Cerebrospinal Fluid Biomarkers Distinguish Postmortem-Confirmed Alzheimer's Disease from Other Dementias and Healthy Controls in the OPTIMA Cohort

Article type: Research Article

Authors: Seeburger, Jeffrey L.^{a; 1} | Holder, Daniel J.^{a; 1} | Combrinck, Marc^{b; c} | Joachim, Catharine^b | Laterza, Omar^a | Tanen, Michael^a | Dallob, Aimee^a | Chappell, Derek^a | Snyder, Karen^a | Flynn, Mary^a | Simon, Adam^a | Modur, Vijay^a | Potter, William Z.^a | Wilcock, Gordon^b | Savage, Mary J.^{a; *} | Smith, A. David^{b; d}

Affiliations: [a] Merck Research Laboratories, Merck & Co., Inc., Whitehouse Station, NJ, USA | [b] OPTIMA, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK | [c] Current address: University of Cape Town, Groote Schuur Hospital, Cape Town, ZA | [d] OPTIMA, Department of Pharmacology, Mansfield Rd., Oxford, UK

Correspondence: [*] Correspondence to: Dr. Mary J. Savage, Molecular Biomarkers & Diagnostics, Merck Research Laboratories, RY50-1D-131, 126 E. Lincoln Avenue, Rahway, NJ 07065, USA. Tel.: +1 732 594 1089; E-mail: mary_savage@merck.com.

Note: [1] These authors contributed equally to this work.

Abstract: Cerebrospinal fluid (CSF) amyloid-β (Aβ) and tau have been studied as markers of Alzheimer's disease (AD). Combined Aβ42 and t-tau distinguishes AD from healthy controls with a sensitivity and specificity (sens/spec) near 89% across studies. This study examined these markers in the homogeneous OPTIMA cohort, using extensive longitudinal follow up and postmortem evaluation to confirm clinicopathological status. Baseline CSF was analyzed from 227 participants with AD (97% autopsy-confirmed), mild cognitive impairment (MCI; 73% confirmed), other dementia syndrome (ODS; 100% confirmed), and controls (CTL; 27% confirmed, follow up approximately 9–13 years). Biomarker concentrations were analyzed using validated ELISAs. AD patients had lower CSF Aβ42 and higher t-tau, p-tau, t-tau/Aβ42, and t-tau/Aβ40 compared to CTLs, with MCI intermediate. CTL and MCI participants who progressed to AD demonstrated more AD-like profiles. Aβ40, sAβPPα, and sAβPPβ were lower in AD compared to CTL. High-level discriminators of AD from CTL were t-tau/Aβ40 (AUROC 0.986, sens/spec of 92%/94%), p-tau/Aβ42 (AUROC 0.972, sens/spec of 94%/90%), and Aβ42 (AUROC 0.941, sens/spec of 88%). For discriminating AD from ODS, p-tau/Aβ42 demonstrated sens/spec of 88%/100% (95%/86% at the AD versus CTL cutoff) and Aβ42 demonstrated sens/spec of 84%/100% (88%/100% at the AD versus CTL cutoff). In a well-characterized, homogeneous population, a single cutoff for baseline CSF Aβ and tau markers can distinguish AD with a high level of sens/spec compared to other studies. It may be important to characterize sources of demographic and biological variability to support the effective use of CSF diagnostic assays in the broader AD population.

Keywords: Alzheimer's disease, amyloid-β, biomarker, cerebrospinal fluid, frontotemporal dementia, mild cognitive impairment, postmortem examination, tau

DOI: 10.3233/JAD-141725

Journal: Journal of Alzheimer's Disease, vol. 44, no. 2, pp. 525-539, 2015