DOI: 10.1126/scitranslmed.aea2816 ISSN: 1946-6234

Distinct tau PET dynamics in early versus late age-of-onset Alzheimer’s disease

Konstantinos Chiotis, Ganna Blazhenets, David N. Soleimani-Meigooni, Paul S. Aisen, Alinda Amuiri, Alireza Atri, Laurel Beckett, Michael Brickhouse, David G. Clark, Jeffrey L. Dage, Gregory S. Day, Ranjan Duara, Ani Eloyan, Tatiana Foroud, Neill R. Graff-Radford, Ian M. Grant, Dustin B. Hammers, Lawrence S. Honig, Erik C. B. Johnson, David T. Jones, Kala Kirby, Robert Koeppe, Joel H. Kramer, Walter A. Kukull, Julien Lagarde, Antoine Leuzy, Piyush Maiti, Joseph C. Masdeu, Mario F. Mendez, Erik Musiek, Kelly N. Nudelman, Chiadi U. Onyike, Meghan Riddle, Salma Rocha, Emily Rogalski, Stephen Salloway, Daniel R. Schonhaut, Sharon J. Sha, Ranjani Shankar, Alexander Taurone, Maryanne Thangarajah, Arthur W. Toga, Alexandra Touroutoglou, Raymond Scott Turner, Prashanthi Vemuri, Thomas S. Wingo, David A. Wolk, Kyle Womack, Jiaxiuxiu Zhang, Maria C. Carrillo, Bradford C. Dickerson, Liana G. Apostolova, Renaud La Joie, Gil D. Rabinovici

Early-onset Alzheimer’s disease (EOAD) and late-onset AD (LOAD) differ in clinical presentations and rates of progression. We aimed to compare baseline and longitudinal tau positron emission tomography (PET) burden measured with 18 F-flortaucipir and its relationship with clinical variables in amyloid PET–positive, cognitively impaired participants from the Longitudinal Early-Onset Alzheimer’s Disease Study (EOAD; n  = 390) and Alzheimer’s Disease Neuroimaging Initiative (LOAD; n  = 211). Participants with EOAD showed higher baseline tau PET burden, broader neuroanatomical involvement, and stronger associations of tau PET with amyloid PET and global cognition. Higher baseline tau PET burden in EOAD was independently validated in participants with EOAD from ADNI. Longitudinally, tau PET increased more rapidly in EOAD than in LOAD, independent of amyloid PET and clinical stage. We conclude that earlier age of onset in AD is linked to a more aggressive tauopathy, which in turn is a primary driver of clinical decline.

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