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This study investigates magnetic resonance imaging (MRI) \u2010based atrophy patterns in AD patients with \u03b1\u2010syn copathology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      We study two independent cohorts: Hospital Clinic Barcelona (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a0139) and Alzheimer's Disease Neuroimaging Initiative (ADNI) (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a0191). Participants were classified into AD\u2013\u03b1\u2010syn seed amplification assay positive (\u03b1SAA+), AD\u2010\u03b1SAA\u2010, and healthy controls (CTR). Group comparisons of MRI regions were conducted using permutation tests adjusting for age and sex.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Compared to CTR, both AD\u2010\u03b1SAA\u2010 and AD\u2010\u03b1SAA+ showed widespread cortical thinning. Direct comparison of AD\u2010\u03b1SAA+ versus AD\u2010\u03b1SAA\u2010 revealed differential involvement of insular, entorhinal, lateral temporal, pre and postcentral gyrus, frontal cortices, and amygdala, although with minimum size effect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>\u03b1\u2010Syn copathology was associated with more extensive and pronounced atrophy, especially in frontal, lateral temporal, entorhinal, and amygdalar regions. This suggests that \u03b1\u2010syn is associated with greater neurodegeneration beyond typical AD patterns.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dad2.70347","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T03:31:59Z","timestamp":1779679919000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Atrophy signature for alpha\u2010synuclein copathology in Alzheimer's disease"],"prefix":"10.1002","volume":"18","author":[{"given":"Diana","family":"Esteller\u2010Gauxax","sequence":"first","affiliation":[{"name":"Alzheimer's disease and other cognitive disorders Group, Service of Neurology Hospital Cl\u00ednic de Barcelona, Fundaci\u00f3 Recerca Cl\u00ednic Barcelona\u2010IDIBAPS  Barcelona Spain"},{"name":"Departament de Medicina, Facultat de Medicina i Ci\u00e8ncies de la Salut Universitat de Barcelona  Barcelona 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