Impact of clinical severity on plasma p-tau performance in predementia Alzheimer’s disease
Bibliographic record
Abstract
Abstract Background and objectives Detecting Alzheimer’s disease (AD) biological and clinical changes is crucial for early diagnostic and therapeutic interventions. Here we investigate the relationship between clinical severity and levels of phosphorylated tau, focusing on plasma biomarkers, in preclinical and prodromal AD. Methods In this study (n=621), we examined two independent cohorts consisting of preclinical and prodromal AD. Cohort-1 included 431 participants classified as either cognitively normal (CN) or mild cognitive impaired (MCI) with normal or abnormal cerebrospinal fluid (CSF) Aβ42/40 ratio (A) and p-tau181 (T) [CN A-/T-, n=169; A+/T-, CN=26; MCI=24; A+/T+, CN=40; MCI=105; CN=34; MCI=33]. A total of n=418 of the participants had longitudinal assessments of verbal memory up to 9.67 years from baseline. Cohort-2 included 190 participants in whom amyloid status was determined using Aβ positron emission tomography (PET) [Aβ- CN= 118; Aβ+ CN= 49; Aβ+ MCI= 21]. Results In cohort-1, plasma p-tau217 showed a moderate correlation with its corresponding CSF biomarker (rho=0.65, p<.001) and high accuracy identifying Aβ+ participants (AUC: 0.85). Diagnostic accuracy of plasma p-tau217 was significantly greater for MCI Aβ+ (AUC: 0.89) versus CN Aβ+ (AUC: 0.79, p<.05) and for A+/T+ (AUC: 0.88) versus A+/T- (AUC: 0.78, p<.05). P-tau181 and p-tau231 showed significantly weaker CSF-plasma correlations (rho= 0.47, and rho=0.32, p<.001, respectively) and levels were not as tightly associated with cognitive status in the Aβ+ group. While all the CSF p-tau markers were associated to future cognitive deterioration, p-tau217 was the only plasma biomarker associated with future memory decline (β=0.05, p<0.05). In cohort 1 and 2, plasma p-tau217 showed significantly higher concentrations in MCI Aβ+ as compared to CN Aβ+. Furthermore, plasma p-tau217 demonstrates similar biomarker elevations when compared to CN Aβ- controls in both cohorts. Discussion Our findings indicate that, unlike p-tau181 and p-tau231, plasma p-tau217 consistently aligns with cognitive status in Aβ+ individuals and more closely reflects CSF biomarker abnormalities, potentially reducing discrepancies between clinical and biochemical findings. The associations of plasma p-tau217 with baseline and future cognitive decline make it a valuable complement to clinical evaluations in preclinical and prodromal AD, especially when CSF analysis or PET are not feasible.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".