Fig. 5: External validation of the unified prognostic staging system using the ADNI cohort.

a Adjusted survival curves for very mild and mild dementia outcomes shows consistent separation of worsening prognosis across stages, while less differentiation is found for moderate dementia outcome due to limited event occurrence. A log-rank test corrected for weighting was used to assess overall differences among stages, yielding \(P=2.03\times {10}^{-6}\) for very mild dementia, \(P=3.52\times {10}^{-5}\) for mild dementia, and P = 0.0419 for moderate dementia. Stages with fewer than 10 participants (i.e., III, IVA, IVB) were excluded from this analysis. b Pairwise comparisons between stages using multivariable Cox proportional hazards models demonstrated significant differences in progression risk for adjacent stage pairs, supporting external discriminative validity. P values within each survival outcome were corrected for multiple hypothesis testing using a Benjamini-Hochberg procedure. c Longitudinal changes in clinical dementia rating–sum of boxes (CDR-SB) and mini-mental state examination (MMSE) also showed progressively steeper decline in higher stages over time. Data are presented as least squares means (LSmeans) and their 95% confidence intervals estimated with generalized estimating equations. All statistical tests were two-sided, and source data are provided as a Source data file.