Impact of CSF pTau/Aβ42 ratio on brain structure and metabolism in middle‐aged cognitively unimpaired individuals

Abstract

AbstractBackgroundThe cerebrospinal fluid (CSF) pTau/Aβ42 ratio has emerged as a promising biomarker to monitor the pathological progression of Alzheimer’s disease (AD), even at preclinical stages. To date, no studies have assessed the impact of this continuous biomarker on the brain structure and metabolism in cognitively unimpaired (CU) individuals.MethodWe included 243 CU participants from the ALFA study (mean age=61.68 years) who underwent a lumbar puncture, magnetic resonance imaging (MRI) and 18F‐Fluorodeoxyglucose (FDG) positron emission tomography (PET). CSF Aβ42 and pTau181 were measured with the Elecsys® immunoassay (Roche Diagnostics International Ltd). After image preprocessing, we applied a voxel‐wise linear regression to test the impact of CSF pTau/Aβ42 ratio, as well as its interaction with age, sex and APOE‐ε4, on both gray matter volume (GMv) and brain metabolism. The statistical significance threshold was set to p<0.005, with a cluster extent correction of 100 voxels.ResultThere were no main effects of pTau/Aβ42 on either GMv or brain metabolism. However, a significant interaction with age indicated that for older individuals, a higher pTau/Aβ42 was associated with reduced GMv in the middle cingulum, the middle and superior frontal gyrus, and the angular gyrus (Fig. 1a). An interaction with sex indicated that for females, a higher pTau/Aβ42 was associated with reduced GMv in the precuneus, superior frontal and fusiform gyrus (Fig. 1b). For FDG, we found a significant interaction with sex indicating that females exhibited a metabolism reduction with increasing levels of pTau/Aβ42, in the hippocampus and anterior cingulum (Fig. 1c). Finally, an interaction with APOE‐ε4 indicated that ε4‐carriers showed lower metabolism in the bilateral striatum, as a function of increasing pTau/Aβ42 ratio (Fig.1 d).ConclusionIn CU individuals, the impact of the progression of AD pathophysiology as indicated by a higher CSF pTau/Aβ42 ratio, on both brain structure and metabolism is modulated by AD risk factors. These data suggest that each of these risk factors confers a higher vulnerability to the progression of AD pathology in asymptomatic individuals, as manifested by an early impact on brain structure and metabolism in brain areas which are known to be affected in clinical AD stages.