Association of β-amyloid level, clinical progression and longitudinal cognitive change in normal older individuals.

Abstract

To determine the effect of Aβ level on progression risk to MCI or dementia and longitudinal cognitive change in cognitively normal (CN) older individuals. All CN from the Australian Imaging Biomarkers and Lifestyle study (AIBL) with Aβ PET and ≥3 years follow-up were included (n=534; age 72±6 yrs; 27% Aβ positive; follow-up 5.3±1.7 yrs). Aβ level was divided using the standardised 0-100 Centiloid scale: <15 CL negative, 15-25 CL uncertain, 26-50 CL moderate, 51-100 CL high, >100 CL very high, noting >25 CL approximates a positive scan. Cox proportional hazards analysis and linear mixed effect models were used to assess risk of progression and cognitive decline. Aβ levels in 63% were negative, 10% uncertain, 10% moderate, 14% high and 3% very high. Fifty-seven (11%) progressed to MCI or dementia. Compared to negative Aβ, the hazard ratio for progression for moderate Aβ was 3.2 (95% CI 1.3-7.6; p<0.05), for high was 7.0 (95% CI 3.7-13.3; p<0.001) and for very high was 11.4 (95% CI 5.1-25.8; p<0.001). Decline in cognitive composite score was minimal in the moderate group (-0.02 SD/year, p=0.05) while the high and very high declined substantially (high -0.08 SD/year, p<0.001; very high -0.35 SD/year p<0.001). The risk of MCI or dementia over 5 years in older CN is related to Aβ level on PET, 5% if negative vs 25% if positive but ranging from 12% if 26-50 CL to 28% if 51-100 CL and 50% if >100 CL. This information may be useful for dementia risk counselling and aid design of preclinical AD trials.