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The implications of different approaches to define AT(N) in Alzheimer disease
Open accessAbstract
Objective To compare different β-amyloid (Aβ), tau, and neurodegeneration (AT[N]) variants within the Swedish BioFINDER studies. Methods A total of 490 participants were classified into AT(N) groups. These include 53 cognitively unimpaired (CU) and 48 cognitively impaired (CI) participants (14 mild cognitive impairment [MCI] and 34 Alzheimer disease [AD] dementia) from BioFINDER-1 and 389 participants from BioFINDER-2 (245 CU and 144 CI [138 MCI and 6 AD dementia]). Biomarkers for A were CSF Aβ42 and amyloid-PET ([18F]flutemetamol); for T, CSF phosphorylated tau (p-tau) and tau PET ([18F]flortaucipir); and for (N), hippocampal volume, temporal cortical thickness, and CSF neurofilament light (NfL). Binarization of biomarkers was achieved using cutoffs defined in other cohorts. The relationship between different AT(N) combinations and cognitive trajectories (longitudinal Mini-Mental State Examination scores) was examined using linear mixed modeling and coefficient of variation. Results Among CU participants, A−T−(N)− or A+T−(N)− variants were most common. However, more T+ cases were seen using p-tau than tau PET. Among CI participants, A+T+(N)+ was more common; however, more (N)+ cases were seen for MRI measures relative to CSF NfL. Tau PET best predicted longitudinal cognitive decline in CI and p-tau in CU participants. Among CI participants, continuous T (especially tau PET) and (N) measures improved the prediction of cognitive decline compared to binary measures. Conclusions Our findings show that different AT(N) variants are not interchangeable, and that optimal variants differ by clinical stage. In some cases, dichotomizing biomarkers may result in loss of important prognostic information.
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“Indeed, blood-based biomarkers for AD could pave the way in supporting the diagnosis of AD in clinical practice and in improving the development of clinical trials for the earliest stages of AD [53,54,55].”
From Treatment of Alzheimer’s Disease: Beyond Symptomatic Therapies (2023) · cites this paper as [53]
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“Studies demonstrate that robust tau pathology is more commonly seen in patients with amyloid pathology”
From The amyloid hypothesis in Alzheimer disease: new insights from new therapeutics (2022) · cites this paper as [24]
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“These and other studies 13,24,133,134 strongly support the concept of AD as being an amyloid-provoked, or facilitated, tauopathy, although there is also evidence that both pathologies act in synergy 135 .”
From The amyloid hypothesis in Alzheimer disease: new insights from new therapeutics (2022) · cites this paper as [24]
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Metadata
- Authors
- Mattsson-Carlgren, N., Leuzy, A., Janelidze, S., Palmqvist, S., Stomrud, E., Strandberg, O., Smith, R., & Hansson, O.
- Affiliations
- From the Clinical Memory Research Unit, Department of Clinical Sciences (N.M.-C., A.L., S.J., S.P., E.S., O.S., R.S., O.H.), and Wallenberg Centre for Molecular Medicine (N.M.-C.), Lund University, Malmö; and Department of Neurology (N.M.-C., S.P., R.S.) and Memory Clinic (E.S., O.H.), Skåne University Hospital, Lund, Sweden.
- Lund University (SE)
- Corresponding author
- Hansson, Oskar
- Venue
- Neurology
- Published
- 2020-05-26
- Volume
- 94
- Issue
- 21
- Pages
- e2233-e2244
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC7357296
- OpenAlex
- W3025228866
- Cited by
- 114
- References
- 34
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 18 · 2023: 28 · 2022: 19 · 2021: 27 · 2020: 4
- FWCI
- 14.23
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Neurology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- 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, amyloid PET, tau PET, neurodegeneration biomarkers, phosphorylated tau, hippocampal volume, cortical thickness, mild cognitive impairment, cognitive decline, longitudinal cognitive trajectories
- MeSH terms
- Mental Status and Dementia Tests, Aged, Alzheimer Disease, Aniline Compounds, Brain, Carbolines, Female, Humans, Longitudinal Studies, Male, Middle Aged, Nerve Degeneration, Sweden, Biomarkers, Case-Control Studies, Amyloid beta-Peptides, tau Proteins, Neurofilament Proteins, Positron-Emission Tomography, Benzothiazoles, Cognitive Dysfunction
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