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Ramanan VK, Graff-Radford J, Syrjanen J, Shir D, Algeciras-Schimnich A, Lucas J, Martens YA, Carrasquillo MM, Day GS, Ertekin-Taner N, Lachner C, Willis FB, Knopman DS, Jack CR, Petersen RC, Vemuri P, Graff-Radford N, Mielke MM. Association of Plasma Biomarkers of Alzheimer Disease With Cognition and Medical Comorbidities in a Biracial Cohort. Neurology 2023; 101:e1402-e1411. [PMID: 37580163 PMCID: PMC10573134 DOI: 10.1212/wnl.0000000000207675] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/06/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recent advances in blood-based biomarkers offer the potential to revolutionize the diagnosis and management of Alzheimer disease (AD), but additional research in diverse populations is critical. We assessed the profiles of blood-based AD biomarkers and their relationships to cognition and common medical comorbidities in a biracial cohort. METHODS Participants were evaluated through the Mayo Clinic Jacksonville Alzheimer Disease Research Center and matched on age, sex, and cognitive status. Plasma AD biomarkers (β-amyloid peptide 1-42 [Aβ42/40], plasma tau phosphorylated at position 181 [p-tau181], glial fibrillary acidic protein [GFAP], and neurofilament light) were measured using the Quanterix SiMoA HD-X analyzer. Cognition was assessed with the Mini-Mental State Examination. Wilcoxon rank sum tests were used to assess for differences in plasma biomarker levels by sex. Linear models tested for associations of self-reported race, chronic kidney disease (CKD), and vascular risk factors with plasma AD biomarker levels. Additional models assessed for interactions between race and plasma biomarkers in predicting cognition. RESULTS The sample comprised African American (AA; N = 267) and non-Hispanic White (NHW; N = 268) participants, including 69% female participants and age range 43-100 (median 80.2) years. Education was higher in NHW participants (median 16 vs 12 years, p < 0.001) while APOE ε4 positivity was higher in AA participants (43% vs 34%; p = 0.04). We observed no differences in plasma AD biomarker levels between AA and NHW participants. These results were unchanged after stratifying by cognitive status (unimpaired vs impaired). Although the p-tau181-cognition association seemed stronger in NHW participants while the Aβ42/40-cognition association seemed stronger in AA participants, these findings did not survive after excluding individuals with CKD. Female participants displayed higher GFAP (177.5 pg/mL vs 157.73 pg/mL; p = 0.002) and lower p-tau181 (2.62 pg/mL vs 3.28 pg/mL; p = 0.001) levels than male participants. Diabetes was inversely associated with GFAP levels (β = -0.01; p < 0.001). DISCUSSION In a biracial community-based sample of adults, we observed that sex differences, CKD, and vascular risk factors, but not self-reported race, contributed to variation in plasma AD biomarkers. Although some prior studies have reported primary effects of race/ethnicity, our results reinforce the need to account for broad-based medical and social determinants of health (including sex, systemic comorbidities, and other factors) in effectively and equitably deploying plasma AD biomarkers in the general population.
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Affiliation(s)
- Vijay K Ramanan
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Jonathan Graff-Radford
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Jeremy Syrjanen
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Dror Shir
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Alicia Algeciras-Schimnich
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - John Lucas
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Yuka A Martens
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Minerva M Carrasquillo
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Gregory S Day
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Nilüfer Ertekin-Taner
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christian Lachner
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Floyd B Willis
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - David S Knopman
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Clifford R Jack
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ronald C Petersen
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Prashanthi Vemuri
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Neill Graff-Radford
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michelle M Mielke
- From the Department of Neurology (V.K.R., J.G.-R., D.S., D.S.K., R.C.P.), Department of Quantitative Health Sciences (J.S., R.C.P.), and Department of Laboratory Medicine and Pathology (A.A.-S.), Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology (J.L., C.L.), Department of Neuroscience (Y.A.M., M.M.C., G.S.D., N.E.-T.), Department of Neurology (N.E.-T., C.L., N.G.-R.), and Department of Family Medicine (F.B.W.), Mayo Clinic, Jacksonville, FL; Department of Radiology (C.R.J., P.V.), Mayo Clinic, Rochester, MN; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
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