Mechanisms underlying the initial accumulation of tau pathology across the human brain are largely unknown. We examined whether baseline factors including age, amyloid-β, and neural activity predicted longitudinal tau accumulation in temporal lobe regions that reflect distinct stages of tau pathogenesis. Seventy cognitively normal human older adults (77±6 years, 59% female) received ≥2 18F-Flortaucipir (FTP) and 11C-Pittsburgh Compound B (PiB) PET scans (2.5±1.1 years follow-up) to quantify tau and amyloid-β. Linear mixed effects models were used to calculate slopes of FTP change in entorhinal cortex (EC), parahippocampal cortex (PHC), and inferior temporal gyrus (IT), and slopes of global PiB change. Thirty-seven participants received functional MRI to measure baseline activation. Older age predicted EC tau accumulation, and baseline EC tau predicted subsequent tau accumulation in EC and PHC. In IT, however, baseline EC tau interacted with Aβ to predict IT tau accumulation. Higher baseline local activatio...