Dynamical Aβ-Tau-Neurodegeneration Model Predicts Alzheimer's Disease Mechanisms and Biomarker Progression

Alzheimers disease is characterised by the pathological interaction of two proteins, amyloid-beta (A{beta}) and tau, which collectively drive neurodegeneration and cognitive decline. The progression of A{beta}, tau, and neurodegeneration biomarkers is captured by the ATN framework, which is a powerful tool for disease classification. However, since the ATN framework is mainly descriptive, it cannot quantify or predict relationships between biomarkers over time. We address this limitation by introducing a dynamical ATN (dATN) model that mechanistically simulates the spatiotemporal progression of A{beta}, tau, and neurodegeneration. The dATN model integrates mechanisms of prion-like protein aggregation of A{beta} and tau, network-based tau propagation, A{beta}-driven catalysis of tau progression, and tau-driven neurodegeneration. We calibrated the model using multimodal longitudinal imaging data from both the ADNI and BioFINDER-2 cohorts and show that it accurately fits longitudinal regional A{beta}, tau, and neurodegeneration data. Using the dATN model, we show that A{beta}-induced effects predict Braak-like cortical tau progression, that the spatial colocalisation of A{beta} and tau is a crucial biomarker of disease acceleration, and that tau-driven atrophy strongly correlates with observed neurodegeneration. Furthermore, by integrating the disease progression model with pharmacokinetic-pharmacodynamic simulations, we present a powerful tool that facilitates regional evaluation of therapeutic strategies targeting A{beta}, identification of critical intervention windows, and prediction of heterogeneous treatment effects across brain regions. This framework unifies mechanistic understanding with clinical imaging biomarkers, offering a quantitative approach for forecasting disease progression, testing mechanistic hypotheses, and optimising personalised treatment strategies in AD. One Sentence SummaryColocalisation of A{beta} and tau predicts regional tau progression and optimal A{beta}-targeted intervention windows, while tau predicts neurodegeneration.