DOI: 10.1002/alz.078657 ISSN: 1552-5260

Amyloid‐dependent tau phosphorylation drives faster accumulation of tau aggregates in female

Yi‐Ting Wang, Joseph Therriault, Stijn Servaes, Cécile Tissot, Nesrine Rahmouni, Jaime Fernandez Arias, Andrea Lessa Benedet, Sulantha Mathotaarachchi, Jenna Stevenson, Nicholas J. Ashton, Thomas K Karikari, Henrik Zetterberg, Kaj Blennow, Pedro Rosa‐Neto
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



The high prevalence of Alzheimer’s dementia in females have long puzzled researchers in the field. Despite similar amyloid levels, females show higher load of neurofibrillary tangles (NFTs). Previous literature proposed that amyloid‐β (Aβ) and phosphorylated tau (p‐tau) synergism accelerates biomarker abnormalities. However, it remains to be answered whether this synergism is the driving force behind faster tau progression in females. The overarching goal of the study wa to investigate whether amyloid‐β aggregates differentially impose tau hyperphosphorylation and neurofibrillary tangles formation in a sex‐specific manner.


In this longitudinal study, we assessed 287 participants from TRIAD cohort at McGill University Research Centre for Studies in Aging. Cerebral Aβ and tau deposition were assessed with positron emission tomography (PET) radiotracers [18F]AZD4694 ([18F]NAV4694) and [18F]MK6240, respectively. Cerebrospinal fluid (CSF) p‐tau181 and p‐tau217 were also measured (analysed at the Clinical Neurochemistry Laboratory at the University of Gothenburg, Sweden). Regression and voxel‐based models with interaction terms were used to evaluate baseline tau load and NFT accumulation rate as a function of sex and baseline biomarkers (Aβ and p‐tau).


We identified sex difference in the relationships between CSF p‐tau, Aβ and NFT (Fig 1). Specifically, voxelwise analyses demonstrated that female presented stronger positive correlations between CSF p‐tau and AD core biomarkers (Aβ and NFT). Furthermore, we discovered that Aβ and CSF ptau181 interactively potentiated tau accumulation in females but not males (Fig 2, Table 1). Together, the present results support that Aβ load imposes higher tau aggregation in females.


Aβ‐dependent tau phosphorylation was the key driver for faster NFT accumulation observed in female.

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