Hemispheric Complementarity is Associated with Distinct Functional and Structural Brain Profiles

Hemispheric specialization is thought to follow a principle of complementarity, with homotopic functions such as language and attention lateralizing to opposite hemispheres, yet its consistency across individuals and relevance for cognition remain unclear. Using multimodal neuroimaging and twin-family data from 987 Human Connectome Project participants, we identified three sustained attentional lateralization phenotypes (right, left, bilateral) that were independent of handedness, differed by sex, and tracked broad shifts in brain organization, with bilateral individuals showing stronger intrahemispheric and homotopic connectivity. Examining attention and language revealed three multidomain profiles (crowded, mixed, split) reflecting whether functions colocalize within or are distributed across hemispheres. Mixed organization was linked to higher planum polare myelination, whereas crowded organization showed higher fiber density connectivity across dorsal attention-default network. Both phenotypes were heritable, yet neither predicted cognitive performance. These findings reveal a brain organization in which specialization emerges from flexible, heritable patterns linking function, structural connectivity, and myeloarchitecture.