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Performance at digital testing in Alzheimer’s Disease is predicted by selective disruption of microstructural integrity
Toniolo S, Attaallah B, Broulidakis J, Maio MR, Slavkova E, Dickson S, Plant O, Idris IM et al.. medRxiv, 2026-02-12
Topic: Brain imaging, connectivity and assessment
White matter microstructural abnormalities are increasingly found to be associated with cognitive impairment in Alzheimer’s Disease (AD). Here, we investigated the relationship between visual short-term memory (VSTM) performance, measured using a digital cognitive task, and integrity of brain white matter tracts. 52 AD and 60 age-matched healthy controls were recruited from the Oxford Cognitive Disorders Clinic. An established digital VSTM test – the Oxford Memory Task (OMT) – was used to measure several key memory metrics including: Identification Accuracy (percentage of correctly identified items), Target detection (probability of correctly identifying the target) and Misbinding (erroneously localizing an item to the remembered location of another item in memory). TBSS (Tract-Based Spatial Statistics) was then applied to investigate in which regions of the brain microstructural disruption of physiological diffusivity correlated with behavioural performance. A key common area, comprising the left optic radiation, forceps major and middle longitudinal fasciculus (MLF), was associated with performance across several VSTM metrics in patients with AD. In addition, misbinding was linked to the left MLF (part III), left inferior fronto-occipital fasciculus and left vertical occipital fasciculus. Microstructural disruption associated with target detection was additionally associated with superior longitudinal fasciculus, and Identification Accuracy with left superior thalamic radiation in AD. These findings reveal a common shared area of altered diffusivity in AD patients linked to global impairment in VSTM, while distinct types of memory errors are associated with disruption of additional contributions of selective white matter tracts. Key points A key common area, comprising the left optic radiation, forceps major and middle longitudinal fasciculus (MLF), was associated with performance across several visual-short-term memory metrics in patients with Alzheimer’s Disease (AD). An analogous area on the right was related to identification accuracy performance in healthy individuals. Specific visual working memory functions were associated with selective disruption of other white matter tracts, such as the left MLF (part III), inferior fronto-occipital fasciculus, vertical occipital fasciculus, superior longitudinal fasciculus, and superior thalamic radiation in AD.
Key findings
- White matter microstructural abnormalities are increasingly found to be associated with cognitive impairment in Alzheimer’s Disease (AD).
- A key common area, comprising the left optic radiation, forceps major and middle longitudinal fasciculus (MLF), was associated with performance across several VSTM metrics in patients with AD.
- Microstructural disruption associated with target detection was additionally associated with superior longitudinal fasciculus, and Identification Accuracy with left superior thalamic radiation in AD.
- These findings reveal a common shared area of altered diffusivity in AD patients linked to global impairment in VSTM, while distinct types of memory errors are associated with disruption of additional contributions of selective white matter tracts.
- Key points A key common area, comprising the left optic radiation, forceps major and middle longitudinal fasciculus (MLF), was associated with performance across several visual-short-term memory metrics in patients with Alzheimer’s Disease (AD).
Study details
- Study designlongitudinal study
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 39 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 24 of the 62 points we could judge it on, which is 39 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 7 / 12 | A longitudinal study following the same people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Points | 24 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 24 of the 62 points we could judge it on is 39 out of 100. |
| Total | 39 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
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APA 7th
Toniolo, S., Attaallah, B., Broulidakis, J., Maio, M. R., Slavkova, E., Dickson, S., et al. (2026). Performance at digital testing in Alzheimer’s Disease is predicted by selective disruption of microstructural integrity. medRxiv. https://doi.org/10.64898/2026.02.10.26345988
Vancouver
Toniolo S, Attaallah B, Broulidakis J, Maio MR, Slavkova E, Dickson S, et al. Performance at digital testing in Alzheimer’s Disease is predicted by selective disruption of microstructural integrity. medRxiv. 2026. doi:10.64898/2026.02.10.26345988.
BibTeX
@article{toniolo2026-c0e8215f,
author = {Toniolo, S. and Attaallah, B. and Broulidakis, J. and Maio, M. R. and Slavkova, E. and Dickson, S. and Plant, O. and Idris, I. M. and others},
title = {{Performance at digital testing in Alzheimer’s Disease is predicted by selective disruption of microstructural integrity}},
journal = {medRxiv},
year = {2026},
doi = {10.64898/2026.02.10.26345988},
url = {https://doi.org/10.64898/2026.02.10.26345988}
}
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