Abstract
BACKGROUND: Odor identification impairment is an early marker of Alzheimer's disease (AD) that predicts memory decline, yet its underlying microstructural basis remains unclear. We hypothesized that mild cognitive impairment (MCI) involves early myelin and lipid disruption within olfactory-limbic circuits, detectable using a synthetic MRI-derived contrast that provides complementary sensitivity to myelin volume fraction (MVF). METHODS: Thirty-three older adults (healthy controls [HC], n = 16; mild cognitive impairment [MCI], n = 17) completed olfactory and cognitive testing and underwent 3T brain MRI using a QALAS sequence. An MVF map and synthetic FLAIR and DIR images were generated, and a FLAIR-DIR-derived metric (FD) was computed as FD = (FLAIR - DIR) / FLAIR. We investigated ROI-based group differences in olfactory-limbic gray-matter regions and associated white-matter tracts, voxel-wise regressions investigating FD-odor identification associations, and ROI-based MCI vs HC classification using cross-validated logistic regression models. RESULTS: Compared with HC, MCI showed significantly lower FD across olfactory-limbic gray-matter regions and white-matter pathways-including hippocampus, amygdala, orbitofrontal cortex, thalamus, and corpus callosum-whereas MVF differences were more limited. FD achieved moderate discrimination, with baseline performance comparable to MVF. Voxel-wise analyses revealed that better odor identification was associated with higher FD in the hippocampus/parahippocampal and insula; the association persisted after adjusting for voxel-wise MVF. MVF also showed significant positive voxel-wise associations with odor identification in the insula and genu of the corpus callosum. CONCLUSION: FD is a practical, myelin- and lipid-sensitive contrast derived from routinely acquired synthetic FLAIR & DIR images that complement quantitative MVF. It captures behaviorally relevant variance beyond local myelin content and may improve detection of early olfactory-limbic microstructural changes in MCI. These findings support FD as a scalable candidate marker linking early network disruption to olfactory symptoms across the AD continuum.