• Min Young Chun, Hyemin Jang, Soo-Jong Kim, Yu Hyun Park, Jihwan Yun, Samuel N Lockhart, Michael Weiner, Charles De Carli, Seung Hwan Moon, Jae Yong Choi, Kyung Rok Nam, Byung-Hyun Byun, Sang-Moo Lim, Jun Pyo Kim, Yeong Sim Choe, Young Ju Kim, Duk L Na, Hee Jin Kim, and Sang Won Seo.
• Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea.
• J. Neurol. Neurosurg. Psychiatr. 2023 Dec 14; 95 (1): 445144-51.

ObjectivesAlzheimer's disease (AD) is characterised by amyloid-beta accumulation (A), tau aggregation (T) and neurodegeneration (N). Vascular (V) burden has been found concomitantly with AD pathology and has synergistic effects on cognitive decline with AD biomarkers. We determined whether cognitive trajectories of AT(N) categories differed according to vascular (V) burden.MethodsWe prospectively recruited 205 participants and classified them into groups based on the AT(N) system using neuroimaging markers. Abnormal V markers were identified based on the presence of severe white matter hyperintensities.ResultsIn A+ category, compared with the frequency of Alzheimer's pathological change category (A+T-), the frequency of AD category (A+T+) was significantly lower in V+ group (31.8%) than in V- group (64.4%) (p=0.004). Each AT(N) biomarker was predictive of cognitive decline in the V+ group as well as in the V- group (p<0.001). Additionally, the V+ group showed more severe cognitive trajectories than the V- group in the non-Alzheimer's pathological changes (A-T+, A-N+; p=0.002) and Alzheimer's pathological changes (p<0.001) categories.ConclusionThe distribution and longitudinal outcomes of AT(N) system differed according to vascular burdens, suggesting the importance of incorporating a V biomarker into the AT(N) system.© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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