Comparing the Clinical Utility and Diagnostic Performance of CSF P-Tau181, P-Tau217, and P-Tau231 Assays
Antoine Leuzy, Shorena Janelidze, Niklas Mattsson, Sebastian Palmqvist, Dirk Jacobs, Claudia Cicognola, Erik Stomrud, Eugeen Vanmechelen, Jeffrey L. Dage, Oskar Hansson
Abstract
BACKGROUND AND OBJECTIVES: Phosphorylated tau (p-tau) in CSF is considered an important biomarker in Alzheimer disease (AD) and has been incorporated in recent diagnostic criteria. Several variants exist, including p-tau at threonines 181 (p-tau181), 217 (p-tau217), and 231 (p-tau231). However, no studies have compared their diagnostic performance or association to β-amyloid (Aβ) and tau-PET. Understanding which p-tau variant to use remains an important yet answered question. We aimed to compare the diagnostic accuracy of p-tau181, p-tau217, and p-tau231 in CSF for AD and their association with Aβ and tau-PET. METHODS: ) and p-tau231, we also included p-tau181 measurements from 2 commonly used assays (Innotest and Elecsys). RESULTS: < 0.0001). DISCUSSION: seems to be more useful than other included p-tau assays in the workup of AD. Varied results across p-tau181 assays highlights the importance of anti-tau antibodies for biomarker performance. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that p-tau217 provides higher diagnostic accuracy for diagnosis of AD dementia than p-tau181 or p-tau231.