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Peer-Reviewed Publication
Neurology2026;106(5):e214606.March 10, 2026Journal Article

Association of Cortical Free Water With Brain Tau Tangle Load in the Alzheimer Disease Continuum.

Brandon J Hall1,2,3, Etienne Aumont1,2, Seyyed Ali Hosseini1,2, Jaime Fernandez Arias1,2, Arnaud Boré4, Gleb Bezgin1,2, Lydia Trudel1,2, Tevy Chan1,2, Joseph Therriault1,2, Arthur C Macedo1,2, Marcel Seungsu Woo2,5,6,7, Delphine Oliva-Lopez1,2, Nesrine Rahmouni1,2, Yansheng Zheng1,2, Stijn Servaes1,2, Jenna Stevenson1,2, Serge Gauthier2, Andrea L Benedet8, Matthieu Dumont9, Jean-Christophe Houde9, Gallen Triana-Baltzer10, Hartmuth Christian Kolb10, Nicholas J Ashton11, Henrik Zetterberg12,13,14,15, Yasser Iturria Medina2, Paolo Vitali2, Maxime Descoteaux4,9, Jesse Michael Klostranec2,3, Tharick Pascoal16, Pedro Rosa-Neto1,2,17
1Translational Neuroimaging Laboratory, McGill University Research Centre for Studies in Aging, McConnell Brain Imaging Centre (BIC), Montreal Neurological Institute, Montreal Neurological Institute-Hospital, Quebec, Canada.
2Douglas Hospital Research Centre - Centre intégré universitaire de santé et services sociaux de l'Ouest-de-l'Île-de-Montréal, Verdun, Quebec, Canada.
3Department of Diagnostic Radiology, McGill University, Montréal, Quebec, Canada.
4Sherbrooke Connectivity Imaging Laboratory (SCIL), Université de Sherbrooke, Quebec, Canada.
5Translational Neurodegeneration Laboratory, Department of Neurology, University Medical Centre Hamburg Eppendorf, Germany.
6Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Germany.
7Department of Neurology and Neurosurgery, McGill University, Montréal, Quebec, Canada.
8Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden.
9Imeka Solutions Inc., Sherbrooke, Quebec, Canada.
10Precision Measures, Johnson & Johnson, La Jolla, CA.
11Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden.
12Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
13Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
14Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison.
15Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison.
16University of Pittsburgh, PA; and.
17The Peter O'Donnell Jr. Brain Institute (OBI), University of Texas Southwestern Medical Centre (UTSW), Dallas.

Abstract

BACKGROUND AND OBJECTIVES: Neurofibrillary tangles (NFTs) progressively damage gray matter in Alzheimer disease (AD). Resulting cortical microstructural alterations might not be detectable using macrostructural metrics but may be studied using isotropic water diffusion, as it reflects extracellular free water content. The aim of this study was to examine the effect of NFTs on cortical microstructu…

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