Investigating White Matter Functional Network Connectivity Across the Alzheimer's Disease Spectrum Using...

White matter (WM) has traditionally been considered structurally important but functionally inert in fMRI research. However, growing evidence indicates that WM exhibits meaningful BOLD fluctuations and participates in functional connectivity. Here, we investigate alterations in WM functional network connectivity (FNC) across the Alzheimer's disease (AD) spectrum using resting-state fMRI data from the Alzheimer's Disease Neuroimaging Initiative (ADNI; 415 cognitively normal (CN), 283 mild cognitive impairment (MCI), 91 AD). We applied a guided independent component analysis (ICA) approach based on a combined multiscale template including 202 intrinsic connectivity networks (ICNs; 97 WM, 105 gray matter (GM)) to estimate subject-specific timecourses and compute static FNC (sFNC). Group differences in WM-WM, GM-GM, and WM-GM connectivity (AD-CN, AD-MCI, MCI-CN) were assessed using two-sample t-tests with covariates for age, sex, and motion, with false discovery rate correction. Results showed robust alterations in WM-WM and WM-GM connectivity in AD, particularly involving WM subcortical, frontal, sensorimotor, and occipitotemporal networks. Several WM-GM interactions with cerebellar and hippocampal GM networks were also disrupted, including reduced GM-cerebellar:WM-frontal coupling and increased GM-hippocampal:WM-frontal connectivity. Notably, MCI already showed WM-GM dysconnectivity relative to CN, suggesting that functional disruption of WM circuits emerges prior to overt dementia. These findings provide converging evidence that WM functional connectivity is both measurable and selectively altered across the AD continuum. Our findings support WM sFNC as a complementary candidate biomarker to GM-based measures for staging and monitoring AD. This is, to our knowledge, the first large-scale ADNI study to jointly model WM and GM intrinsic connectivity networks and quantify WM-GM dysconnectivity across CN, MCI, and AD.