Cited by 290Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsCancer-related cognitive impairment studies

Prevalence Estimates of Amyloid Abnormality Across the Alzheimer Disease Clinical Spectrum

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Jansen, Willemijn J., Janssen, Olin, Tijms, Betty M., Vos, Stephanie J. B., Ossenkoppele, Rik, Visser, Pieter Jelle, Amyloid Biomarker Study Group, Aarsland, Dag +175 more·2022·JAMA Neurology

Abstract

IMPORTANCE: One characteristic histopathological event in Alzheimer disease (AD) is cerebral amyloid aggregation, which can be detected by biomarkers in cerebrospinal fluid (CSF) and on positron emission tomography (PET) scans. Prevalence estimates of amyloid pathology are important for health care planning and clinical trial design. OBJECTIVE: To estimate the prevalence of amyloid abnormality in persons with normal cognition, subjective cognitive decline, mild cognitive impairment, or clinical AD dementia and to examine the potential implications of cutoff methods, biomarker modality (CSF or PET), age, sex, APOE genotype, educational level, geographical region, and dementia severity for these estimates. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional, individual-participant pooled study included participants from 85 Amyloid Biomarker Study cohorts. Data collection was performed from January 1, 2013, to December 31, 2020. Participants had normal cognition, subjective cognitive decline, mild cognitive impairment, or clinical AD dementia. Normal cognition and subjective cognitive decline were defined by normal scores on cognitive tests, with the presence of cognitive complaints defining subjective cognitive decline. Mild cognitive impairment and clinical AD dementia were diagnosed according to published criteria. EXPOSURES: Alzheimer disease biomarkers detected on PET or in CSF. MAIN OUTCOMES AND MEASURES: Amyloid measurements were dichotomized as normal or abnormal using cohort-provided cutoffs for CSF or PET or by visual reading for PET. Adjusted data-driven cutoffs for abnormal amyloid were calculated using gaussian mixture modeling. Prevalence of amyloid abnormality was estimated according to age, sex, cognitive status, biomarker modality, APOE carrier status, educational level, geographical location, and dementia severity using generalized estimating equations. RESULTS: Among the 19 097 participants (mean [SD] age, 69.1 [9.8] years; 10 148 women [53.1%]) included, 10 139 (53.1%) underwent an amyloid PET scan and 8958 (46.9%) had an amyloid CSF measurement. Using cohort-provided cutoffs, amyloid abnormality prevalences were similar to 2015 estimates for individuals without dementia and were similar across PET- and CSF-based estimates (24%; 95% CI, 21%-28%) in participants with normal cognition, 27% (95% CI, 21%-33%) in participants with subjective cognitive decline, and 51% (95% CI, 46%-56%) in participants with mild cognitive impairment, whereas for clinical AD dementia the estimates were higher for PET than CSF (87% vs 79%; mean difference, 8%; 95% CI, 0%-16%; P = .04). Gaussian mixture modeling-based cutoffs for amyloid measures on PET scans were similar to cohort-provided cutoffs and were not adjusted. Adjusted CSF cutoffs resulted in a 10% higher amyloid abnormality prevalence than PET-based estimates in persons with normal cognition (mean difference, 9%; 95% CI, 3%-15%; P = .004), subjective cognitive decline (9%; 95% CI, 3%-15%; P = .005), and mild cognitive impairment (10%; 95% CI, 3%-17%; P = .004), whereas the estimates were comparable in persons with clinical AD dementia (mean difference, 4%; 95% CI, -2% to 9%; P = .18). CONCLUSIONS AND RELEVANCE: This study found that CSF-based estimates using adjusted data-driven cutoffs were up to 10% higher than PET-based estimates in people without dementia, whereas the results were similar among people with dementia. This finding suggests that preclinical and prodromal AD may be more prevalent than previously estimated, which has important implications for clinical trial recruitment strategies and health care planning policies.

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Crossref · 10.1001/jamaneurol.2021.5216

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  • Amyloid PET imaging results remain inconsistent, with some studies reporting attenuated or delayed amyloid deposition in APOE2/4 individuals relative to APOE3/4, whereas others have reported no significant difference between these genotypes.

    “Amyloid PET imaging results remain inconsistent, with some studies reporting attenuated or delayed amyloid deposition in APOE2/ 4 individuals relative to APOE3/4 44,45 , whereas others have reported no signi fi cant difference between these genotypes 46 .”

    From APOE2 attenuates APOE4-associated amyloid pathology and related toxicity in a mouse model of Alzheimer’s disease (2026) · cites this paper as [45]

    The Results section reports that PET-based amyloid abnormality prevalence was 10 percentage points higher in APOE ε3ε4 than ε2ε4 carriers (P = .001). Although it notes that a 2015 study found similar frequencies, this source's own result is a significant difference, contrary to the finding attributed to it. (LLM, conf=0.88)

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  • Estimates from memory clinic and community-based studies suggest the prevalence of amyloid-β pathology in individuals with MCI is relatively low for individuals in their 60s but reaches 75-80% by age 90 years.

    “Estimates from memory clinic and community-based studies suggests the prevalence of amyloid-β pathology in individuals with MCI is relatively low for individuals in their 60s but reaches 75–80% by age 90 years19,20.”

    From Diagnosis of Alzheimer's disease using plasma biomarkers adjusted to clinical probability (2024) · cites this paper as [19]

    The Results section reports that amyloid abnormality in people with MCI increases with age, supporting the claimed trend. But the Discussion gives 65% in this study and 16% in a population-based study at ages 80–89; our copy does not substantiate the specific 75–80% estimate at age 90. (LLM, conf=0.82)

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  • Prevalence-adjusted PPVs and NPVs were calculated using the Bayesian formula provided by Altman and Bland using age-associated prevalence of Aβ+ from published meta-analyses.

    “Prevalence-adjusted (that is, pretest probability-adjusted) PPVs and NPVs were calculated using the Bayesian formula provided by Altman and Bland15,64,65 using age-associated prevalence of Aβ+ in MCI, probable AD dementia and non-AD dementia syndromes (frontotemporal dementia, vascular dementia and corticobasal syndrome) from published meta-analyses18,19 using the following formulas:”

    From Diagnosis of Alzheimer's disease using plasma biomarkers adjusted to clinical probability (2024) · cites this paper as [19]

    The Results sections report age-associated amyloid-abnormality prevalence in mild cognitive impairment and clinical AD dementia. The Methods > Participants section lists those groups but not frontotemporal dementia, vascular dementia, or corticobasal syndrome, so this paper does not support the non-AD dementia portion. The Bayesian PPV/NPV calculation is attributed to other citations in the citing sentence, not to this source. (LLM, conf=0.88)

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  • In all degenerative dementias, onset of symptoms is associated with already established brain pathology, which develops many years before symptom onset.

    “In all the degenerative dementias the onset of symptoms is associated with already established brain pathology, which develops many years before symptom onset [3, 4].”

    From The use of neuroimaging techniques in the early and differential diagnosis of dementia (2023) · cites this paper as [3]

    The Discussion says amyloid aggregation is an early marker that becomes abnormal years before dementia onset. That supports pre-onset pathology in Alzheimer disease, but the paper does not establish the claim for all degenerative dementias or show that pathology is established before the onset of any symptoms. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • There is a suggested 2- to 30-year interval between first development of Aβ positivity and onset of dementia.

    “In epidemiological cohorts assessing patients without dementia using amyloid PET status or CSF profile, Aβ pathology was associated with APOE genotype, presence of cognitive impairment and suggested a 2- to 30- year interval between first development of Αβ positivity and onset of dementia [3, 169].”

    From The use of neuroimaging techniques in the early and differential diagnosis of dementia (2023) · cites this paper as [3]

    The Discussion (page unavailable in our copy) says amyloid aggregation can become abnormal years before dementia onset, supporting the general sequence. It does not give or substantiate the claimed 2- to 30-year interval. (LLM, conf=0.86)

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Authors
Jansen, W. J., Janssen, O., Tijms, B. M., Vos, S. J. B., Ossenkoppele, R., Visser, P. J., Amyloid Biomarker Study Group, Aarsland, D., Alcolea, D., Altomare, D., von Arnim, C., Baiardi, S., Baldeiras, I., Barthel, H., Bateman, R. J., Van Berckel, B., Binette, A. P., Blennow, K., Boada, M., Boecker, H., Bottlaender, M., den Braber, A., Brooks, D. J., Van Buchem, M. A., Camus, V., Carill, J. M., Cerman, J., Chen, K., Chételat, G., Chipi, E., Cohen, A. D., Daniels, A., Delarue, M., Didic, M., Drzezga, A., Dubois, B., Eckerström, M., Ekblad, L. L., Engelborghs, S., Epelbaum, S., Fagan, A. M., Fan, Y., Fladby, T., Fleisher, A. S., Van der Flier, W. M., Förster, S., Fortea, J., Frederiksen, K. S., Freund-Levi, Y., Frings, L., Frisoni, G. B., Fröhlich, L., Gabryelewicz, T., Gertz, H.-J., Gill, K. D., Gkatzima, O., Gómez-Tortosa, E., Grimmer, T., Guedj, E., Habeck, C. G., Hampel, H., Handels, R., Hansson, O., Hausner, L., Hellwig, S., Heneka, M. T., Herukka, S.-K., Hildebrandt, H., Hodges, J., Hort, J., Huang, C.-C., Iriondo, A. J., Itoh, Y., Ivanoiu, A., Jagust, W. J., Jessen, F., Johannsen, P., Johnson, K. A., Kandimalla, R., Kapaki, E. N., Kern, S., Kilander, L., Klimkowicz-Mrowiec, A., Klunk, W. E., Koglin, N., Kornhuber, J., Kramberger, M. G., Kuo, H.-C., Van Laere, K., Landau, S. M., Landeau, B., Lee, D. Y., de Leon, M., Leyton, C. E., Lin, K.-J., Lleó, A., Löwenmark, M., Madsen, K., Maier, W., Marcusson, J., Marquié, M., Martinez-Lage, P., Maserejian, N., Mattsson, N., de Mendonça, A., Meyer, P. T., Miller, B. L., Minatani, S., Mintun, M. A., Mok, V. C. T., Molinuevo, J. L., Morbelli, S. D., Morris, J. C., Mroczko, B., Na, D. L., Newberg, A., Nobili, F., Nordberg, A., Olde Rikkert, M. G. M., de Oliveira, C. R., Olivieri, P., Orellana, A., Paraskevas, G., Parchi, P., Pardini, M., Parnetti, L., Peters, O., Poirier, J., Popp, J., Prabhakar, S., Rabinovici, G. D., Ramakers, I. H., Rami, L., Reiman, E. M., Rinne, J. O., Rodrigue, K. M., Rodríguez-Rodriguez, E., Roe, C. M., Rosa-Neto, P., Rosen, H. J., Rot, U., Rowe, C. C., Rüther, E., Ruiz, A., Sabri, O., Sakhardande, J., Sánchez-Juan, P., Sando, S. B., Santana, I., Sarazin, M., Scheltens, P., Schröder, J., Selnes, P., Seo, S. W., Silva, D., Skoog, I., Snyder, P. J., Soininen, H., Sollberger, M., Sperling, R. A., Spiru, L., Stern, Y., Stomrud, E., Takeda, A., Teichmann, M., Teunissen, C. E., Thompson, L. I., Tomassen, J., Tsolaki, M., Vandenberghe, R., Verbeek, M. M., Verhey, F. R. J., Villemagne, V., Villeneuve, S., Vogelgsang, J., Waldemar, G., Wallin, A., Wallin, Å. K., Wiltfang, J., Wolk, D. A., Yen, T.-C., Zboch, M., & Zetterberg, H.
Affiliations
  • Maastricht University (NL)
  • Amsterdam Neuroscience (NL)
  • Lund University (SE)
  • Karolinska Institutet (SE)
  • Stavanger University Hospital (NO)
  • Hospital de Sant Pau (ES)
  • Centro San Giovanni di Dio Fatebenefratelli (IT)
  • Division of Geriatrics, University of Goettingen Medical School, Goettingen, Germany
  • Unidade Local de Saúde de Coimbra (PT)
  • Center for Neuroscience and Cell Biology (CIBB), University of Coimbra, Coimbra, Portugal
  • Washington University in St. Louis (US)
  • Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
  • Douglas Mental Health University Institute (CA)
  • Sahlgrenska University Hospital (SE)
  • Research Center and Memory Clinic of Fundació Alzheimer Centre Educacional, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
  • Centre National de la Recherche Scientifique (FR)
  • Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
  • Aarhus University (DK)
  • Department of Neurology, University Hospital Leiden, Leiden, the Netherlands
  • Universidad de Cantabria (ES)
  • Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
  • Inserm (FR)
  • University of Pittsburgh (US)
  • German Center for Neurodegenerative Diseases (DE)
  • Assistance Publique – Hôpitaux de Paris (FR)
  • University of Turku (FI)
  • Vrije Universiteit Brussel (BE)
  • Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • Eli Lilly (United States) (US)
  • King's College London (GB)
  • School of Medical Sciences, Örebro University, Örebro, Sweden
  • University of Geneva (CH)
  • Heidelberg University (DE)
  • University Hospital Leipzig (DE)
  • Greek Association of Alzheimer's Disease and Related Disorders (GR)
  • Hospital Universitario Fundación Jiménez Díaz (ES)
  • Department of Neurology, Fundación Jiménez Díaz, Madrid, Spain
  • Aix Marseille University, AP-HM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, Centre Européen de Recherche en Imagerie Médicale (CERIMED), Nuclear Medicine Department, Marseille, France
  • Columbia University Irving Medical Center (US)
  • University of Freiburg (DE)
  • University of Massachusetts Chan Medical School (US)
  • Carl von Ossietzky Universität Oldenburg (DE)
  • The University of Sydney (AU)
  • Charles University (CZ)
  • Chang Gung Memorial Hospital (TW)
  • Osaka City University (JP)
  • Cliniques Universitaires Saint-Luc (BE)
  • Lawrence Berkeley National Laboratory (US)
  • University of Cologne (DE)
  • Copenhagen University Hospital (DK)
  • Emory University (US)
  • National and Kapodistrian University of Athens (GR)
  • Uppsala University (SE)
  • Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
  • Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
  • Chang Gung University (TW)
  • Division of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
  • Seoul National University (KR)
  • Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, New York
  • Uppsala University Hospital (SE)
  • University of Bonn (DE)
  • Linköping University (SE)
  • Instituto de Salud Carlos III (ES)
  • Center for Research and Advanced Therapies, CITA-Alzheimer Foundation, Donostia-San Sebastian, Spain
  • Biogen (United States) (US)
  • University of Lisbon (PT)
  • Faculty of Medicine, University of Lisboa, Lisboa, Portugal
  • University of California, San Francisco (US)
  • Chinese University of Hong Kong (HK)
  • Alzheimer’s Disease and Other Cognitive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Clinic University Hospital, Barcelona, Spain
  • Medical University of Białystok (PL)
  • Thomas Jefferson University (US)
  • Radboudumc Alzheimer Centre, Radboud University Medical Center, Nijmegen, the Netherlands
  • Istituto delle Scienze Neurologiche di Bologna (IT)
  • University of Perugia (IT)
  • Charité – Universitätsmedizin Berlin (DE)
  • Centre Hospitalier Universitaire Vaudois (CH)
  • University of Zurich (CH)
  • Hospital Clínic de Barcelona (ES)
  • Turku PET Centre (FI)
  • The University of Texas at Dallas (US)
  • Neurology Department, Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
  • Studies on Prevention of Alzheimer’s Disease (StOP-AD) Centre, Montreal, Quebec, Canada
  • Department of Neurology, Medical Center, Zaloska 7, Ljubljana, Slovenia
  • The University of Melbourne (AU)
  • Biomedical Research Networking Center on Neurodegenerative Diseases (ES)
  • Service of Neurology, University Hospital Marqués de Valdecilla-IDIVAL, CIBERNED, Santander, Spain
  • Norwegian University of Science and Technology (NO)
  • Akershus University Hospital (NO)
  • University of Rhode Island (US)
  • University of Eastern Finland (FI)
  • Brigham and Women's Hospital (US)
  • Carol Davila University of Medicine and Pharmacy (RO)
  • Brown University (US)
  • Aristotle University of Thessaloniki (GR)
  • Radboud University Nijmegen (NL)
  • Montreal Neurological Institute and Hospital (CA)
  • University of Copenhagen (DK)
  • Universitätsmedizin Göttingen (DE)
  • University of Wrocław (PL)
Corresponding author
  • Jansen, Willemijn J.
  • Janssen, Olin
ORCID
Venue
JAMA Neurology
Published
2022-03-01
Volume
79
Issue
3
Pages
228
ISSN
2168-6149 (ISSN-L)
OpenAlex
W4210650500
Cited by
290
References
37
Citations by year
2026: 53 · 2025: 80 · 2024: 69 · 2023: 58 · 2022: 29 · 2021: 1
FWCI
38.46
Type
journal article
Language
en
Open access
Locations
  • JAMA Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
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  • Research Portal (King's College London) (submittedVersion)
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  • Lund University Publications (Lund University) (submittedVersion)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
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Funders
  • Alzheimer's Association
  • Eli Lilly and Company
  • Brigham and Women's Hospital
  • Massachusetts General Hospital
  • Biogen
  • Alnylam Pharmaceuticals
  • Brown University
  • Celgene
  • McLean Hospital
  • University of Pennsylvania
  • Emory University
  • Univerzita Karlova v Praze
  • Aarhus Universitet
  • Itä-Suomen Yliopisto
  • University of Pittsburgh
  • Thomas Jefferson University
  • McGill University
  • Faculty of Medicine, McGill University
  • Uniwersytet Jagielloński Collegium Medicum
  • Norges Teknisk-Naturvitenskapelige Universitet
  • Institut de Neurosciences des Systèmes
  • Prothena
  • Postgraduate Institute of Medical Education and Research, Chandigarh
  • Lui Che Woo Institute of Innovative Medicine
  • Universitätsmedizin Göttingen
  • Carl von Ossietzky Universität Oldenburg
  • Amsterdam University Medical Centers
  • Imperial College London
  • King's College London
  • University College London
  • Newcastle University
  • European Commission
  • Council of Scientific and Industrial Research, India
  • Universität Heidelberg
  • Institut National de la Santé et de la Recherche Médicale (INSERM U930)
  • University of Sydney
  • ZonMw (733050822)
  • Radboud Universiteit
  • Vrije Universiteit Amsterdam
  • Universiteit Maastricht
  • Seoul National University
  • Sungkyunkwan University
  • Albert-Ludwigs-Universität Freiburg
  • Chang Gung University
  • Gentofte Hospital
  • Nederlandse Organisatie voor Wetenschappelijk Onderzoek (733050822)
  • Lunds Universitet
  • Örebro Universitet
  • Eisai
  • Linköpings Universitet
  • KU Leuven
  • Karolinska Institutet
  • Kuopion Yliopistollinen Sairaala
  • Novo Nordisk
  • Seoul National University Hospital
  • Vrije Universiteit Brussel
  • Chang Gung Medical Foundation
  • Università degli Studi di Genova
  • Centre National de la Recherche Scientifique
  • Instytut Medycyny Doswiadczalnej i Klinicznej im. M. Mossakowskiego, Polskiej Akademii Nauk
  • Chinese University of Hong Kong
  • Leids Universitair Medisch Centrum
  • Rigshospitalet
  • National and Kapodistrian University of Athens
  • Deutsches Zentrum für Neurodegenerative Erkrankungen
  • Turun Yliopisto
  • Shionogi
  • Technische Universität München
  • Universidade de Coimbra
  • Sahlgrenska Universitetssjukhuset
  • Göteborgs Universitet
  • Università di Bologna
  • Radboud Universitair Medisch Centrum
  • Universidad de Cantabria
  • Université de Genève
  • Université de Lausanne
  • Aristotle University of Thessaloniki
  • Uppsala Universitet
  • Université Paris-Saclay
  • Università degli Studi di Brescia
  • Universiteit Antwerpen
  • Universitatea de Medicină şi Farmacie "Carol Davila" Bucureşti
  • Universität zu Köln
  • Rheinische Friedrich-Wilhelms-Universität Bonn
  • Assistance publique-Hôpitaux de Paris
  • Alzheimer Nederland
  • Siemens Healthineers
  • Servier
  • Akershus Universitetssykehus
  • University of Texas at Dallas
  • Universitätsklinikum Köln
  • H. Lundbeck A/S
  • Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas
  • Université de Caen Normandie
  • UK Dementia Research Institute
  • Région Normandie
  • Instituto de Investigación Marqués de Valdecilla
  • Sorbonne Université
  • Amsterdam Neuroscience
  • Université de Paris
  • Fondation pour la Recherche sur Alzheimer
  • National Institutes of Health (NR170024, 5u01ag024904-10)
  • Genentech
  • Samsung
  • Weill Cornell Medical College
  • Perelman School of Medicine, University of Pennsylvania
  • University of California, San Francisco
  • Avid Radiopharmaceuticals
  • Irving Medical Center, Columbia University
  • Wydział Lekarski, Uniwersytet Jagielloński Collegium Medicum
  • Instituto de Salud Carlos III
  • Sahlgrenska Akademin
  • European Regional Development Fund
  • Institut de Recherches Servier
  • Healthy Aging Research Center
  • Faculty of Medicine and Health, University of Sydney
  • Medizinische Fakultät der Albert-Ludwigs-Universität Freiburg
  • National Institute on Aging (U01-AG-024904, R01AG031581, U01AG032438, P01AG036694, P30AG062422)
  • National Institute of Neurological Disorders and Stroke (R01NS104147)
  • Cliniques Universitaires Saint-Luc
  • Lawrence Berkeley National Laboratory
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 › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
Keywords
Alzheimer's disease, amyloid PET, cerebrospinal fluid biomarkers, prevalence, subjective cognitive decline, mild cognitive impairment, dementia severity, APOE genotype, Gaussian mixture model, health planning, clinical trial design, cognitive aging, educational attainment, sex differences, age differences, regional variation
MeSH terms
Aged, Alzheimer Disease, Amyloidosis, Apolipoproteins E, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Peptide Fragments, Biomarkers, Prevalence, Amyloid beta-Peptides, tau Proteins, Positron-Emission Tomography, Amyloidogenic Proteins, Cognitive Dysfunction

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