White Matter Neurometabolite Vulnerability Predicts Cognitive Decline in Alzheimer’s Disease: A High-Resolution 3D 1H-MRSI Study

White matter (WM) damage plays an important role in AD and different mechanisms have been suggested for different brain areas from postmortem studies. Understanding the spatial patterns of pathological changes in WM is of great importance in AD diagnosis. Using a high-resolution 3D MRSI technique, we investigated the spatial patterns of neurometabolic changes in WM regions. We firstly derived neurometabolite vulnerability maps in AD, showing spatially varying patterns of NAA reduction and mIn elevation in WM regions, in distinct association with gray matter volume or Aβ deposition, respectively. The neurometabolic biomarkers showed improved prediction of cognitive decline of AD patients.