The purpose of this study was to determine correlations among disease progression, diffusion abnormalities in the posterior cingulum and hippocampal volume in patients with Alzheimer's disease (AD). We studied 25 AD patients by neuropsychological testing, including the Mini-Mental State Examination (MMSE), and by magnetic resonance imaging, including diffusion tensor imaging (DTI) and high-resolution three-dimensional T1-weighted imaging. The MMSE score was used as an indicator of disease progression. Diffusion tensor tractography of the posterior cingulum was generated from the DTI; mean diffusivity (MD) and fractional anisotropy (FA) were measured in co-registered voxels along the posterior cingulum. Hippocampal volume was measured using automated voxel-based morphometry. The relationships among MMSE score, hippocampal volume and MD and FA of the posterior cingulum were evaluated by bivariate correlation analysis. MD in the posterior cingulum correlated significantly with the MMSE score. No significant correlation was seen between FA and MMSE score and between hippocampal volume and MMSE score, FA or MD. Our results suggest that MD in the posterior cingulum is a more sensitive indicator of progression of AD than FA of the posterior cingulum and hippocampal volume.