Explainable Graph Neural Networks: Understanding Brain Connectivity and Biomarkers in Dementia

Dementia is a progressive neurodegenerative disorder with multiple etiologies, including Alzheimer's disease, Parkinson's disease, frontotemporal dementia, and vascular dementia. Its clinical and biological heterogeneity makes diagnosis and subtype differentiation highly challenging. Graph Neural Networks (GNNs) have recently shown strong potential in modeling brain connectivity, but their limited robustness, data scarcity, and lack of interpretability constrain clinical adoption. Explainable Graph Neural Networks (XGNNs) have emerged to address these barriers by combining graph-based learning with interpretability, enabling the identification of disease-relevant biomarkers, analysis of brain network disruptions, and provision of transparent insights for clinicians. This paper presents the first comprehensive review dedicated to XGNNs in dementia research. We examine their applications across Alzheimer's disease, Parkinson's disease, mild cognitive impairment, and multi-disease diagnosis. A taxonomy of explainability methods tailored for dementia-related tasks is introduced, alongside comparisons of existing models in clinical scenarios. We also highlight challenges such as limited generalizability, underexplored domains, and the integration of Large Language Models (LLMs) for early detection. By outlining both progress and open problems, this review aims to guide future work toward trustworthy, clinically meaningful, and scalable use of XGNNs in dementia research.