation in the discretized subgroups of duration from symptom onset to surgery in patients with PD. The frequency of AS accumulation in the GI tract of patients with PD increases from 67% in the before-PD onset group to 100% in the ≥11-year group. In the LGI tract subgroup, the frequency of AS accumulation decreases to 45% in the 0–5-year group but increases thereafter. The duration from symptom onset to surgery is confirmed as an independent predictor of AS accumulation in the GI tract in PD in the multivariate regression analyses, excluding the confounding effect of the surgical site (rostrocaudal gradient). c, d Detailed distribution of the frequency of AS accumulation layer by layer in the upper and lower GI tract in patients with PD. AS accumulation is more frequent in the upper GI tract than in the lower GI tract (rostrocaudal gradient). AS alpha-synuclein, PD Parkinson’s disease, GI gastrointestinal, UGI upper gastrointestinal, LGI lower gastrointestinal.