MRI Network Vulnerability Index Enhances Alzheimer's Staging with Plasma p-tau217/Aβ42

An MRI-based network vulnerability index improved prediction of MCI-to-dementia conversion (HR 1.47, p=0.004) when added to plasma p-tau217/Aβ42 model—supporting a plasma+MRI triage pathway for Alzheimer's.

• In plasma p-tau217/Aβ42-positive individuals, neurodegeneration epicenters were consistently anchored to the default mode network and limbic axis.
• The Network Vulnerability Index (NVI) tracked PET tau accumulation (meta-temporal r=0.547) and hippocampal atrophy (r=-0.455).
• Adding NVI to a baseline model with plasma biomarkers and clinical scores improved MCI-to-dementia conversion prediction (HR 1.47, p=0.004).

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