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From a complex systems perspective, clinical syndromes emerging from neurodegenerative diseases are thought to result from multiscale interactions between aggregates of misfolded proteins and the disequilibrium of large-scale networks coordinating functional operations underpinning cognitive phenomena. Across all syndromic presentations of Alzheimer’s disease, age-related disruption of the default mode network is accelerated by amyloid deposition. Conversely, syndromic variability may reflect selective neurodegeneration of modular networks supporting specific cognitive abilities. In this study, we leveraged the breadth of the Human Connectome Project-Aging cohort of non-demented individuals (N = 724) as a normative cohort to assess the robustness of a biomarker of default mode network dysfunction in Alzheimer’s disease, the network failure quotient, across the aging spectrum. We then examined the capacity of the network failure quotient and focal markers of neurodegeneration to discriminate patients with amnestic (N = 8) or dysexecutive (N = 10) Alzheimer’s disease from the normative cohort at the patient level, as well as between Alzheimer’s disease phenotypes. Importantly, all participants and patients were scanned using the Human Connectome Project-Aging protocol, allowing for the acquisition of high-resolution structural imaging and longer resting-state connectivity acquisition time. Using a regression framework, we found that the network failure quotient related to age, global and focal cortical thickness, hippocampal volume, and cognition in the normative Human Connectome Project-Aging cohort, replicating previous results from the Mayo Clinic Study of Aging that used a different scanning protocol. Then, we used quantile curves and group-wise comparisons to show that the network failure quotient commonly distinguished both dysexecutive and amnestic Alzheimer’s disease patients from the normative cohort. In contrast, focal neurodegeneration markers were more phenotype-specific, where the neurodegeneration of parieto-frontal areas associated with dysexecutive Alzheimer’s disease, while the neurodegeneration of hippocampal and temporal areas associated with amnestic Alzheimer’s disease. Capitalizing on a large normative cohort and optimized imaging acquisition protocols, we highlight a biomarker of default mode network failure reflecting shared system-level pathophysiological mechanisms across aging and dysexecutive and amnestic Alzheimer’s disease and biomarkers of focal neurodegeneration reflecting distinct pathognomonic processes across the amnestic and dysexecutive Alzheimer’s disease phenotypes. These findings provide evidence that variability in inter-individual cognitive impairment in Alzheimer’s disease may relate to both modular network degeneration and default mode network disruption. These results provide important information to advance complex systems approaches to cognitive aging and degeneration, expand the armamentarium of biomarkers available to aid diagnosis, monitor progression and inform clinical trials.

© 2022 the Alzheimer's Association.Background: Grey matter covariance networks become disrupted early in Alzheimer’s disease (AD), when amyloid starts aggregating, and before the onset of irreversible atrophy. However, the precise relationship of grey matter network breakdown and the AD pathophysiological process remains unclear. Here, we studied to what extent shared familial (genes and family environment) or environmental factors unique to a twin contribute to these relationships in a sample of older monozygotic twins with intact cognition. Method: From the EMIF-AD PreclinAD study we included monozygotic twins who had at least an MRI scan (n=197) and CSF available (n=124). We assessed the upper limit of genetic contribution to grey matter network measures (size, degree, connectivity density, clustering, path length, small-world measures) with within-twin pair correlations. Associations between CSF AD markers (Aβ42/40, t-tau, p-tau) and other markers related to AD pathophysiology (neurogranin, Aβ38, Aβ40, BACE1) with grey matter network disruptions were assessed with linear mixed models. Twin analyses (cross-twin cross-trait, twin difference analyses) were used to assess the contribution of shared familial and/or unique environmental factors to these associations. Result: Twenty individuals (16%) had abnormal CSF Aβ42/40 levels. Grey matter network measures were highly correlated within twin pairs (r=0.54-0.97; all p

Background: Brain amyloid-β (Aβ) is the pathological hallmark of Alzheimer's disease (AD). In logistic disease models, Aβ accumulation is a sigmoid function of time-since-disease-onset (TSDO) (figure 1). Previous positron emission tomography (PET)-based models vary accumulation onset(t50) and duration(r) globally; capacity(K) and baseline(NS) regionally (Whittington2018). We confirm existing approaches and propose a more powerful ICA-based approach to quantify disease severity and estimate TSDO. Method: We used 1071 18F-florbetapir standard uptake value ratio (SUVR) images from the ADNI-2 study (adni.loni.usc.edu/data-samples/data-types/pet). Images were mapped into MNI space. Averages were extracted using the Harvard-Oxford brain-atlas. Whole-brain tracer-specific sigmoid parameters (Jack2013) obtained from the literature were used to estimate TSDO. Of 16 models of regional Aβ accumulation (each of the 4 regional sigmoid parameters varied either regionally or globally), the optimal Bayesian information criterion was found with global t50 and r, and regional NS and K (figure 1) with global values r=6.16y and t50=4.10y. Linearised maps of NS and K were obtained by regressing the SUVR maps onto the global sigmoid. We also estimated these maps as independent components, using a 2-component ICA on the SUVR maps. Both outcomes were used to quantify Aβ accumulation from SUVR images as weighting factors of the accumulation map. We compared the weights from the logistic model and the ICA model in ADNI, using effect size measured with Hedges' g between cognitively normal (CN), subjective memory complaints (SMC), mild cognitive impairment (EMCI/MCI/LMCI) and AD groups. We compared 3 longitudinal visits (N=112) in the OASIS-3 study (see www.oasis-brains.org) with both methods, global SUVR and Centiloid (Klunk2015) using 11C-PiB PET SUVR images. Result: Maps of accumulation capacity from both models had spatial correlation of 0.86 (figure 2); baseline maps had spatial correlation of 0.95. Hedges' g between ADNI groups was 2.25 for K, and 2.42 for ICA (1.46 for global SUVR). In OASIS-3, Hedges' g between visits was 1.24 for K, 1.46 for ICA (global SUVR 0.15, Centiloid 0.4). Conclusion: We demonstrate that linear accumulation models can be used to quantify brain Aβ with PET; maps obtained by ICA yield larger effect sizes than the logistic method for differentiating groups and measuring changes between visits.

Given the prevalence of dementia and the development of pathology-specific disease modifying therapies, high-value biomarker strategies to inform medical decision making are critical. In-vivo tau positron emission tomography (PET) is an ideal target as a biomarker for Alzheimer’s disease diagnosis and treatment outcome measure. However, tau PET is not currently widely accessible to patients compared to other neuroimaging methods. In this study, we present a convolutional neural network (CNN) model that impute tau PET images from more widely-available cross-modality imaging inputs. Participants (n=1,192) with brain MRI, fluorodeoxyglucose (FDG) PET, amyloid PET, and tau PET were included. We found that a CNN model can impute tau PET images with high accuracy, the highest being for the FDG-based model followed by amyloid PET and MRI. In testing implications of AI-imputed tau PET, only the FDG-based model showed a significant improvement of performance in classifying tau positivity and diagnostic groups compared to the original input data, suggesting that application of the model could enhance the utility of the metabolic images. The interpretability experiment revealed that the FDG- and MRI-based models utilized the non-local input from physically remote ROIs to estimate the tau PET, but this was not the case for the PiB-based model. This implies that the model can learn the distinct biological relationship between FDG PET, MRI, and tau PET from the relationship between amyloid PET and tau PET. Our study suggests that extending neuroimaging’s use with artificial intelligence to predict protein specific pathologies has great potential to inform emerging care models.

Background and purpose Temporal lobe epilepsy secondary to hippocampal sclerosis is related to epileptogenic networks rather than a focal epileptogenic source. Graph‐theoretical gray and white matter networks may help to identify alterations within these epileptogenic networks. Methods Twenty‐seven patients with hippocampal sclerosis and 14 controls underwent magnetic resonance imaging, including 3D‐T1, fluid‐attenuated inversion recovery, and diffusion tensor imaging. Subject‐specific structural gray and white matter network properties (normalized path length, clustering, and small‐worldness) were reconstructed. Group differences and differences between those with higher and lower seizure burden ( .05). Patients with lower seizure burden had significantly lower gray matter small‐worldness and normalized clustering compared to controls and those with higher seizure burden (all p, Temporal lobe epilepsy secondary to hippocampal sclerosis is related to abnormal epileptogenic networks, including multiple temporal and extra‐temporal structures, rather than a single focal epileptogenic source. This study aims to assess alterations within structural gray and white matter networks in patients with hippocampal sclerosis, through a graph theory analysis. In patients with hippocampal sclerosis, a more rigidly organized network (higher small‐worldness) was related to having more monthly seizures; also, patients with low seizure burden had significantly lower gray matter small‐worldness and normalized clustering compared to controls and those with high seizure burden.

Impairment in instrumental activities of daily living (IADL) is an early clinical feature of Alzheimer's disease (AD). The neurobiology underlying IADL disruptions is still unclear. We aimed to investigate the relationship between IADL functioning and cortical atrophy across the AD spectrum. We selected 162 memory-clinic subjects with subjective cognitive decline (n = 49), mild cognitive impairment (n = 26) or AD dementia (n = 87), and an available structural MRI acquired at 3.0 Tesla and Amsterdam IADL Questionnaire (A-IADL-Q) assessment. We used linear regression correcting for age, sex, education, vascular injuries, and total intracranial volume to investigate the association between gray matter volume and A-IADL-Q score, and voxel-based morphometry to investigate whether any associations were specific for distinct regions. Less gray matter volume was associated with lower A-IADL-Q scores (β = 0.346, 95% CI = [0.185-0.507], p < 0.001), specifically in cortical regions covering the medial temporal lobes, cingulate cortex, and precuneus (all p(familywise error–corrected) < 0.05). Results were similar when repeating the analyses in amyloid-positive subjects (n = 78). Our findings illustrate that the A-IADL-Q detects functional impairment related to AD-specific neurodegeneration.

Alzheimer’s disease (AD) is characterised by abnormal amyloid beta and tau processing. Previous studies reported that cerebrospinal fluid (CSF) total tau (t-tau) levels vary between patients. Here we show that CSF t-tau variability is associated with distinct impairments in neuronal plasticity mediated by gene repression factors SUZ12 and REST. AD individuals with abnormal t-tau levels have increased CSF concentrations of plasticity proteins regulated by SUZ12 and REST. AD individuals with normal t-tau, on the contrary, have decreased concentrations of these plasticity proteins and increased concentrations in proteins associated with blood-brain and blood CSF-barrier dysfunction. Genomic analyses suggested that t-tau levels in part depend on genes involved in gene expression. The distinct plasticity abnormalities in AD as signaled by t-tau urge the need for personalised treatment.

The development of preventive strategies in early-stage Alzheimer's disease (AD) requires measures that can predict future brain atrophy. Gray matter network measures are related to amyloid burden in cognitively normal older individuals and predict clinical progression in preclinical AD. Here, we show that within individuals with preclinical AD, gray matter network measures predict hippocampal atrophy rates, whereas other AD biomarkers (total gray matter volume, cerebrospinal fluid total tau, and Mini-Mental State Examination) do not. Furthermore, in brain areas where amyloid is known to start aggregating (i.e. anterior cingulate and precuneus), disrupted network measures predict faster atrophy in other distant areas, mostly involving temporal regions, which are associated with AD. When repeating analyses in age-matched, cognitively unimpaired individuals without amyloid or tau pathology, we did not find any associations between network measures and hippocampal atrophy, suggesting that the associations are specific for preclinical AD. Our findings suggest that disrupted gray matter networks may indicate a treatment opportunity in preclinical AD individuals but before the onset of irreversible atrophy and cognitive impairment.

Objectives Grey matter network disruptions in Alzheimer's disease (AD) are associated with worse cognitive impairment cross‐sectionally. Our aim was to investigate whether indications of a more random network organization are associated with longitudinal decline in specific cognitive functions in individuals with subjective cognitive decline (SCD). Experimental design: We included 231 individuals with SCD who had annually repeated neuropsychological assessment (3 ± 1 years; n = 646 neuropsychological investigations) available from the Amsterdam Dementia Cohort (54% male, age: 63 ± 9, MMSE: 28 ± 2). Single‐subject grey matter networks were extracted from baseline 3D‐T1 MRI scans and we computed basic network (size, degree, connectivity density) and higher‐order (path length, clustering, betweenness centrality, normalized path length [lambda] and normalized clustering [gamma]) parameters at whole brain and/or regional levels. We tested associations of network parameters with baseline and annual cognition (memory, attention, executive functioning, language composite scores, and global cognition [all domains with MMSE]) using linear mixed models, adjusted for age, sex, education, scanner and total gray matter volume. Principal observations: Lower network size was associated with steeper decline in language (β ± SE = 0.12 ± 0.05, p

Gray matter networks are disrupted in Alzheimer's disease and related to cognitive impairment. However, it is still unclear whether these disruptions are associated with cognitive decline over time. Here, we studied this question in a large sample of patients with mild cognitive impairment with extensive longitudinal neuropsychological assessments. Gray matter networks were extracted from baseline structural magnetic resonance imaging, and we tested associations of network measures and cognitive decline in Mini–Mental State Examination and 5 cognitive domains (i.e., memory, attention, executive function, visuospatial, and language). Disrupted network properties were cross-sectionally related to worse cognitive impairment. Longitudinally, lower small-world coefficient values were associated with a steeper decline in almost all domains. Lower betweenness centrality values correlated with a faster decline in Mini–Mental State Examination and memory, and at a regional level, these associations were specific for the precuneus, medial frontal, and temporal cortex. Furthermore, network measures showed additive value over established biomarkers in predicting cognitive decline. Our results suggest that gray matter network measures might have use in identifying patients who will show fast disease progression.

ObjectiveTo investigate the relationship between cognitive reserve (CR) and clinical progression across the Alzheimer disease (AD) spectrum.MethodsWe selected 839 β-amyloid (Aβ)–positive participants with normal cognition (NC, n = 175), mild cognitive impairment (MCI, n = 437), or AD dementia (n = 227) from the Alzheimer's Disease Neuroimaging Initiative (ADNI). CR was quantified using standardized residuals (W scores) from a (covariate-adjusted) linear regression with global cognition (13-item Alzheimer's Disease Assessment Scale–cognitive subscale) as an independent variable of interest, and either gray matter volumes or white matter hyperintensity volume as dependent variables. These W scores, reflecting whether an individual's degree of cerebral damage is lower or higher than clinically expected, were tested as predictors of diagnostic conversion (i.e., NC to MCI/AD dementia, or MCI to AD dementia) and longitudinal changes in memory (ADNI-MEM) and executive functions (ADNI-EF).ResultsThe median follow-up period was 24 months (interquartile range 6–42). Corrected for age, sex, APOE4 status, and baseline cerebral damage, higher gray matter volume-based W scores (i.e., greater CR) were associated with a lower diagnostic conversion risk (hazard ratio [HR] 0.22, p < 0.001) and slower decline in memory (β = 0.48, p < 0.001) and executive function (β = 0.67, p < 0.001). Stratified by disease stage, we found similar results for NC (diagnostic conversion: HR 0.30, p = 0.038; ADNI-MEM: β = 0.52, p = 0.028; ADNI-EF: β = 0.42, p = 0.077) and MCI (diagnostic conversion: HR 0.21, p < 0.001; ADNI-MEM: β = 0.43, p = 0.003; ADNI-EF: β = 0.59, p < 0.001), but opposite findings (i.e., more rapid decline) for AD dementia (ADNI-MEM: β = −0.91, p = 0.002; ADNI-EF: β = −0.77, p = 0.081).ConclusionsAmong Aβ-positive individuals, greater CR related to attenuated clinical progression in predementia stages of AD, but accelerated cognitive decline after the onset of dementia.

Myelin determines the conduction of neuronal signals along axonal connections in networks of the brain. Loss of myelin integrity in neuronal circuits might result in cognitive decline in Alzheimer's disease (AD). Recently, the ratio of T1‐weighted by T2‐weighted MRI has been used as a proxy for myelin content in gray matter of the cortex. With this approach, we investigated whether AD dementia patients show lower cortical myelin content (i.e., a lower T1‐w/T2‐w ratio value). We selected structural T1‐w and T2‐w MR images of 293 AD patients and 172 participants with normal cognition (NC). T1‐w/T2‐w ratios were computed for the whole brain and within 90 automated anatomical labeling atlas regions using SPM12, compared between groups and correlated with the neuronal injury marker tau in cerebrospinal fluid (CSF) and Mini Mental State Examination (MMSE). In contrast to our hypothesis, AD patients showed higher whole brain T1‐w/T2‐w ratios than NC, and regionally in 31 anatomical areas (p

Background Grey matter (GM) atrophy in Alzheimer's disease (AD) is most commonly modeled as a function of time. However, this approach does not take into account inter-individual differences in initial disease severity or changes due to aging. Here, we modeled GM atrophy within individuals across the AD clinical spectrum as a function of time, aging and MMSE, as a proxy for disease severity, and investigated how these models influence estimates of GM atrophy. Methods We selected 523 individuals from ADNI (100 preclinical AD, 288 prodromal AD, 135 AD dementia) with abnormal baseline amyloid PET/CSF and ≥1 year of MRI follow-up. We calculated total and 90 regional GM volumes for 2281 MRI scans (median [IQR]; 4 [3–5] scans per individual over 2 [1.6–4] years) and used linear mixed models to investigate atrophy as a function of time, aging and decline on MMSE. Analyses included clinical stage as interaction with the predictor and were corrected for baseline age, sex, education, field strength and total intracranial volume. We repeated analyses for a sample of participants with normal amyloid (n = 387) to assess whether associations were specific for amyloid pathology. Results Using time or aging as predictors, amyloid abnormal participants annually declined −1.29 ± 0.08 points and − 0.28 ± 0.03 points respectively on the MMSE and −12.23 ± 0.47 cm3 and −8.87 ± 0.34 respectively in total GM volume (p, Highlights • Modeling atrophy as a function of time or aging show similar anatomical patterns. • GM atrophy as a function of time or aging seems nonspecific for amyloid pathology. • GM atrophy as a function of MMSE shows involvement of different anatomical patterns. • Atrophy modeled based on time or age was steeper than modeled based on MMSE. • Atrophy patterns based on MMSE were specific for amyloid pathology.

Structural brain changes underlying mild cognitive impairment (MCI) have been well-researched, but most previous studies required subjective cognitive complaints (SCC) as a diagnostic criterion, diagnosed MCI based on a single screening test or lacked analyses in relation to neuropsychological impairment. This longitudinal voxel-based morphometry study aimed to overcome these limitations: The relationship between regional gray matter (GM) atrophy and behavioral performance was investigated over the course of 3 years in individuals unaware of cognitive decline, identified as amnestic MCI based on an extensive neuropsychological test battery. Region of interest analyses revealed GM atrophy in the left amygdala, hippocampus, and parahippocampus in MCI individuals compared to normally aging participants, which was specifically related to verbal memory impairment and evident already at the first measurement point. These findings demonstrate that GM atrophy is detectable in individuals with amnestic MCI despite unawareness of beginning cognitive decline. Thus, individuals with GM atrophy in regions associated with verbal memory impairment do not necessarily need to experience SCC before meeting neuropsychological criteria for MCI. These results have important implications for future research and diagnostic procedures of MCI.