Activity-dependent epidemic spreading on multiscale brain networks predicts Alzheimer's disease progression

Abstract

Neurodegenerative diseases can be viewed as spreading processes on brain networks, in which pathological proteins propagate between anatomically connected brain regions. Mathematical models have been used to study this process, but they generally ignore the influence of neuronal activity, even though experimental studies show that neuronal firing promotes protein transmission. Here, we couple a general node-activity process to susceptible--infected--susceptible dynamics. In this framework, an epidemic threshold determines whether small pathological seeds can grow, while a dominant network mode determines where growth begins. We derive approximations showing how neuronal activity shifts this threshold and redirects spreading by mixing structural network modes. For networks with multiscale structure, we decompose these changes into contributions from regional mean activity and within-region activity variation, allowing us to account for activity heterogeneity that is not resolved by brain imaging. Stochastic simulations validate the theoretical results across synthetic networks. We next use longitudinal human positron emission tomography to test whether neuronal activity predicts where and how broadly pathology spreads. Regional glucose metabolism serves as a proxy for neuronal activity, while tau accumulation measures disease progression. Adding neuronal activity to the network model captures spatial patterns of disease progression that are not explained by structural connectivity and established disease markers alone. Across individuals, predicted epidemic thresholds are also associated with how broadly pathology spreads through the brain. Together, these results connect epidemic theory to neurodegeneration, implicate neuronal activity as a driver of Alzheimer's disease progression, and motivate activity-modulating therapies to slow or prevent pathological spread.