Rates of clinical progression according to biological Alzheimer's disease stages

IF 11.1 1区医学 Q1 CLINICAL NEUROLOGY

Alzheimer's & Dementia Pub Date : 2025-09-15 DOI:10.1002/alz.70624

Lydia Trudel, Joseph Therriault, Arthur C. Macedo, Stijn Servaes, Seyyed Ali Hosseini, Gleb Bezgin, Nesrine Rahmouni, Tevy Chan, Jaime Fernandez-Arias, Étienne Aumont, Yi-Ting Wang, Yansheng Zheng, Brandon Hall, Robert Hopewell, Chris Hung-Hsin Hsiao, Arthur W. Toga, Meredith N. Braskie, Karin L. Meeker, Jean-Paul Soucy, Serge Gauthier, Paolo Vitali, Sid E. O'Bryant, Tharick A. Pascoal, Pedro Rosa-Neto

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引用次数: 0

Abstract

INTRODUCTION

Predicting the rate of cognitive decline and the likelihood of progression to dementia remains a critical unmet need in clinical settings.

METHODS

We assessed progression to mild cognitive impairment (MCI) and all-cause dementia in 492 individuals from the TRIAD, ADNI, and HABS-HD cohorts followed for an average of 2.49 years. Amyloid-positive participants were staged according to the Alzheimer's Association biological staging framework (A+T₂-/A+T_2MTL+/A+T_2MOD+/A+T_2HIGH+).

RESULTS

Cognitively unimpaired (CU) individuals in the A+T_2MTL+, A+T_2MOD+, and A+T_2HIGH+ biological Alzheimer's disease (AD) stages were at significantly higher risk of clinical progression compared to non-AD CU individuals. In individuals with MCI, advanced tau stage was associated with an 83% likelihood of developing dementia over 4 years. Biological AD staging demonstrated superior accuracy in predicting clinical progression compared to amyloid-PET (positron emission tomography) status, tau-PET status, and demographic information. All tau-PET-positive individuals showed a significantly faster rate of cognitive decline than non-AD controls, with the A+T_2HIGH+ stage showing the steepest rate of decline (p < 0.001).

DISCUSSION

Our results highlight the prognostic value of biological AD staging.

Highlights

Cognitively unimpaired (CU) individuals in all tau-PET (positron emission tomography)–positive biological Alzheimer's disease (AD) stages were at significantly higher risk of clinical progression compared to individuals without AD.
In individuals with mild cognitive impairment (MCI), only the A+T_2HIGH+ stage reached a point where 50% of individuals had progressed to all-cause dementia, after 2.36 years.
Biological AD staging demonstrated superior accuracy in predicting clinical progression to dementia compared to other PET biomarkers and demographic information.
All tau-PET-positive individuals showed a significantly faster rate of cognitive decline than individuals without AD, with the A+T_2HIGH+ stage showing the steepest rate of decline.

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根据阿尔茨海默病生物学分期的临床进展率

在临床环境中，预测认知能力下降的速度和进展为痴呆的可能性仍然是一个关键的未满足的需求。方法：我们评估了来自TRIAD、ADNI和HABS-HD队列的492名患者向轻度认知障碍（MCI）和全因痴呆的进展，平均随访时间为2.49年。淀粉样蛋白阳性参与者根据阿尔茨海默病协会生物分期框架（A+T2-/A+T2MTL+/A+T2MOD+/A+T2HIGH+）进行分期。结果认知未受损（CU）个体在A+T2MTL+、A+T2MOD+和A+T2HIGH+生物阿尔茨海默病（AD）阶段的临床进展风险显著高于非AD CU个体。在MCI患者中，晚期tau蛋白阶段与4年内发生痴呆的可能性相关，概率为83%。与淀粉样蛋白- pet（正电子发射断层扫描）状态、tau-PET状态和人口统计学信息相比，AD生物分期在预测临床进展方面表现出更高的准确性。所有tau- pet阳性个体的认知能力下降速度明显快于非ad对照组，其中a +T2HIGH+期下降速度最快（p < 0.001）。我们的研究结果强调了AD生物分期的预后价值。在所有tau-PET（正电子发射断层扫描）阳性的生物阿尔茨海默病（AD）阶段，认知未受损（CU）个体的临床进展风险明显高于未患AD的个体。在轻度认知障碍（MCI）的个体中，只有A+T2HIGH+阶段达到50%的个体在2.36年后发展为全因痴呆的程度。与其他PET生物标志物和人口统计学信息相比，AD生物分期在预测痴呆临床进展方面表现出更高的准确性。所有tau- pet阳性个体的认知能力下降速度都明显快于未患AD的个体，其中a +T2HIGH+阶段下降速度最快。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Alzheimer's & Dementia 医学-临床神经学

CiteScore

14.50

自引率

5.00%

发文量

299

审稿时长

3 months

期刊介绍： Alzheimer's & Dementia is a peer-reviewed journal that aims to bridge knowledge gaps in dementia research by covering the entire spectrum, from basic science to clinical trials to social and behavioral investigations. It provides a platform for rapid communication of new findings and ideas, optimal translation of research into practical applications, increasing knowledge across diverse disciplines for early detection, diagnosis, and intervention, and identifying promising new research directions. In July 2008, Alzheimer's & Dementia was accepted for indexing by MEDLINE, recognizing its scientific merit and contribution to Alzheimer's research.