Cited by 1,603Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsAmyotrophic Lateral Sclerosis Research

Discriminative accuracy of plasma phospho-tau217 for Alzheimer disease vs other neurodegenerative disorders

Open access
Palmqvist, Sebastian, Janelidze, Shorena, Quiroz, Yakeel T., Zetterberg, Henrik, Lopera, Francisco, Stomrud, Erik, Su, Yi, Chen, Yinghua +14 more·2020·JAMA

Abstract

Importance: There are limitations in current diagnostic testing approaches for Alzheimer disease (AD). Objective: To examine plasma tau phosphorylated at threonine 217 (P-tau217) as a diagnostic biomarker for AD. Design, Setting, and Participants: Three cross-sectional cohorts: an Arizona-based neuropathology cohort (cohort 1), including 34 participants with AD and 47 without AD (dates of enrollment, May 2007-January 2019); the Swedish BioFINDER-2 cohort (cohort 2), including cognitively unimpaired participants (n = 301) and clinically diagnosed patients with mild cognitive impairment (MCI) (n = 178), AD dementia (n = 121), and other neurodegenerative diseases (n = 99) (April 2017-September 2019); and a Colombian autosomal-dominant AD kindred (cohort 3), including 365 PSEN1 E280A mutation carriers and 257 mutation noncarriers (December 2013-February 2017). Exposures: Plasma P-tau217. Main Outcomes and Measures: Primary outcome was the discriminative accuracy of plasma P-tau217 for AD (clinical or neuropathological diagnosis). Secondary outcome was the association with tau pathology (determined using neuropathology or positron emission tomography [PET]). Results: Mean age was 83.5 (SD, 8.5) years in cohort 1, 69.1 (SD, 10.3) years in cohort 2, and 35.8 (SD, 10.7) years in cohort 3; 38% were women in cohort 1, 51% in cohort 2, and 57% in cohort 3. In cohort 1, antemortem plasma P-tau217 differentiated neuropathologically defined AD from non-AD (area under the curve [AUC], 0.89 [95% CI, 0.81-0.97]) with significantly higher accuracy than plasma P-tau181 and neurofilament light chain (NfL) (AUC range, 0.50-0.72; P < .05). The discriminative accuracy of plasma P-tau217 in cohort 2 for clinical AD dementia vs other neurodegenerative diseases (AUC, 0.96 [95% CI, 0.93-0.98]) was significantly higher than plasma P-tau181, plasma NfL, and MRI measures (AUC range, 0.50-0.81; P < .001) but not significantly different compared with cerebrospinal fluid (CSF) P-tau217, CSF P-tau181, and tau-PET (AUC range, 0.90-0.99; P > .15). In cohort 3, plasma P-tau217 levels were significantly greater among PSEN1 mutation carriers, compared with noncarriers, from approximately 25 years and older, which is 20 years prior to estimated onset of MCI among mutation carriers. Plasma P-tau217 levels correlated with tau tangles in participants with (Spearman ρ = 0.64; P < .001), but not without (Spearman ρ = 0.15; P = .33), β-amyloid plaques in cohort 1. In cohort 2, plasma P-tau217 discriminated abnormal vs normal tau-PET scans (AUC, 0.93 [95% CI, 0.91-0.96]) with significantly higher accuracy than plasma P-tau181, plasma NfL, CSF P-tau181, CSF Aβ42:Aβ40 ratio, and MRI measures (AUC range, 0.67-0.90; P < .05), but its performance was not significantly different compared with CSF P-tau217 (AUC, 0.96; P = .22). Conclusions and Relevance: Among 1402 participants from 3 selected cohorts, plasma P-tau217 discriminated AD from other neurodegenerative diseases, with significantly higher accuracy than established plasma- and MRI-based biomarkers, and its performance was not significantly different from key CSF- or PET-based measures. Further research is needed to optimize the assay, validate the findings in unselected and diverse populations, and determine its potential role in clinical care.

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Crossref · 10.1001/jama.2020.12134

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  • Plasma p-tau217 often shows a superior association with temporal lobe tau load compared to other plasma biomarkers, including other p-tau species.

    “Nonetheless, plasma p‐tau217 often shows a superior association with temporal lobe tau load compared to other plasma biomarkers (including other p‐tau species), 13 , 25 , 36”

    From Machine learning prediction of tau‐PET in Alzheimer's disease using plasma, MRI, and clinical data (2025) · cites this paper as [25]

    The Results section (page unavailable in our copy) reports that plasma p-tau217 was most strongly associated with tau-PET signal in temporoparietal regions. It also discriminated abnormal from normal temporal tau-PET scans better than plasma p-tau181 and NfL. Those biomarker comparisons concern classification of tau-PET status, not the strength of association with temporal-lobe tau load, so they do not fully establish the claim as phrased. (LLM, conf=0.82)

    Experimental — accuracy not yet measured
  • Plasma p-tau181, p-tau217, and p-tau231 have good or better accuracy than amyloid CSF Abeta and tau and PET measures of tau and amyloid pathology in discriminating people with amyloid pathology who may have clinical symptoms.

    “Plasma p-tau181, p-tau217, and p-tau231 have a good or better accuracy than amyloid CSF Abeta and tau and PET measures of tau and amyloid pathology in discriminating people with amyloid pathology who may have clinical symptoms.(452-454)”

    From Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission (2024) · cites this paper as [453]

    The Discussion (page not specified) reports that plasma p-tau217 performed comparably to tau-PET for distinguishing AD dementia from other neurodegenerative diseases. The Accuracy section reports that plasma p-tau181 was less accurate than p-tau217, while the CSF Aβ42:Aβ40 ratio was significantly more accurate than plasma p-tau217 for identifying abnormal amyloid-PET scans. The cited passages do not evaluate plasma p-tau231, so they do not support the claim for all three plasma markers. (LLM, conf=0.90)

    Experimental — accuracy not yet measured
  • A standardized method of determining plasma biomarker abnormality was used across centers.

    “Abnormality for plasma biomarkers was determined in a standardized manner across all cohorts using z-scores created based on the means and s.d. of cognitively unimpaired individuals without elevated amyloid-β pathology, as previously done in several studies8,62,63.”

    From Diagnosis of Alzheimer's disease using plasma biomarkers adjusted to clinical probability (2024) · cites this paper as [8]

    The Statistical Analysis section reports that cohort 2 used biomarker cutoffs based on the mean plus 2 standard deviations in amyloid-β-negative controls. It does not report z-scores across all cohorts: cohort 1 had no control sample and instead used a Youden Index cutoff. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Abnormality for plasma biomarkers was determined in a standardized manner across all cohorts using z-scores created based on the means and s.d. of cognitively unimpaired individuals without elevated amyloid-β pathology.

    “Abnormality for plasma biomarkers was determined in a standardized manner across all cohorts using z-scores created based on the means and s.d. of cognitively unimpaired individuals without elevated amyloid-β pathology, as previously done in several studies8,62,63.”

    From Diagnosis of Alzheimer's disease using plasma biomarkers adjusted to clinical probability (2024) · cites this paper as [8]

    The Statistical Analysis section (page unavailable) says cohort 2 used biomarker cutoffs based on the mean plus two standard deviations in Aβ-negative controls. It does not describe using z-scores across all cohorts: cohort 1 had no control sample and instead used cutoffs based on the highest Youden Index. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Among p-tau variants, p-tau217 has demonstrated the highest accuracy in detecting AD pathology and predicting future cognitive decline.

    “Among different p-tau variants, tau phosphorylated at threonine 217 (p-tau217) has demonstrated the highest accuracy in detecting AD pathology and predicting future cognitive decline23,27,29–31.”

    From Highly accurate blood test for Alzheimer's disease is similar or superior to clinical cerebrospinal fluid tests (2024) · cites this paper as [23]

    The neuropathology-cohort results report that plasma P-tau217 distinguished AD from non-AD more accurately than plasma P-tau181, supporting the claim about detecting AD pathology. The study does not establish that P-tau217 predicts future cognitive decline; its Limitations section says longitudinal analyses are needed. Page numbers are unavailable in our copy. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

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Authors
Palmqvist, S., Janelidze, S., Quiroz, Y. T., Zetterberg, H., Lopera, F., Stomrud, E., Su, Y., Chen, Y., Serrano, G. E., Leuzy, A., Mattsson-Carlgren, N., Strandberg, O., Smith, R., Villegas, A., Sepulveda-Falla, D., Chai, X., Proctor, N. K., Beach, T. G., Blennow, K., Dage, J. L., Reiman, E. M., & Hansson, O.
Affiliations
  • Lund University (SE)
  • Harvard University (US)
  • Sahlgrenska University Hospital (SE)
  • Universidad de Antioquia (CO)
  • Banner Alzheimer’s Institute (US)
  • Banner Sun Health Research Institute (US)
  • Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
  • Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellin, Colombia
  • Eli Lilly (United States) (US)
  • Translational Genomics Research Institute (US)
Corresponding author
Hansson, Oskar
Venue
JAMA
Published
2020-08-25
Volume
324
Issue
8
Pages
772
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
OpenAlex
W3045997188
Cited by
1,603
References
42
Citations by year
2026: 365 · 2025: 352 · 2024: 271 · 2023: 176 · 2022: 208 · 2021: 187 · 2020: 41 · 2015: 1
FWCI
111.82
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
  • Repositorio Digital - Academia Colombiana de Ciencias Exactas, Fisicas y Naturales (submittedVersion, other-oa)
Funders
  • Vetenskapsrådet
  • Marcus och Amalia Wallenbergs minnesfond
  • National Institute on Aging (P30AG019610)
  • National Institute of Neurological Disorders and Stroke (U24NS072026)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Neurology › Amyotrophic Lateral Sclerosis Research
Keywords
Alzheimer's disease, plasma p-tau217, tau phosphorylation, diagnostic biomarkers, mild cognitive impairment, neurodegenerative diseases, PSEN1 E280A mutation, autosomal dominant Alzheimer's disease, tau PET, neurofilament light chain, p-tau181, differential diagnosis, neuropathology
MeSH terms
Adult, Aged, Aged, 80 and over, Alzheimer Disease, Cross-Sectional Studies, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Mutation, Biomarkers, Amyloid beta-Peptides, tau Proteins, Area Under Curve, Neurodegenerative Diseases, Positron-Emission Tomography, Presenilin-1, Plaque, Amyloid

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