Association of CSF GAP-43 With the Rate of Cognitive Decline and Progression to Dementia in Amyloid-Positive Individuals.

• To test the associations between the presynaptic growth-associated protein 43 (GAP-43) protein, quantified in cerebrospinal fluid (CSF), and biomarkers of Alzheimer's disease (AD) pathophysiology, cross-sectionally and longitudinally.In this retrospective study, GAP-43 was measured in participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort using an in-house ELISA method, and levels were compared between groups, both cross-sectionally and longitudinally. Linear regression models tested the associations between biomarkers of AD (Aβ and tau pathologies, neurodegeneration and cognition) adjusted by age, sex and diagnosis. Linear mixed effect models (LME) evaluated how baseline GAP-43 predicts brain hypometabolism, atrophy and cognitive decline over time. Cox-proportional hazard regression models tested how GAP-43 levels and Aβ status, at baseline, increased the risk of progression to AD dementia over time.This study included 786 participants from the ADNI cohort, which were further classified in cognitively unimpaired (CU) Aβ-negative (nCU-=197); CU Aβ-positive (nCU+=55), mild cognitively impaired (MCI) Aβ-negative (nMCI-=228), MCI Aβ-positive (nMCI+=193) and AD dementia Aβ-positive (nAD=113). CSF GAP-43 levels were increased in Aβ-positive compared to Aβ-negative participants, independent of the cognitive status. In Aβ-positive participants, high baseline GAP-43 levels led to worse brain metabolic decline (P=0.01), worse brain atrophy (P=8.8x10-27) as well as worse MMSE scores (P= 0.03) over time, as compared to those with low GAP-43 levels. Similarly, Aβ-positive participants with high baseline GAP-43 had the highest risk to convert to AD dementia (hazard ratio [HR=8.56, 95% CI, 4.94-14.80, P=1.5x10-14]). Despite the significant association with Aβ pathology (η 2 Aβ PET=0.09, P Aβ PET<0.001), CSF tTau and P-Tau had a larger effect size on GAP43 than had Aβ PET (η 2 pTau-181=0.53, P pTau-181<0.001; η 2 tTau=0.59, P tTau<0.001).and Classification of Evidence: This study provides Class III classification of evidence that high baseline levels of CSF GAP-43 are associated to progression in Aβ-positive individuals, with a more aggressive neurodegenerative process, faster rate of cognitive decline and increased risk of converting to dementia.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Medicinska och farmaceutiska grundvetenskaper -- Neurovetenskaper (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Basic Medicine -- Neurosciences (hsv//eng)

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