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Longitudinal relationships among biomarkers for Alzheimer disease in the Adult Children Study
Open accessAbstract
OBJECTIVE: To determine whether and how longitudinal rates of change in MRI volumetrics, CSF concentrations of Alzheimer-related proteins, molecular imaging of cerebral fibrillar amyloid with PET using the [(11)C] benzothiazole tracer, Pittsburgh compound B (PiB), and cognition were associated among asymptomatic middle-aged to older individuals. METHODS: Multivariate mixed models for repeated measures were used to assess the correlations on the rates of changes across markers. RESULTS: Among 209 asymptomatic middle-aged to older individuals longitudinally followed for up to 11 years (mean 6.7 years), a faster intraindividual decrease in CSF Aβ42 was associated with a faster increase in PiB mean cortical standardized uptake value ratio (MCSUVR, p = 0.04), but not others. The rate of change in CSF tau (and Ptau181) was correlated with the rate of change in PiB MCSUVR (p = 0.002), hippocampal volume (p = 0.04), and global cognition (p = 0.008). The rate of change in hippocampal volume was correlated with the rate of change in global cognition (p = 0.04). Only 3 significant correlations were observed at baseline: CSF Aβ42 and PiB MCSUVR (p < 0.001), CSF tau and PiB MCSUVR (p < 0.001), and CSF Aβ42 and global cognition (p = 0.01). CONCLUSIONS: CSF tau (Ptau181), PiB MCSUVR, and hippocampal volume were all longitudinally correlated with each other, whereas CSF Aβ42 was correlated only with PiB binding. Unlike the baseline values, the longitudinal change in CSF tau (Ptau181) and hippocampal volume were correlated with the longitudinal change in global cognition, validating the role of these biomarkers in Alzheimer disease prevention trials.
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“Consequently, a widely held view is that amyloid biomarkers represent the earliest evidence of AD neuropathologic change currently detectable in living persons [9,11,72,103,104].”
From NIA‐AA Research Framework: Toward a biological definition of Alzheimer's disease (2018) · cites this paper as [104]
Experimental — accuracy not yet measuredIn the citing paper
“Compared with the simple correlation estimation method (Pearson or Spearman correlation), the multivariate LME model can adjust for covariates such as EYO, as well as accounting for the correlation within the family cluster63,64.”
From A soluble phosphorylated tau signature links tau, amyloid and the evolution of stages of dominantly inherited Alzheimer’s disease (2020) · cites this paper as [64]
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NIA‐AA Research Framework: Toward a biological definition of Alzheimer's disease
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Association of Amyloid and Tau With Cognition in Preclinical Alzheimer Disease: A Longitudinal Study
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Self-citationthe Dominantly Inherited Alzheimer Network, Barthélemy, N. R., Li, Y., Joseph-Mathurin, N., Gordon, B. A., Hassenstab, J., Benzinger, T. L. S., Buckles, V., Fagan, A. M., Perrin, R. J., et al. (2020) · Nature Medicine · doi:10.1038/s41591-020-0781-z · Cited by 651
Self-citationBiomarker Changes during 20 Years Preceding Alzheimer’s Disease
Jia, J., Ning, Y., Chen, M., Wang, S., Yang, H., Li, F., Ding, J., Li, Y., Zhao, B., Lyu, J., et al. (2024) · New England Journal of Medicine · doi:10.1056/nejmoa2310168 · Cited by 455
Jack, C. R., Wiste, H. J., Botha, H., Weigand, S. D., Therneau, T. M., Knopman, D. S., Graff-Radford, J., Jones, D. T., Ferman, T. J., Boeve, B. F., et al. (2019) · Brain · doi:10.1093/brain/awz268 · Cited by 200
“Our data along with that from other studies (Arriagada et al., 1992; Ingelsson et al., 2004; Bateman et al., 2012; Benzinger et al., 2013; Xiong et al., 2016; Leal et al., 2018; Hanseeuw et al., 2019) support a dynamic biomarker model (Jack et al.”
Baker, J. E., Lim, Y. Y., Pietrzak, R. H., Hassenstab, J. J., Snyder, P. J., Masters, C. L., & Maruff, P. T. (2016) · Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring · doi:10.1016/j.dadm.2016.09.002 · Cited by 214
“Although 60% of studies using PET neuroimaging classified Ab burden using a dichotomous outcome (e.g., low/negative or high/positive) in studies using the [11C] PiB-PET tracer, and calculating burden using distribution volume ratios, the criterion score used to define abnormality has ranged between 1.06 [35] and 1.80…”
BackgroundInfluentialSelf-citationTargeting Amyloidogenic Processing of APP in Alzheimer’s Disease
Zhao, J., Liu, X., Xia, W., Zhang, Y., & Wang, C. (2020) · Frontiers in Molecular Neuroscience · doi:10.3389/fnmol.2020.00137 · Cited by 178
Comparison of Pittsburgh compound B and florbetapir in cross‐sectional and longitudinal studies
Su, Y., Flores, S. E., Wang, G., Hornbeck, R. C., Speidel, B. A., Joseph‐Mathurin, N., Vlassenko, A. G., Gordon, B. A., Koeppe, R. A., Klunk, W. E., et al. (2019) · Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring · doi:10.1016/j.dadm.2018.12.008 · Cited by 138
“These models can handle missing, unbalanced, and unevenly spaced longitudinal data and have been used in previous studies of AD [30].”
MethodSelf-citationSleep Deprivation Affects Tau Phosphorylation in Human Cerebrospinal Fluid
Barthélemy, N. R., Liu, H., Lu, W., Kotzbauer, P. T., Bateman, R. J., & Lucey, B. P. (2020) · Annals of Neurology · doi:10.1002/ana.25702 · Cited by 141
Xu, W., Initiative, A. D. N., Zhang, C. M., Li, J., Tan, C., Cao, X., Tan, L., & Yu, J. (2019) · Aging · doi:10.18632/aging.101971 · Cited by 74
Sequence of Alzheimer disease biomarker changes in cognitively normal adults
Luo, J. R., Agboola, F., Grant, E., Masters, C. L., Albert, M., Johnson, S. C., McDade, E., Vöglein, J., Fagan, A. M., Benzinger, T. L. S., et al. (2020) · Neurology · doi:10.1212/wnl.0000000000010747 · Cited by 59
“CSFTau, Ptau, andMRI hippocampal volume all predicted the rate of longitudinal change in cognition among cognitively normal individuals and, more importantly, that the longitudinal rate of change in CSF Tau (Ptau), but not CSF Aβ42 or PiB PET SUVR, was correlated negatively with longitudinal rate of cognitive change o…”
ResultSelf-citationLuo, J. R., Agboola, F., Grant, E., Morris, J. C., Masters, C. L., Albert, M., Johnson, S. C., McDade, E., Fagan, A. M., Benzinger, T. L. S., et al. (2022) · Brain · doi:10.1093/brain/awac238 · Cited by 47
Self-citationXiong, C., Luo, J. R., Coble, D. W., Agboola, F., Kukull, W. A., & Morris, J. C. (2020) · Alzheimer s & Dementia · doi:10.1002/alz.12060 · Cited by 42
Self-citationNedelská, Z., Schwarz, C. G., Lesnick, T. G., Boeve, B. F., Przybelski, S. A., Lowe, V. J., Kremers, W. K., Gunter, J. L., Senjem, M. L., Graff‐Radford, J., et al. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.16439 · Cited by 38
Llibre‐Guerra, J. J., Li, Y., Schindler, S. E., Gordon, B. A., Fagan, A. M., Morris, J. C., Benzinger, T. L. S., Hassenstab, J. J., Wang, G., Allegri, R., et al. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.17126 · Cited by 40
Self-citationLuo, J., Ma, Y., Agboola, F. J., Grant, E., Morris, J. C., McDade, E., Fagan, A. M., Benzinger, T. L. S., Hassenstab, J., Bateman, R. J., et al. (2023) · Neurology · doi:10.1212/wnl.0000000000207378 · Cited by 35
“and the AD biomarker was derived from the estimated covariance matrix and tested against zero using an asymptotic standard normal test, similar to what we previously implemented.(14) These analyses were repeated after accounting for the main effects of major covariates: baseline age, race, sex, APOE e4 status, educati…”
MethodSelf-citationClinical and biomarker trajectories in sporadic Alzheimer's disease: A longitudinal study
Wang, H.-F., Shen, X., Li, J., Suckling, J., Tan, C., Wang, Y., Feng, L., Zhang, C. M., Tan, L., Dong, Q., et al. (2020) · Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring · doi:10.1002/dad2.12095 · Cited by 36
Guest, F. L., Rahmoune, H., & Guest, P. C. (2020) · Advances in Experimental Medicine and Biology · doi:10.1007/978-3-030-42667-5_8 · Cited by 34
Wang, G., Coble, D. W., McDade, E., Hassenstab, J. J., Fagan, A. M., Benzinger, T. L. S., Bateman, R. J., Morris, J. C., Xiong, C., & and the Dominantly Inherited Alzheimer Network (DIAN) (2019) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2018.12.008 · Cited by 26
“Importantly, these methods dichotomized each biomarker independently, ignoring the well-established correlations between biomarkers and clinical/cognitive outcomes [5].”
MethodSelf-citationMa, Y., Wu, J., Xu, W., Shen, X., Wang, H.-F., Hou, X., Cao, X., Bi, Y., Dong, Q., Feng, L., et al. (2020) · Journal of Alzheimer s Disease · doi:10.3233/jad-200410 · Cited by 24
“42 and CSF tau showed faster change rate of Pittsburgh compound B (PiB) mean cortical standardized uptake value ratio and brain atrophy [28, 33].”
Racial differences in longitudinal Alzheimer's disease biomarkers among cognitively normal adults
Xiong, C., Luo, J. R., Schindler, S. E., Fagan, A. M., Benzinger, T. L. S., Hassenstab, J. J., Balls‐Berry, J. E., Agboola, F., Grant, E., Moulder, K. L., et al. (2022) · Alzheimer s & Dementia · doi:10.1002/alz.12608 · Cited by 23
Self-citationIdland, A., Sala‐Llonch, R., Watne, L. O., Brækhus, A., Hansson, O., Blennow, K., Zetterberg, H., Sørensen, Ø., Walhovd, K. B., Wyller, T. B., et al. (2020) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2020.04.002 · Cited by 22
“Furthermore, lack of relationship between Ab42 and the Tau-proteins in cognitively unimpaired adults has also been found in previous studies (Roe et al., 2013; Xiong et al., 2016), although weak to moderate negative correlations have also been reported (Bos et al.”
ResultBiomarkers and Tools for Predicting Alzheimer’s Disease in the Preclinical Stage
Li, T.-R., Yang, Q. Z., Hu, X., & Han, Y. (2021) · Current Neuropharmacology · doi:10.2174/1570159x19666210524153901 · Cited by 23
“Furthermore, it should be noted that it was the levels of CSF Aβ significantly correlated with global cognition, not the levels of NFTs deposition or neurodegeneration [50].”
sPDGFRβ and neuroinflammation are associated with AD biomarkers and differ by race: The ASCEND Study
Butts, B., Huang, H., Hu, W. T., Kehoe, P. G., Miners, J. S., Verble, D. D., Zetterberg, H., Zhao, L., Trotti, L. M., Benameur, K., et al. (2023) · Alzheimer s & Dementia · doi:10.1002/alz.13457 · Cited by 20
“47,48 As these findings suggest the higherADriskinferredbyhavingafirst-degreerelativewithADmaybe associated with higher amyloid burden, a more comprehensive understanding of the interplay of family history, genetics, and vascular risk factors among high-risk populations is urgently needed.”
BackgroundWang, G., Xiong, C., McDade, E., Hassenstab, J. J., Aschenbrenner, A. J., Fagan, A. M., Benzinger, T. L. S., Gordon, B. A., Morris, J. C., Li, Y., et al. (2018) · Alzheimer s & Dementia Translational Research & Clinical Interventions · doi:10.1016/j.trci.2018.10.009 · Cited by 19
“Adecline in hippocampal volumehas beendemonstrated to be associated with cognitive decline [7,8], but the results with baseline hippocampal volume are inconsistent [7,8].”
MethodResultInfluentialSelf-citationCerebrospinal Fluid and Plasma Tau as a Biomarker for Brain Tauopathy
Shoji, M. (2019) · Advances in experimental medicine and biology · doi:10.1007/978-981-32-9358-8_29 · Cited by 20
Parent, C., Rousseau, L., Predovan, D., Duchesne, S., & Hudon, C. (2023) · Aging Brain · doi:10.1016/j.nbas.2023.100074 · Cited by 21
“17 [35] PET & CSF Global cognition: Episodic memory, Working memory, Semantic knowledge, Executive function, Attention, Visuospatial PET: r = 0.”
BackgroundBlood‐based biomarkers for Alzheimer's disease and cognitive function from mid‐ to late life
Wang, X., Bakulski, K. M., Karvonen-Gutierrez, C. A., Park, S. K., Morgan, D., Albin, R. L., & Paulson, H. L. (2023) · Alzheimer s & Dementia · doi:10.1002/alz.13583 · Cited by 19
“19 Another investigation of 167 initially cognitively unimpaired participants from the WRAP study in late middle age found that those with tau pathophysiology, as determined by PET scans, exhibited accelerated decline in retrospective cognition compared to those without elevated biomarkers.”
BackgroundBiomarkers and Tools for Predicting Alzheimer's Disease in the Preclinical Stage
Li, T., Yang, Q. Z., Hu, X., & Han, Y. (2022) · Kölner Universitäts PublikationsServer (Universität zu Köln) · Cited by 17
Disease stage–specific atrophy markers in Alzheimer's disease
Baumeister, H., Gellersen, H. M., Polk, S. E., Lattmann, R., Wuestefeld, A., Wisse, L. E. M., Glenn, T. W., Yakupov, R., Stark, M., Kleineidam, L., et al. (2025) · Alzheimer s & Dementia · doi:10.1002/alz.70482 · Cited by 20
“73 The complex interplay of disease stage and intended use can be illustrated by the associations of CA1 volume and FCSRT-96 scores.”
Xiong, C., Luo, J. R., Agboola, F., Li, Y., Albert, M., Johnson, S. C., Koscik, R. L., Masters, C. L., Soldan, A., Villemagne, V. L., et al. (2019) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2019.06.4955 · Cited by 13
“Our earlier reports on the WU ACS alone [1,9] and others [4,27,29] suggested that biomarker changes may first appear around age 50 years for late-onset AD, depending on factors such as APOE ε4 status.”
BackgroundSelf-citationYu, G.-X., Initiative, A. D. N., Zhang, T., Hou, X., Ou, Y., Hu, H., Wang, Z.-T., Guo, Y., Xu, W., Tan, L., et al. (2021) · Journal of Alzheimer s Disease · doi:10.3233/jad-201117 · Cited by 9
“Available evidence supports that amyloid(A ) burden represents the earliest evidence of AD neuropathologic change [16, 17].”
BackgroundXiong, C., Schindler, S. E., Henson, R. L., Wolk, D. A., Shaw, L. M. J., Agboola, F., Morris, J. C., Lu, R., & Luo, J. R. (2023) · Statistical Methods in Medical Research · doi:10.1177/09622802231215810 · Cited by 8
“CSF A 𝛽 42 showed a correlation of about of 0.30–0.37 with Animals and a correlation of about 0.40–0.45 with Vegetables , suggesting that larger values of the CSF A 𝛽 42 are associated with better cognitive performance, consistent with our previous reports.”
ResultInfluentialSelf-citationGenome-Wide Association Study Identifies SLAMF1 Affecting the Rate of Memory Decline
Chen, S.-D., Initiative, O. B. O. A. D. N., Li, H., Shen, X., Li, J., Xu, W., Huang, Y., Tan, L., Dong, Q., & Yu, J. (2020) · Journal of Alzheimer s Disease · doi:10.3233/jad-191214 · Cited by 8
“The protective advantage conferred by minor allele was also supported by the evidence from endophenotypes at biomolecular level, including CSF A (cid:2) 42 concentration and florbetapir SUVr in cerebral cortex which represent the earliest evidence of AD neuropathological change [24–26].”
Xiong, C., McCue, L. M., Buckles, V., Grant, E., Agboola, F., Coble, D. W., Bateman, R. J., Fagan, A. M., Benzinger, T. L. S., Hassenstab, J. J., et al. (2023) · Alzheimer s & Dementia · doi:10.1002/alz.12912 · Cited by 7
Self-citationXiong, C., Lu, R., Bui, Q. V. P., Popp, B., Schindler, S. E., Shriver, L. P., Cruchaga, C., Hassenstab, J. J., Benzinger, T. L. S., Agboola, F., et al. (2025) · Journal of Alzheimer s Disease · doi:10.1177/13872877251362667 · Cited by 5
Self-citationXiong, C., Luo, J., Agboola, F., Grant, E., & Morris, J. C. (2022) · Statistical Methods in Medical Research · doi:10.1177/09622802211072511 · Cited by 3
Self-citationBrown, C., Cousins, K. A. Q., Korecka, M., McGrew, E., Chen‐Plotkin, A. S., Detre, J. A., McMillan, C. T., Lee, E. B., Das, S. R., Mechanic-Hamilton, D. J., et al. (2026) · Annals of Neurology · doi:10.1002/ana.78194 · Cited by 4
Simple Synthesis of [18F] AV-45 and its Clinical Application in the Diagnosis of Alzheimer's Disease
Zhang, Q., Yilihamu, N., Li, Y., Li, X.-H., & Qin, Y. (2023) · Current Medicinal Chemistry · doi:10.2174/0929867331666230731123226 · Cited by 1
Xiong, C., Agboola, F., & Luo, J. (2026) · BMC Medical Research Methodology · doi:10.1186/s12874-026-02806-3 · Cited by 1
“Further, major covariates, such as sex, APOE genotypes, and racial and ethnic groups are well established risk factors of AD [3, 33, 34], and may also affect the age when longitudinal changes in AD biomarkers accelerate.”
Self-citationPeng, J., Mai, Y., & Liu, J. (2024) · Aging Medicine · doi:10.1002/agm2.12325 · Cited by 1
“28 However, to meet the neuropathological criteria for AD, evidence of both A β plaque deposition and phosphorylated tau (P-tau) deposition is required.”
BackgroundMasters, C. L., Gu, B. J., Laws, S. M., Lim, Y. Y., Roberts, B. R., Villemagne, V. L., & Beyreuther, K. T. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-811304-2.00003-1 · Cited by 1
Alzheimer's disease-associated biomarkers in delirium and cognitively normal older adults
Idland, A. (2020) · NORA - Norwegian Open Research Archives · Cited by 1
Brown, C., Cousins, K. A. Q., Korecka, M., McGrew, E., Chen‐Plotkin, A. S., Detre, J. A., McMillan, C. T., Lee, E. B., Das, S. R., Mechanic-Hamilton, D. J., et al. (2025) · medRxiv · doi:10.1101/2025.09.04.25334935 · Cited by 1
Xiong, C., McCue, L. M., Buckles, V., Grant, E., Agboola, F., Coble, D., Bateman, R. J., Fagan, A. M., Benzinger, T. L. S., Hassenstab, J. J., et al. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3928499
Self-citationXiong, C., Lu, R., Bui, Q. V. P., Popp, B., Schindler, S. E., Shriver, L. P., Cruchaga, C., Hassenstab, J. J., Benzinger, T. L. S., Agboola, F., et al. (2024) · Research Square · doi:10.21203/rs.3.rs-5118913/v1
Self-citationUniversal black-box attacks against a third-party Alzheimer’s diagnostic system
Sigvard, C. S., Franco-Valiente, J. M., & Mato, G. (2025) · Biomedical Physics & Engineering Express · doi:10.1088/2057-1976/ae1baf
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“Additionally, these results suggest that A β₁₋₄₂ showed similar signi�cant associations with cognitive measures as tau and p-tau-18, contradicting previous literature that suggested tau to have stronger relationships with cognition 24, 25 .”
Chang, C., Lee, S. J., Na, D. L., & Yoon, J. H. (2026) · International Journal of Language & Communication Disorders · doi:10.1111/1460-6984.70196
Pietilä, E. M., Mira, K., Helin, S., Snellman, A., Matti, V., Antti, J., Rinne, J. O., & Ekblad, L. L. (2026) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2026.06.004
Xiong, C., Nie, Y., Luo, J. R., Lu, R., Wolk, D. A., Shaw, L. M. J., Gleason, C. E., Johnson, S. C., Agboola, F., Morris, J. C., et al. (2026) · Statistical Methods in Medical Research · doi:10.1177/09622802261468023
Self-citationXiong, C., Luo, J. R., Hartz, S. M., Schindler, S. E., Kukull, W. A., Hassenstab, J. J., Wolk, D. A., Gleason, C. E., Johnson, S. C., Sperling, R. A., et al. (2026) · Annals of Neurology · doi:10.1002/ana.78392
Self-citation
Metadata
- Authors
- Xiong, C., Jasielec, M. S., Weng, H., Fagan, A. M., Benzinger, T. L. S., Head, D., Hassenstab, J., Grant, E., Sutphen, C. L., Buckles, V., Moulder, K. L., & Morris, J. C.
- Affiliations
- From the Charles F. and Joanne Knight Alzheimer's Disease Research Center (C.X., M.S.J., H.W., A.M.F., T.L.S.B., D.H., J.H., E.G., C.L.S., V.B., K.L.M., J.C.M.), Departments of Neurology (V.B., K.L.M., A.M.F., J.H., J.C.M., C.L.S.), Pathology and Immunology (J.C.M.), Physical Therapy (J.C.M.), and Occupational Therapy (J.C.M.), Division of Biostatistics (C.X., M.S.J., H.W., E.G.), and Departments of Psychology (D.H., J.H.), Radiology (T.L.S.B., D.H.), and Neurological Surgery (T.L.S.B.), Washington...
- ORCID
- Venue
- Neurology
- Published
- 2016-04-19
- Volume
- 86
- Issue
- 16
- Pages
- 1499-1506
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC4836885
- OpenAlex
- W2308877313
- Cited by
- 54
- References
- 39
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 3 · 2023: 8 · 2022: 4 · 2021: 3 · 2020: 11 · 2019: 10 · 2018: 3 · 2016: 1
- FWCI
- 4.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (R01AG034119, P50AG005681, P01AG003991, P01AG026276)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK094982)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Oncology › Cancer-related cognitive impairment studies
- Keywords
- Alzheimer's disease, biomarkers, CSF tau, CSF amyloid-beta 42, Pittsburgh compound B, amyloid PET, hippocampal volume, longitudinal change, cognition, biomarker correlation
- MeSH terms
- Adult, Aged, Alzheimer Disease, Apolipoproteins E, Brain, Cognition, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Organ Size, Peptide Fragments, Phosphorylation, Biomarkers, Amyloid beta-Peptides, tau Proteins, Adult Children, Positron-Emission Tomography
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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