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To reduce confounding from age\u2010related comorbidities, we examined PVSs in autosomal dominant AD (ADAD).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>In this cross\u2010sectional study of 96 non\u2010demented individuals (62 mutation carriers), we quantified PVS count fraction and mean diameter in white matter and basal ganglia using automated magnetic resonance imaging analysis. Linear mixed models assessed group differences along the disease course, adjusting for cardiovascular risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Compared to non\u2010carriers, mutation carriers showed lower PVS count fraction in white matter and basal ganglia, and larger PVS diameter in basal ganglia and the temporal lobe. Changes were evident up to 18 years before expected dementia onset and followed trajectories similar to amyloid beta 42 and tau biomarkers.<\/jats:p><\/jats:sec><jats:sec><jats:title>DISCUSSION<\/jats:title><jats:p>ADAD is associated with early PVS alterations, suggesting perivascular changes may be integral to primary AD pathology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Highlights<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Autosomal dominant Alzheimer's disease (ADAD) mutation carriers have reduced magnetic resonance imaging\u2013visible perivascular space (PVS) count fraction in the white matter and basal ganglia.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>ADAD mutation carriers show enlarged PVS in the basal ganglia and temporal white matter.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>PVS alterations start 18 years before the estimated time of dementia diagnosis.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>The spatial localization of PVS changes overlaps with regions of amyloid beta (A\u03b2) accumulation.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>The temporal evolution of PVS alterations aligns with A\u03b2 and tau changes in the cerebrospinal fluid.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/alz.70588","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T03:20:20Z","timestamp":1756092020000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Alterations in MRI\u2010visible perivascular spaces precede dementia diagnosis by 18 years in autosomal dominant Alzheimer's disease"],"prefix":"10.1002","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5569-6090","authenticated-orcid":false,"given":"Riccardo","family":"Leone","sequence":"first","affiliation":[{"name":"Computational Neurology Group Ruhr University Bochum  Bochum Germany"},{"name":"Faculty of Medicine University of Bonn  Bonn Germany"},{"name":"German Center for Neurodegenerative Diseases (DZNE)  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xenia","family":"Kobeleva","sequence":"additional","affiliation":[{"name":"Computational Neurology Group Ruhr University Bochum  Bochum Germany"},{"name":"German Center for Neurodegenerative Diseases (DZNE)  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Rowe","sequence":"additional","affiliation":[{"name":"Department of Neurology, Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeiran","family":"Choupan","sequence":"additional","affiliation":[{"name":"Laboratory of Neuro Imaging (LONI), Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine University of Southern California  Los Angeles California USA"},{"name":"NeuroScope Inc. 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