Disentangling Neurodegeneration with Brain Age Gap Prediction Models: A Graph Signal Processing Perspective

Neurodegeneration, characterized by the progressive loss of neuronal structure or function, is commonly assessed in clinical practice through reductions in cortical thickness or brain volume, as visualized by structural MRI. While informative, these conventional approaches lack the statistical sophistication required to fully capture the spatially correlated and heterogeneous nature of neurodegeneration, which manifests both in healthy aging and in neurological disorders. To address these limitations, brain age gap has emerged as a promising data-driven biomarker of brain health. The brain age gap prediction (BAGP) models estimate the difference between a person's predicted brain age from neuroimaging data and their chronological age. The resulting brain age gap serves as a compact biomarker of brain health, with recent studies demonstrating its predictive utility for disease progression and severity. However, practical adoption of BAGP models is hindered by their methodological obscurities and limited generalizability across diverse clinical populations. This tutorial article provides an overview of BAGP and introduces a principled framework for this application based on recent advancements in graph signal processing (GSP). In particular, we focus on graph neural networks (GNNs) and introduce the coVariance neural network (VNN), which leverages the anatomical covariance matrices derived from structural MRI. VNNs offer strong theoretical grounding and operational interpretability, enabling robust estimation of brain age gap predictions. By integrating perspectives from GSP, machine learning, and network neuroscience, this work clarifies the path forward for reliable and interpretable BAGP models and outlines future research directions in personalized medicine.