Tau‐PET is superior to phospho‐tau when predicting cognitive decline in symptomatic AD patients
Ruben Smith, Nicholas Cullen, Alexa Pichet Binette, Antoine Leuzy, Kaj Blennow, Henrik Zetterberg, Gregory Klein, Edilio Borroni, Rik Ossenkoppele, Shorena Janelidze, Sebastian Palmqvist, Niklas Mattsson, Erik Stomrud, Oskar Hansson, for the Alzheimer's Disease Neuroimaging Initiative
Abstract
Abstract Introduction Biomarkers for the prediction of cognitive decline in patients with amnestic mild cognitive impairment (MCI) and amnestic mild dementia are needed for both clinical practice and clinical trials. Methods We evaluated the ability of tau‐PET (positron emission tomography), cortical atrophy on magnetic resonance imaging (MRI), baseline cognition, apolipoprotein E gene ( APOE ) status, plasma and cerebrospinal fluid (CSF) levels of phosphorylated tau‐217, neurofilament light (NfL), and amyloid beta (Aβ) 42/40 ratio (individually and in combination) to predict cognitive decline over 2 years in BioFINDER‐2 and Alzheimer's Disease Neuroimaging Initiative (ADNI). Results Baseline tau‐PET and a composite baseline cognitive score were the strongest independent predictors of cognitive decline. Cortical thickness and NfL provided some additional information. Using a predictive algorithm to enrich patient selection in a theoretical clinical trial led to a significantly lower required sample size. Discussion Models including baseline tau‐PET and cognition consistently provided the best prediction of change in cognitive function over 2 years in patients with amnestic MCI or mild dementia.