Frequency of Biologically Defined Alzheimer Disease in Relation to Age, Sex, ε4, and Cognitive Impairment.

TitleFrequency of Biologically Defined Alzheimer Disease in Relation to Age, Sex, ε4, and Cognitive Impairment.
Publication TypeJournal Article
Year of Publication2021
AuthorsTherriault J, Pascoal TA, Benedet AL, Tissot C, Savard M, Chamoun M, Lussier F, Kang MSu, Berzgin G, Wang T, Fernandes-Arias J, Massarweh G, Soucy J-P, Vitali P, Saha-Chaudhuri P, Gauthier S, Rosa-Neto P
Date Published2021 02 16
KeywordsAge Factors, Aged, Alzheimer Disease, Amyloid beta-Peptides, Apolipoprotein E4, Brain, Cognition, Cognitive Dysfunction, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Positron-Emission Tomography, Sex Factors, tau Proteins

OBJECTIVE: To assess the frequency of biologically defined Alzheimer disease (AD) in relation to age, sex, ε4, and clinical diagnosis in a prospective cohort study evaluated with amyloid-PET and tau-PET.METHODS: We assessed cognitively unimpaired (CU) elderly (n = 166), patients with amnestic mild cognitive impairment (n = 77), and patients with probable AD dementia (n = 62) who underwent evaluation by dementia specialists and neuropsychologists in addition to amyloid-PET with [F]AZD4694 and tau-PET with [F]MK6240. Individuals were grouped according to their AD biomarker profile. Positive predictive value for biologically defined AD was assessed in relation to clinical diagnosis. Frequency of AD biomarker profiles was assessed using logistic regressions with odds ratios (ORs) and 95% confidence intervals (CIs).RESULTS: The clinical diagnosis of probable AD dementia demonstrated good agreement with biologically defined AD (positive predictive value 85.2%). A total of 7.88% of CU were positive for both amyloid-PET and tau-PET. Frequency of biologically defined AD increased with age (OR 1.14; < 0.0001) and frequency of ε4 allele carriers (single ε4: OR 3.82; < 0.0001; double ε4: OR 17.55, < 0.0001).CONCLUSION: Whereas we observed strong, but not complete, agreement between clinically defined probable AD dementia and biomarker positivity for both β-amyloid and tau, we also observed that biologically defined AD was not rare in CU elderly. Abnormal tau-PET was almost exclusively observed in individuals with abnormal amyloid-PET. Our results highlight that even in tertiary care memory clinics, detailed evaluation by dementia specialists systematically underestimates the frequency of biologically defined AD and related entities.CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that biologically defined AD (abnormal amyloid PET and tau PET) was observed in 85.2% of people with clinically defined AD and 7.88% of CU elderly.

Alternate JournalNeurology
PubMed ID33443136
PubMed Central IDPMC8055338
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