Longitudinal change of plasma biomarkers with incident mild cognitive impairment or Alzheimer’s disease in a multi‐ethnic cohort

Abstract

AbstractBackgroundThe utility of plasma‐based Alzheimer’s biomarkers in differentiating cognitively healthy individuals from those with Mild Cognitive Impairment (MCI) or Alzheimer’s disease (AD) has been widely investigated in cross‐sectional studies. There are fewer data on longitudinal change of these biomarkers over time, particularly in multi‐ethnic cohorts.MethodBased on a community‐based, multi‐ethnic cohort study, the Washington Heights Inwood Columbia Aging Project, we included 610 cognitively normal individuals with three plasma samples collected over a mean period of 6.7 years. We used AD biomarkers, including Aβ40, Aβ42, tau, phosphorylated tau‐181 (P‐tau181), glial fibrillary acid protein (GFAP), and neurofilament light chain (NfL), and two calculated ratio measures (Aβ42/Aβ40, P‐tau181/Aβ42). During the follow‐up, 156 individuals developed MCI, 50 developed AD, and 404 remained cognitively unimpaired. We used generalized estimating equations to examine whether those who developed MCI and AD had different rates of change in plasma biomarkers than controls. Analyses were adjusted for age, years of education, sex, race and ethnicity, and APOE ɛ4 status. Similar analyses were performed to examine whether the rate of biomarker change differed by race and ethnicity, sex, and APOE ɛ4 status.ResultThe initial mean age of individuals was 73.1 (SD = 5.6) years, 419 (69%) were women, and 25.9% carried APOE e4. Individuals self‐identified as non‐Hispanic White (28.9%), non‐Hispanic Black (25.4%), or Hispanic (45.7%). Compared to controls, individuals with incident MCI had an accelerated increase in P‐tau181 (b = 0.029, p = 0.048), NfL (b = 0.027, p = 0.010), GFAP (b = 0.029, p = 0.002), and a more rapid decrease in Aβ42/Aβ40 ratio (b = ‐0.015, p = 0.033). Individuals with incident AD also had a greater increase in NfL (b = 0.041, p = 0.027) and GFAP (b = 0.04, p = 0.006) than controls. Hispanics had a faster increase in NfL (b = 0.033, p = 0.002) and GFAP (b = 0.034, p<0.001), and Black participants had a faster increase in NfL (b = 0.028, p = 0.023), compared to Whites. Neither sex nor APOE ɛ4 genotype affected rates of biomarker changes.ConclusionLongitudinal change in plasma biomarkers may have clinical utility, since incident MCI and AD are accompanied by faster increases in P‐tau181, NfL, and GFAP, and a faster decrease in Aβ42/ Aβ40 ratio. The trajectories of AD biomarker change may also vary by race and ethnicity.