Hemispheric Asymmetry of Tau Pathology is Related to Asymmetric Amyloid Deposition in Alzheimer's Disease

The distribution of tau pathology in Alzheimers disease (AD) shows remarkable inter-individual heterogeneity, including hemispheric asymmetry. However, the factors driving this asymmetry remain poorly understood. We explored whether tau asymmetry is linked to i) reduced inter-hemispheric brain connectivity (potentially restricting tau spread), or ii) asymmetry in amyloid-beta (A{beta}) distribution (indicating greater hemisphere-specific vulnerability to AD pathology). 452 participants from the Swedish BioFINDER-2 cohort with evidence of both A{beta} pathology (CSF A{beta}42/40 or neocortical A{beta}-PET) and tau pathology (temporal tau-PET), were categorised as left asymmetric (n=102), symmetric (n=306), or right asymmetric (n=44) based on temporal lobe tau-PET uptake distribution. Edge-wise inter-hemispheric functional (RSfMRI; n=318) and structural connectivity (dMRI; n=352) patterns were examined but no differences in inter-hemispheric functional or structural connectivity were found between groups. However, a strong association was observed between tau and A{beta} laterality patterns based on PET uptake (n=233; {beta}=0.632, p<0.001), which was replicated in three independent cohorts (n=234; {beta}=0.535, p<0.001). In a longitudinal A{beta}-positive sample, baseline A{beta} asymmetry predicted the progression of tau laterality over time (n=289; {beta}=0.025, p=0.028). These findings suggest that tau asymmetry is not associated with a weaker inter-hemispheric connectivity but might reflect hemispheric differences in vulnerability to A{beta} pathology, underscoring the role of regional vulnerability in determining the distribution of AD pathology.