Multimodal DTI-ALPS and hippocampal microstructural signatures unveil stage-specific pathways in Alzheimer’s disease progression

The framework reveals distinct biomarker trajectories: DTI-ALPS distinguishes symptomatic AD from preclinical stages, while right hippocampal MD progression reflects tau-mediated neurodegeneration. Early FA reductions in MCI combined with CSF profiles suggest a hierarchical staging model: amyloid-associated perivascular dysfunction is associated with asymmetric tau-driven hippocampal degeneration. This multimodal approach provides clinically actionable biomarkers for AD progression monitoring.