{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T21:56:26Z","timestamp":1791669386334,"version":"4.3.4"},"reference-count":71,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T00:00:00Z","timestamp":1758412800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The hippocampus is highly vulnerable in Alzheimer's disease (AD), with early microstructural changes potentially detectable via diffusion kurtosis imaging (DKI). Previous studies report promising DKI findings in AD, necessitating systematic evaluation. To compare hippocampal DKI metrics, particularly mean kurtosis (MK), between AD patients and healthy controls (HCs) and explore factors influencing these differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Following PRISMA guidelines, PubMed, Scopus, Web of Science, and Embase were searched until November 2024. Two reviewers independently extracted hippocampal MK values. Risk of bias was evaluated using the Newcastle\u2013Ottawa Scale. Meta\u2010analysis employed random\u2010effects models (STATA v17). Subgroup analyses (sex, age, magnetic resonance imaging [MRI] parameters) and sensitivity and trim\u2010and\u2010fill assessments were conducted. Standardized mean difference (SMD),\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      for heterogeneity, and Egger's\/Begg's tests for publication bias (significance:\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ten studies (215 AD patients, 217 HCs; mean age: 65\u201375 years) using 3.0\u00a0T MRI were included. Eight articles were included in the meta\u2010analysis to compare MK between groups. AD patients exhibited significantly reduced bilateral hippocampal MK compared to HCs (left: SMD\u00a0=\u00a0\u22121.32, 95% confidence interval [95% CI] [\u22121.97 to \u22120.66]; right: SMD\u00a0=\u00a0\u22121.22 [\u22121.88 to \u22120.56]; both\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      &lt;\u00a00.001), indicating compromised microstructural complexity. Subgroup analyses revealed more pronounced MK reductions in studies with higher male ratios (&gt;42%; left: SMD\u00a0=\u00a0\u22121.87; right: SMD\u00a0=\u00a0\u22121.91;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05). Age, echo time, repetition time, and diffusion directions did not significantly influence effect sizes. Sensitivity analyses confirmed robustness, and publication bias was detected, but trim\u2010and\u2010fill analyses revealed no missing studies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reduced hippocampal MK in AD reflects microstructural degeneration, with sex\u2010related differences in effect magnitude.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.70919","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T06:57:36Z","timestamp":1758524256000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Microstructural Hippocampal Alterations in Alzheimer's Disease: A Systematic Review and Meta\u2010Analysis of Diffusion Kurtosis Imaging"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2133-4283","authenticated-orcid":false,"given":"Amir Mahmoud","family":"Ahmadzadeh","sequence":"first","affiliation":[{"name":"Department of Radiology, School of Medicine Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1334-8826","authenticated-orcid":false,"given":"Sadegh","family":"Ghaderi","sequence":"additional","affiliation":[{"name":"Neuromuscular Research Center, Department of Neurology Shariati Hospital Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2286-9052","authenticated-orcid":false,"given":"Sana","family":"Mohammadi","sequence":"additional","affiliation":[{"name":"Neuromuscular Research Center, Department of Neurology Shariati Hospital Tehran University of Medical Sciences Tehran 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