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These models were applied to 1742 scans from 725 participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort. Individualized diffusion abnormalities were integrated into a composite cholinergic pathway degeneration index (CPDI). Group differences and longitudinal associations with cognitive decline and progression were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>CPDI was higher in MCI and AD participants than in controls, and increased longitudinally in patients with AD and in patients with MCI who progressed to AD. Higher baseline CPDI was associated with an increased risk of progression from MCI to AD and faster decline in global cognition, memory, language, and executive function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>CPDI provides an individualized biomarker of cholinergic pathway degeneration with prognostic relevance in AD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dad2.70485","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:32:22Z","timestamp":1789619542000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Individualized cholinergic pathway degeneration in Alzheimer's disease characterized by normative modeling"],"prefix":"10.1002","volume":"18","author":[{"given":"Shuoyun","family":"Feng","sequence":"first","affiliation":[{"name":"School of 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China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Xu","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering, Shanghai Sixth People's Hospital Shanghai Jiao Tong University  Shanghai China"},{"name":"National Engineering Research Center of Advanced Magnetic Resonance, Technologies for Diagnosis and Therapy (NERC\u2010AMRT) Shanghai Jiao Tong University  Shanghai China"},{"name":"Institute of Medical Robotics Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Guo","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering, Shanghai Sixth People's Hospital Shanghai Jiao Tong University  Shanghai China"},{"name":"National Engineering Research Center of Advanced Magnetic Resonance, Technologies for Diagnosis and Therapy (NERC\u2010AMRT) Shanghai Jiao Tong University  Shanghai China"},{"name":"Institute of Medical Robotics Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Neurology Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine  Shanghai China"},{"name":"Shanghai Professional Technical Service Platform for Genetic and Rare Neurological Diseases  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaou","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beijing Tiantan Hospital Capital Medical University  Beijing China"},{"name":"China National Clinical Research Center for Neurological Diseases  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Guan","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering, Shanghai Sixth People's Hospital Shanghai Jiao Tong University  Shanghai 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