Cerebrospinal fluid p-tau217 performs better than p-tau181 as a biomarker of Alzheimer's disease

Nat Commun. 2020 Apr 3;11(1):1683. doi: 10.1038/s41467-020-15436-0.


Cerebrospinal fluid (CSF) p-tau181 (tau phosphorylated at threonine 181) is an established biomarker of Alzheimer's disease (AD), reflecting abnormal tau metabolism in the brain. Here we investigate the performance of CSF p-tau217 as a biomarker of AD in comparison to p-tau181. In the Swedish BioFINDER cohort (n = 194), p-tau217 shows stronger correlations with the tau positron emission tomography (PET) tracer [18F]flortaucipir, and more accurately identifies individuals with abnormally increased [18F]flortaucipir retention. Furthermore, longitudinal increases in p-tau217 are higher compared to p-tau181 and better correlate with [18F]flortaucipir uptake. P-tau217 correlates better than p-tau181 with CSF and PET measures of neocortical amyloid-β burden and more accurately distinguishes AD dementia from non-AD neurodegenerative disorders. Higher correlations between p-tau217 and [18F]flortaucipir are corroborated in an independent EXPEDITION3 trial cohort (n = 32). The main results are validated using a different p-tau217 immunoassay. These findings suggest that p-tau217 might be more useful than p-tau181 in the diagnostic work up of AD.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / cerebrospinal fluid
  • Alzheimer Disease / diagnosis*
  • Biomarkers / cerebrospinal fluid
  • Brain / diagnostic imaging
  • Carbolines / administration & dosage
  • Contrast Media / administration & dosage
  • Diagnosis, Differential
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Phosphorylation
  • Positron-Emission Tomography
  • Sweden
  • tau Proteins / cerebrospinal fluid*
  • tau Proteins / metabolism


  • Biomarkers
  • Carbolines
  • Contrast Media
  • tau Proteins
  • 7-(6-fluoropyridin-3-yl)-5H-pyrido(4,3-b)indole