ATN classification and clinical progression in subjective cognitive decline: The SCIENCe project. (7th July 2020)

• Record Type: Journal Article
• Authors: Ebenau, Jarith L.; Timmers, Tessa; Wesselman, Linda M.P.; Verberk, Inge M.W.; Verfaillie, Sander C.J.; Slot, Rosalinde E.R.; van Harten, Argonde C.; Teunissen, Charlotte E.; Barkhof, Frederik; van den Bosch, Karlijn A.; van Leeuwenstijn, Mardou; Tomassen, Jori; Braber, Anouk den; Visser, Pieter Jelle; Prins, Niels D.; Sikkes, Sietske A.M.; Scheltens, Philip; van Berckel, Bart N.M.; van der Flier, Wiesje M.
• Is Part Of: Neurology. Volume 95:Number 1(2020)
• Publication Date: 2020-07-07
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000009724
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Objective: To investigate the relationship between the ATN classification system (amyloid, tau, neurodegeneration) and risk of dementia and cognitive decline in individuals with subjective cognitive decline (SCD). Methods: We classified 693 participants with SCD (60 ± 9 years, 41% women, Mini-Mental State Examination score 28 ± 2) from the Amsterdam Dementia Cohort and Subjective Cognitive Impairment Cohort (SCIENCe) project according to the ATN model, as determined by amyloid PET or CSF β-amyloid (A), CSF p-tau (T), and MRI-based medial temporal lobe atrophy (N). All underwent extensive neuropsychological assessment. For 342 participants, follow-up was available (3 ± 2 years). As a control population, we included 124 participants without SCD. Results: Fifty-six (n = 385) participants had normal Alzheimer disease (AD) biomarkers (A–T–N–), 27% (n = 186) had non-AD pathologic change (A–T–N+, A–T+N–, A–T+N+), 18% (n = 122) fell within the Alzheimer continuum (A+T–N–, A+T–N+, A+T+N–, A+T+N+). ATN profiles were unevenly distributed, with A–T+N+, A+T–N+, and A+T+N+ containing very few participants. Cox regression showed that compared to A–T–N–, participants in A+ profiles had a higher risk of dementia with a dose–response pattern for number of biomarkers affected. Linear mixed models showed participants in A+ profiles showed a steeper decline on tests addressing memory, attention, language, and executive functions. In the control group, there was no association between ATN and cognition. Conclusions: Among individuals presenting with SCD at a memory clinic, those with a biomarker profile A–T+N+, A+T–N–, A+T+N–, and A+T+N+ were at increased risk of dementia, and showed steeper cognitive decline compared to A–T–N– individuals. These results suggest a future where biomarker results could be used for individualized risk profiling in cognitively normal individuals presenting at a memory clinic.