In the first part of this study, a functional connectivity analysis was performed to evaluate the DMN connectivity in PD compared to NC. As shown in
Figure 1, there was a considerable change in the connectivity of the DMN in PD. The PD group showed lower functional connectivity than the NC did among the DMN regions. Both the PCC and the mPFC, two fundamental components of the DMN, demonstrated reduced functional connectivity with DMN constituents, including their pairwise connectivity. This result was in line with previous reports [
11,
30]; however, it is not clear why the DMN connectivity is impaired in PD. One study observed the restoration of the DMN after levodopa administration and postulated that the dopaminergic system modulates the DMN in Parkinson’s disease [
31]. Indeed, the change can be attributed to the loss of dopaminergic neurons in the substantia nigra, which is connected to the mPFC via the striatum. Thus, the impact of PD progression can indirectly cause certain functional disconnections in this circuit and may cause a possible impairment in the activity of the frontal regions of the brain [
32]. Considering the fact that the mPFC is a major part of the DMN, it has been claimed that the impaired connectivity of the mPFC with the striatum may influence the integrity of the DMN and the strength of functional connections between the mPFC and the other DMN regions. Looking at it from a broader perspective, the connectivity of the PCC was further examined with 100 ROI from all over the brain, including the DMN regions, using the ROI-to-ROI explorer (
Figure 2). In the NC group, the PCC seemed to be more uniformly and globally connected with other regions of the brain (
Figure 2B), whereas in the PD group, the PCC was connected in a more clustered fashion, and it seemed that certain connections were missing between identical brain regions as selected in the NC analysis (
Figure 2A). Across the temporal cortex, the temporopolar area, area 38 was among the areas missing its connection in PD at the selected threshold value. Studies have shown that this region is also heavily involved in other neurological disorders, such as Alzheimer’s disease, temporal lobe epilepsy, and schizophrenia [
33]. Across the frontal cortex, area 46 was also disconnected in the PD group at the selected threshold value. This area roughly corresponds to the dorsolateral prefrontal cortex (DLPFC) that is thought to be involved in cognitive control of motor behavior through topdown modulations of information processing as a result of motor tasks involving, for instance, the premotor and posterior parietal associative cortices [
34]. It also plays a central role in a variety of cognitive tasks, including working memory and attention [
35]. Regarding resting-state networks, the DLPFC is a prominent node of both the central executive network [
36,
37] and the dorsal attention network [
38,
39], which have also been reported to be affected in PD, especially with cognitive impairments [
40]. Moreover, the functional connectivity with area 3 was missing in the PD group, which might have been related to the motor deficits associated with the disease. Located in the postcentral gyrus of the lateral parietal lobe, this region corresponds to the primary somatosensory cortex and receives extensive thalamocortical projections from sensory input fields [
41]. The connectome ring of the mPFC also demonstrated missing functional connections with several brain areas across the entire brain in PD (
Figure 2B). Motor and somatosensory areas 3, 4, 5, and 6 were among the missing regions in the mPFC connectome ring, which could have possibly explained the motor and somatosensory deficits associated with PD. The loss of connections with the primary (17), secondary (18), and associative (19) visual areas may be related to the visual hallucinations that develop in some PD patients. These hallucinations are known to be more common at an advanced stage and are heavily associated with cognitive impairments [
42,
43]. These areas have been commonly included in studies examining visual hallucinations in PD patients [
44,
45]. One study compared PD patients with visual hallucinations and reported a consistent reduction in the gray matter volume of the occipitoparietal areas, which are related to visual functions [
46]. Overall, these results may provide indications of possible damage to the functional connectivity with other brain areas, apart from the DMN constituents, that can be related to a series of symptoms that develop over the course of PD. It should be noted that these results were all observed at a fixed selected threshold value.
We applied persistent homology to obtain a more comprehensive overview of the network connections and their topology over a range of filtration values. It is obvious that the connections, as well as their strengths, change depending on what threshold value one chooses. Persistent homology allows us to see the changes in connectivity along with the threshold changes. As shown in
Figure 3, the PD group had a slower slope and reaches zero in a slower fashion than the NC did. The slope also had a longer tail at the end, meaning that it reached the state of one giant connected component at bigger filtration values than the NC. For example, if we took the number of connected components at a filtration value of 0.3, in the case of PD group, there were more than 50 connected components at this filtration value, while in the case of normal group, there were less than 20 connected components formed. This implied that, in the case of PD, the network is connected in a more clustered and local fashion than the NC. Furthermore, as shown in
Figure 4, a dendrogram was also produced based on the barcode results with the additional geometrical information of node positions. The colors represent the distance from the giant component [
14,
25]. In the case of PD, as shown in (b), the connections of the nodes are colored in blue for larger filtration values, implying a larger number of locally connected clusters; then, the components start globally connecting and becoming a giant component at larger filtration values, as represented in red. On the other hand, the dendrogram for the NC group, as displayed in (a), shows a lesser proportion of shades of blue and a faster transition to shades of red, implying that the network is less locally connected and more globally connected; it reaches the one giant connected component at lower filtration values. These results indicated that the network in PD has local over-connectivity and global underconnectivity, which can imply a deficit in the global integrity of the large-scale networks that can affect information processing and neural communication across the entire cortex. Such a deficiency can be associated with functional deficits that arise in the course of PD, and the persistent homology was able to reveal these hidden network topologies through changing filtration values. This finding may be able to explain why deep brain stimulation of the subthalamus, which is based on a local perspective of PD pathogenesis, does not have an effect on all the signs and symptoms of the disease [
47].
Overall, by applying seed-based analysis and persistent homology, this study showed that the PD patients had more locally connected networks than the normal group did; this goes beyond the scope of a single network. This indicates that PD is not a disease that only involves limited areas or circuits of the brain. It impacts the functional organization of the entire brain, resulting in decreased connectivity of resting state networks, including the DMN. This study had certain limitations that need to be considered for future work. As indicated by the MMSE records, it appeared that the PD patients of this study had a lower score compared to the NC, indicating that some patients in this group might have developed cognitive impairment, even though the MMSE score by itself is not sufficient to rule out any cognitive impairment. Several studies have demonstrated that cognitive impairments that develop in brain disorders have a considerable impact on the functional connectivity of the DMN [
48,
49]. Consequently, the results of the present study may not clarify whether the network changes are from pure PD pathologies or PD with cognitive impairments. The second limitation of this study is the possibility of the effects of dopaminergic drugs on functional connectivity. Even though the UPDRS and fMRI data were all acquired during the practical off-medication period, there remains the chance that the effects may persist due to the long duration response of the dopamine replacement therapy. Further studies are needed to evaluate the longitudinal changes of the networks, in addition to changes in the networks followed by medication [
50] or other treatment methods, such as deep brain stimulation [
51].