Influence of ethnicity on the diagnostic accuracy of plasma p-tau217 for the identification of Alzheimer's disease: A consecutive mixed memory clinic cohort study

Abstract

Introduction: Blood-based biomarkers have demonstrated high accuracy for identifying Alzheimer's disease (AD) pathology. However, the lack of representative cohorts creates a knowledge gap regarding their real-world applicability. We examined the influence of ethnicity on the diagnostic accuracy of plasma tau phosphorylated at threonine 217 (p-tau217) in identifying AD.

Methods: A total of 1170 mixed memory clinic patients originating from 91 different countries were included. Cerebrospinal fluid or amyloid positron emission tomography supplemented the diagnostic evaluation for 539 patients. Plasma was analyzed for p-tau217.

Results: Plasma p-tau217 concentrations did not differ between ethnic groups, and there was no influence of ethnicity on the diagnostic accuracy of plasma p-tau217. Plasma p-tau217 demonstrated strong discriminative ability for AD and AD-pathology in our ethnically diverse cohort.

Discussion: Our study suggests that ethnicity does not influence the diagnostic accuracy of plasma p-tau217. Nonetheless, medical conditions influencing plasma biomarkers may disproportionally affect minoritized groups because of social determinants of health.

Highlights: Plasma tau phosphorylated at threonine 217 (p-tau217) was highly accurate in the identification of Alzheimer's disease. Geographic origin did not influence the precision of plasma p-tau217. Kidney function may influence p-tau217 concentrations. Representative inclusion in studies and trials should be a priority.

Keywords: Alzheimer's disease; amyloid pathology; blood‐based biomarkers; cerebrospinal fluid; confounders; dementia; diversity; ethnicity; phosphorylated tau; plasma biomarkers; racial groups.