Discriminative accuracy of the A/T/N scheme to identify cognitive impairment due to Alzheimer's disease

IntroductionThe optimal combination of amyloid-beta/tau/neurodegeneration (A/T/N) biomarker profiles for the diagnosis of Alzheimer's disease (AD) dementia is unclear. MethodsWe examined the discriminative accuracy of A/T/N combinations assessed with neuroimaging biomarkers for the differentiation of AD from cognitively unimpaired (CU) elderly and non-AD neurodegenerative diseases in the TRIAD, BioFINDER-1 and BioFINDER-2 cohorts (total n = 832) using area under the receiver operating characteristic curves (AUC). ResultsFor the diagnosis of AD dementia (vs. CU elderly), T biomarkers performed as well as the complete A/T/N system (AUC range: 0.90-0.99). A and T biomarkers in isolation performed as well as the complete A/T/N system in differentiating AD dementia from non-AD neurodegenerative diseases (AUC range; A biomarker: 0.84-1; T biomarker: 0.83-1). DiscussionIn diagnostic settings, the use of A or T neuroimaging biomarkers alone can reduce patient burden and medical costs compared with using their combination, without significantly compromising accuracy.

Automated summary

This study investigates the optimal combination of amyloid-beta/tau/neurodegeneration (A/T/N) biomarkers for the diagnosis of Alzheimer's disease (AD) dementia. The results show that the tau biomarkers perform as well as the complete A/T/N system in diagnosing AD dementia. Additionally, the use of A or T neuroimaging biomarkers alone is equally effective in differentiating AD dementia from non-AD neurodegenerative diseases compared to using the complete A/T/N system.