Unravelling the relationship between amyloid accumulation and brain network function in normal aging and very mild cognitive decline: a longitudinal analysis

Pathological changes in the brain begin accumulating decades before the appearance of cognitive symptoms in Alzheimer’s disease. The deposition of amyloid beta proteins and other neurotoxic changes occur, leading to disruption in functional connections between brain networks. Discrete characterization of the changes that take place in preclinical Alzheimer’s disease has the potential to help treatment development by targeting the neuropathological mechanisms to prevent cognitive decline and dementia from occurring entirely. Previous research has focused on the cross-sectional differences in the brains of patients with mild cognitive impairment or Alzheimer’s disease and healthy controls or has concentrated on the stages immediately preceding cognitive symptoms. The present study emphasizes the early preclinical phases of neurodegeneration. We use a longitudinal approach to examine the brain changes that take place during the early stages of cognitive decline in the Open Access Series of Imaging Studies-3 data set. Among 1098 participants, 274 passed the inclusion criteria (i.e. had at least two cognitive assessments and two amyloid scans). Over 90% of participants were healthy at baseline. Over 8–10 years, some participants progressed to very mild cognitive impairment (n = 48), while others stayed healthy (n = 226). Participants with cognitive decline show faster amyloid accumulation in the lateral temporal, motor and parts of the lateral prefrontal cortex. These changes in amyloid levels were linked to longitudinal increases in the functional connectivity of select networks, including default mode, frontoparietal and motor components. Our findings advance the understanding of amyloid staging and the corresponding changes in functional organization of large-scale brain networks during the progression of early preclinical Alzheimer’s disease.