Biomarkers for the detection of progressive early Alzheimer’s Disease

Abstract

AbstractBackgroundWe investigated the ability of MRI, plasma, and cognitive biomarkers in detecting preclinical or prodromal Alzheimer’s Disease (AD) who will progress to the next syndrome stage of the cognitive continuum.Method589 subjects with longitudinal cognitive data were recruited from the Alzheimer’s Disease Neuroimaging Initiative (ADNI), which included 227 cognitive unimpaired (CU) and 362 mild cognitive impairment (MCI) subjects. Preclinical or prodromal AD was defined by a low amyloid beta (Aβ)42 (A+) and high phosphorylated ‐tau (p‐tau) (T+) on cerebrospinal fluid (CSF) assessment at baseline. The following baseline MRI biomarkers were derived by an automatic segmentation tool (AccuBrain®): AD‐resemblance atrophy index (AD‐RAI), quantitative medial temporal lobe atrophy (QMTA) and hippocampus volume (HV). Plasma biomarkers included p‐tau 181, neurofilament (NFL) and APOE ε4. Montreal Cognitive Assessment (MoCA) score was collected for all subjects at baseline. Conversion (C+) was defined as subjects progressed from CU to MCI and from MCI to dementia within 4 years.ResultsOf the 589 subjects (mean [SD] age, 72.2 [6.9] years; 314 men [53.3%]), 96 (16.3%) were A+T+C+ and 180 (30.6%) were A+T+C‐. In the ROC analysis, AD‐RAI achieved the best detection ability than other individual biomarker with a sensitivity of 83.4%, a specificity of 69.4% and an AUC of 87.8%. A combination of AD‐RAI, plasma p‐tau 181, APOE ε4 and MoCA score achieved the best detection ability with AUC of 89.8%, sensitivity of 85.1% and specificity of 80.2%. In the subgroup analysis, the combination of AD‐RAI, plasma p‐tau 181, APOE ε4 and MoCA score also showed good accuracy in identifying A+T+C+ subjects in the CU group (AUC = 87.6%) and in the MCI group (AUC = 89.3%).ConclusionA panel of MRI, plasma and cognitive biomarkers might help to detect progressive early AD subjects.