BRIDGE: Learning Brain-Gut Metabolic Evidence for Alzheimer's Disease Diagnosis

Pengli Zhu, Ruxi Chang, Tianliang Yao, Yu Jiang, Shengyuan Liu +5

Alzheimer's disease (AD) diagnosis may benefit from gut metabolic information associated with brain-gut interactions, yet existing models largely analyze cerebral glucose metabolism alone. Although whole-body fluorodeoxyglucose positron emission tomography (FDG-PET) can provide paired brain-gut observations, routine brain examinations rarely include gut imaging, limiting direct use of this information for diagnosis. In this paper, we present BRIDGE (Brain and Gut Representation Integration via Distribution-Guided Enhancement), a two-stage framework for transferring brain-gut metabolic knowledge to brain-only diagnosis. Specifically, BRIDGE integrates a conditional brain-to-gut latent transport module and a disease-evidence-guided cerebral pathway to capture subject-specific cross-organ correspondence and disease-relevant cerebral representations. For the cerebral pathway, a large language model (LLM) helps organize literature-derived descriptors into human-approved semantic anchors that guide feature learning. Additionally, we introduce a counterfactual-guided residual fusion mechanism, which uses matched and non-matched virtual-gut evidence to supervise a confidence gate and…