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BackgroundSemantic intrusion errors (SIEs) are associated with mild cognitive impairment (MCI) due to Alzheimer's disease (AD). It is unknown whether accounting for maximum learning capacity still leads to an increase in SIEs when elevated plasma p-tau₂₁₇, a biological indicator of underlying AD, is present. MethodsOne hundred fifty-eight older adult participants completed the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L), a sensitive cognitive challenge test designed to elicit SIEs. Of these, 108 were clinically diagnosed with amnestic MCI (aMCI). Fifty-eight individuals met or exceeded a plasma p-tau₂₁₇positivity of >0.55 pg/ml, while 50 individuals scored below this threshold. ResultsAfter adjusting for demographic covariates and maximum learning capacity, the aMCI p-tau₂₁₇+ group evidenced more SIEs compared to aMCI p-tau₂₁₇- on the first (list B1;p= 0.035) and second trials of the competing list (list B2;p= 0.006). Biological predictors such asApoEε4 status, higher p-tau₂₁₇, and older age were predictors of an elevated number of SIEs [list B2:F(3,104) = 10.92;p= 0.001;R= 0.489)]. ConclusionsUnlike previous studies that used amyloid PET or other plasma biomarkers, individuals with aMCI p-tau₂₁₇+ evidenced more SIEs, even after adjusting for their initial learning capacity, a covariate that has not been studied previously. These findings support that SIEs are more prevalent in the presence of underlying AD pathology and occur independent of learning deficits. 

Neuroimaging and biofluid biomarkers provide a proxy of pathological changes for Alzheimer’s disease (AD) and are useful in improving diagnosis and assessing disease progression. However, it is not clear how race/ethnicity and different prevalence of AD risks impact biomarker levels. In this narrative review, we survey studies focusing on comparing biomarker differences between non-Hispanic White American(s) (NHW), African American(s) (AA), Hispanic/Latino American(s) (HLA), and Asian American(s) with normal cognition, mild cognitive impairment, and dementia. We found no strong evidence of racial and ethnic differences in imaging biomarkers after controlling for cognitive status and cardiovascular risks. For biofluid biomarkers, in AA, higher levels of plasma Aβ42/Aβ40, and lower levels of CSF total tau and p-tau 181, were observed after controlling for APOE status and comorbidities compared to NHW. Examining the impact of AD risks and comorbidities on biomarkers and their contributions to racial/ethnic differences in cognitive impairment are critical to interpreting biomarkers, understanding their generalizability, and eliminating racial/ethnic health disparities.