Clinical outcomes of amyloid and tau markers according to vascular markers

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AbstractBackgroundAlzheimer’s disease (AD) is characterized by amyloid beta (Aβ) aggregation [A] and tau aggregation reflecting neurofibrillary tangles [T]. These AD markers lead to neurodegeneration [N] and cognitive impairments. Recently, the ATN research framework of was presented by National Institute on Aging and Alzheimer’s Association. Cerebral small vessel disease (CSVD, [V]), which is one of most important cause of cognitive impairments, has an additive or synergistic effect on cognitive impairments with AD markers. In the present study, we investigated the frequency of ATV abnormalities in participants with varying degree of AD and CSVD markers. We also determined whether CSVD might synergistically affect cognitive decline with AD markers.MethodWe consecutively recruited 195 subjects (105 AD‐related cognitive impairment subjects, 86 subcortical vascular cognitive impairment subjects) from Samsung Medical Center. [A] and [T] positivities were determined by cut‐off values of Aβ and tau uptakes on PET using iterative outlier methods. [V] was assessed by the presence of severe white matter hyperintensity. All subjects underwent neuropsychological tests including Mini‐Mental State Exam (MMSE) and clinical dementia rating‐sum of boxes (CDR‐SOB). A linear mixed effect model was used to compare cognitive changes over time.ResultThe number of subjects of A‐T‐, A+T‐, and A+T+ groups were 16 (15.1%), 29 (27.4%), and 56 (52.8%) in the V‐ group; and 46 (51.7%), 33 (37.1%), and 8 (9.0%) in the V+ group. The linear mixed effects model analysis showed that A+/T+ were associated with worse cognitive decline, and its impact is higher in the V+ group than in the V‐ group (Figure).ConclusionOur findings suggested that there were interactive effects of AD markers and CSVD on cognitive decline. These findings demonstrate the importance of vascular factor management in patients with cognitive impairment and suggest that the ATV framework is useful in predicting cognitive decline in clinical practice.