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Assessing Cognitive Decline and Dementia Risk in Black and White Older Adults With Blood Biomarkers pTau217, GFAP, NfL, and Aβ Ratio
Capuano AW, Bennett DA, Dage JL, Russ KA, Arfanakis K, Lamar M, Barnes LL, Schneider JA. Neurology, 2025-10-28
Topic: Amyloid, tau and blood-test diagnosis
Background and objectives Alzheimer disease blood-based biomarkers are a cost-effective method for early detection. Few studies provide long-term follow-up of cognition in Black participants. We assessed biomarker association with cognitive decline and dementia risk in Black and White participants. Methods Plasma biomarkers (neurofilament light chain, glial fibrillary acidic protein [GFAP], amyloid-β 42/40 ratio, phosphorylated tau at threonine 217 [pTau217]) were measured in participants from a community-based Chicago cohort without dementia at the time of blood draw. They were evaluated annually for up to 15 years for cognition and dementia. Data included medical history, blood tests (e.g., kidney function), Mini-Mental State Examination (MMSE) score, and APOEε4. Associations of biomarkers with comorbidities, cognitive decline, and risk of dementia were examined within racial groups. To examine racial differences, we repeated the analysis using a Mahalanobis-balanced 1:1 match on biological sex, age, education, Latino/non-Latino status, longitudinal data availability, and clinical status (hypertension, diabetes, glomerular filtration rate, body mass index [BMI], and heart disease). Results Biomarkers were measured in 431 Black and 583 White participants (mean age of 77 and 80 years and 17% and 21% of men, respectively), generating a balanced sample of 366:366. Biomarker levels were similar across races. Within racial groups, the associations of biomarkers with multiple comorbidities (especially kidney dysfunction and BMI) remained after controlling for demographics, APOEε4 status, and dementia or death within 5 years. Men had lower GFAP than women (all p p p = 0.018) and semantic memory (β = -0.068, SE = 0.016, p 3-year, Black 0.81, 95% CI 0.74-0.89; AUC 3-year, White 0.77, 95% CI 0.71-0.83) was good relative to age (AUC 3-year, Black 0.69, 95% CI 0.58-0.79; AUC 3-year, White 0.68, 95% CI 0.62-0.75) and MMSE score (AUC 3-year, Black 0.81, 95% CI 0.74-0.89; AUC 3-year, White 0.72, 95% CI 0.65-0.80). The discrimination by pTau217 did not improve when adding other biomarkers or MMSE score. Discussion pTau217 was highly associated with dementia risk and cognitive decline. The association of biomarkers with cognitive decline in Black and White participants was similar. Higher pTau217 was, however, associated with global and semantic memory decline in Black adults. Generalizability is a limitation.
Key findings
- Results Biomarkers were measured in 431 Black and 583 White participants (mean age of 77 and 80 years and 17% and 21% of men, respectively), generating a balanced sample of 366:366.
- Discussion pTau217 was highly associated with dementia risk and cognitive decline.
- Higher pTau217 was, however, associated with global and semantic memory decline in Black adults.
Why it matters
In Black and White older adults, plasma pTau217 was strongly linked to dementia risk and cognitive decline. This is a biomarker study for detection and risk assessment, not a treatment or cure.
New to this subject? Start with our plain-English guide: Blood tests & biomarkers →
Study details
- Study designcohort
- Participants1,014
- Effect size3-year dementia AUC 0.81 (Black) and 0.77 (White) for pTau217; semantic memory decline beta = -0.068 in Black adults
- Evidence strengthModerate
Limitations
Participants were highly educated, many with a religious lifestyle, and few were men; social drivers of health were not explored, and the authors note race is a social construct so biological and social determinants may interact in ways the study could not address. Generalisability is stated as a limitation.
How this study scored 66/100
Published in a leading specialty journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it. We have no data on free to read, so that was left out: it earned 65 of the 98 points we could judge it on, which is 66 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Neurology) |
| Journal's citation record | 4 / 4 | Neurology: journal h-index 525 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,014 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 7 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 4.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 1 / 4 | Cited 7 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Julie A. Schneider: h-index 151 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | Harvard University: institution h-index 3,235 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41151002) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 65 / 98 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 65 of the 98 points we could judge it on is 66 out of 100. |
| Total | 66 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1212/WNL.0000000000214317
- PubMed: 41151002
- Original source →
- Free full text: PubMed Central →
Full text: free to read — PubMed Central lists this copy as free to read: the link above (checked 10 Oct 2026).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Capuano, A. W., Bennett, D. A., Dage, J. L., Russ, K. A., Arfanakis, K., Lamar, M., et al. (2025). Assessing Cognitive Decline and Dementia Risk in Black and White Older Adults With Blood Biomarkers pTau217, GFAP, NfL, and Aβ Ratio. Neurology. https://doi.org/10.1212/WNL.0000000000214317
Vancouver
Capuano AW, Bennett DA, Dage JL, Russ KA, Arfanakis K, Lamar M, et al. Assessing Cognitive Decline and Dementia Risk in Black and White Older Adults With Blood Biomarkers pTau217, GFAP, NfL, and Aβ Ratio. Neurology. 2025. doi:10.1212/WNL.0000000000214317. PMID: 41151002.
BibTeX
@article{capuano2025-41151002,
author = {Capuano, A. W. and Bennett, D. A. and Dage, J. L. and Russ, K. A. and Arfanakis, K. and Lamar, M. and Barnes, L. L. and Schneider, J. A.},
title = {{Assessing Cognitive Decline and Dementia Risk in Black and White Older Adults With Blood Biomarkers pTau217, GFAP, NfL, and Aβ Ratio}},
journal = {Neurology},
year = {2025},
doi = {10.1212/WNL.0000000000214317},
pmid = {41151002},
url = {https://doi.org/10.1212/WNL.0000000000214317}
}
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