Abstract
ObjectiveTo investigate the relationship between cerebrospinal fluid (CSF) β-amyloid peptide (Aβ42) and CSF Tau in a large population of patients referred to memory clinics for investigation of cognitive dysfunction.MethodsWe analyzed Alzheimer’s disease (AD) biomarkers in CSF taken from 3565 patients referred to 18 French memory clinics. Patients were classified into four profiles according to levels of CSF biomarkers (A: amyloidosis, N: neurodegeneration). The association between CSF Tau and CSF Aβ42 were analyzed using general linear regression models, in the overall population and stratified by biomarkers profiles. We compared linear and quadratic models using Akaike information criterion. We also assessed change in biomarker profiles in a subset of patients who had 2 assessments of biomarkers.ResultsCSF Tau was negatively associated with CSF Aβ42 in the overall population, following a non-linear quadratic model. However, the nature of this association was different in the 4 profiles: positive association in A-N- profile, negative association in A-N+ and A+N+ profiles, lack of association in A+N- patients. When considering patients with longitudinal data on profiles, 36% of those initially classified as A-N+ evolved to an A+N+ profile.ConclusionsThe nature of the association between CSF Aβ42 and CFS Tau depends on the A/N profiles of patients. These results suggest an increase in CSF Aβ42 early in the disease before its decline while tau pathology progresses, this pattern is particularly observed in non-APOE4 subjects. This phenomenon may explain why some patients with neurodegeneration only markers convert to an AD profile (A+N+) over time.
Highlights
Alzheimer’s disease (AD), the most common cause of dementia, is neuropathologically characterized by extracellular β-amyloid peptide (Aβ42) deposits, neurofibrillary tangles composed of intraneuronal abnormally phosphorylated Tau, and neuronal and synaptic loss [1]
Cerebrospinal fluid (CSF) Tau was negatively associated with CSF Aβ42 in the overall population, following a non-linear quadratic model
The nature of this association was different in the 4 profiles: positive association in A-N- profile, negative association in A-N+ and A+N+ profiles, lack of association in A+N- patients
Summary
Alzheimer’s disease (AD), the most common cause of dementia, is neuropathologically characterized by extracellular β-amyloid peptide (Aβ42) deposits, neurofibrillary tangles composed of intraneuronal abnormally phosphorylated Tau, and neuronal and synaptic loss [1]. Based on the amyloid hypothesis, a temporal chronology of AD biomarkers has been proposed [10], and in 2011 the National Institute on Aging-Alzheimer’s Association (NIA-AA) proposed biomarker based recommendations for the staging of preclinical AD [11]. One year after the publication of the NIA-AA recommendations, Jack et al reported an additional category of subjects, characterized by positivity for only neurodegeneration markers (A-N+) and proposed the designation of SNAP, for Suspected Non-Alzheimer’s disease Pathophysiology for these subjects [12]
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