Understanding longitudinal plasma biomarker trajectories relative to brain amyloid changes can help devise Alzheimer's progression assessment strategies. We examined the temporal order of changes in plasma amyloid-β ratio ( ), glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and phosphorylated tau ratios ( , ) relative to 11 C-Pittsburgh compound B (PiB) positron emission tomography (PET) cortical amyloid burden (PiB-/+). Participants (n=199) were cognitively normal at index visit with a median 6.1-year follow-up. PiB groups exhibited different rates of longitudinal change in . Change in brain amyloid correlated with change in GFAP (r=0.5, 95% CI=[0.26, 0.68]). The greatest relative decline in (-1%/year) preceded brain amyloid positivity by 41 years (95% CI=[32, 53]). Plasma may begin declining decades prior to brain amyloid accumulation, whereas p-tau ratios, GFAP, and NfL increase closer in time. HIGHLIGHTS Plasma declines over time among PiB- but does not change among PiB+. Phosphorylated-tau to Aβ42 ratios increase over time among PiB+ but do not change among PiB-. Rate of change in brain amyloid is correlated with change in GFAP and neurofilament light chain. The greatest decline in may precede brain amyloid positivity by decades.
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