Dynamic Alterations of Functional Systems in Alzheimer's Disease: A Co-Activation Pattern Analysis

While resting-state brain dysfunctions have been extensively investigated in Alzheimer's disease (AD), the dynamic alterations of functional systems remain poorly understood. We employed co-activation pattern (CAP) analysis to characterize the functional-state alterations in 243 participants using resting-state fMRI data and applied graph theory analysis to estimate corresponding topological properties. The CAP analysis identified five distinct brain states across groups: State 1 (limbic network dominated), State 2 (dorsal attention network (DAN) and central executive network dominated), State 3 (default mode network and central executive network dominated), State 4 (somatomotor network and ventral attention network dominated), and State 5 (DAN, sensorimotor, and visual networks dominated). Compared to cognitively unimpaired individuals, State 3 demonstrated significantly reduced persistence and resilience in both mild cognitive impairment (MCI) and AD groups. Additionally, both clinical groups (MCI and AD) exhibited decreased transitions from State 2 to State 5 and reduced self-transitions within State 3. Graph theory analysis revealed that compared to cognitively unimpaired individuals, MCI and AD individuals had increased node degree centrality and node efficiency, alongside decreased node local efficiency in regions within the default mode network (DAN) and visual network, which corresponded well with CAP analysis results. Our findings provide a multiscale framework linking dynamic state instability to static network reorganization, advancing understanding of the dynamic functional alterations underlying cognitive decline in AD spectrum disorders.