Assessment of Racial Disparities in Biomarkers for Alzheimer Disease
Morris JC, Schindler SE, McCue LM, Moulder KL, Benzinger TLS, Cruchaga C, Fagan AM, Grant E et al.. JAMA neurology, 2019-03-01
Topic: Amyloid, tau and blood-test diagnosis
Results Of the 1255 participants (707 women and 548 men; mean [SD] age, 70.8 [9.9] years), 116 of 173 African American participants (67.1%) and 724 of 1082 non-Hispanic white participants (66.9%) had normal cognition. There were no racial differences in the frequency of cerebral ischemic lesions noted on results of brain magnetic resonance imaging, mean cortical standardized uptake value ratios for Pittsburgh compound B, or for amyloid-β42 concentrations in CSF. Mean (SE) CSF concentrations of total tau were lower in African American participants than in white participants (293.65 [34.61] vs 443.28 [18.20] pg/mL; P Conclusions and relevance The results of this study suggest that analyses of molecular biomarkers of Alzheimer disease should adjust for race. The lower CSF concentrations of total tau and phosphorylated tau181 in African American individuals appear to reflect a significant race by APOE ε4 interaction, suggesting a differential effect of this Alzheimer risk variant in African American individuals compared with white individuals.
Key findings
- Results Of the 1255 participants (707 women and 548 men; mean [SD] age, 70.8 [9.9] years), 116 of 173 African American participants (67.1%) and 724 of 1082 non-Hispanic white participants (66.9%) had normal cognition.
- There were no racial differences in the frequency of cerebral ischemic lesions noted on results of brain magnetic resonance imaging, mean cortical standardized uptake value ratios for Pittsburgh compound B, or for amyloid-β42 concentrations in CSF.
- Mean (SE) CSF concentrations of total tau were lower in African American participants than in white participants (293.65 [34.61] vs 443.28 [18.20] pg/mL; P Conclusions and relevance The results of this study suggest that analyses of molecular biomarkers of Alzheimer disease should adjust for race.
- The lower CSF concentrations of total tau and phosphorylated tau181 in African American individuals appear to reflect a significant race by APOE ε4 interaction, suggesting a differential effect of this Alzheimer risk variant in African American individuals compared with white individuals.
Why it matters
In 1,255 older adults (173 African American, 1,082 non-Hispanic white), amyloid on PET scans, amyloid-β42 in spinal fluid and ischaemic lesions on MRI showed no racial differences, but spinal-fluid total tau was lower in African American participants (mean 293.65 vs 443.28 pg/mL), as was phosphorylated tau181. The authors say this tau gap "appear[s] to reflect" a race-by-APOE ε4 interaction and recommend that biomarker analyses adjust for race. It is an observational comparison with a much smaller African American group, and it does not show that tau test values should be read differently for individual patients.
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Study details
- Study designcross-sectional
- Participants1,255
- Effect size67.1%; 66.9%
- Evidence strengthModerate
How this study scored 67/100
Published in a leading specialty journal, and it is a snapshot of people at one point in time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (JAMA neurology) |
| Journal's citation record | 2 / 4 | JAMA Neurology: journal h-index 235 (OpenAlex, 2026-10-29) |
| Study design | 4 / 12 | A snapshot of people at one point in 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 | 2 / 5 | 2019 — within 10 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,255 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| 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 | 6 / 7 | Cited 372 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 41.3 citations a year over 9 year(s) since 2019 |
| Impact for its field and year | 5 / 6 | Cited 30.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 53 other studies in this library |
| Still being cited | 3 / 4 | Cited 148 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Chengjie Xiong: h-index 60 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Washington University in St. Louis: institution h-index 1,962 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 30615028) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 67 / 100 | — |
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Read the original
- DOI: 10.1001/jamaneurol.2018.4249
- PubMed: 30615028
- 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's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Morris, J. C., Schindler, S. E., McCue, L. M., Moulder, K. L., Benzinger, T. L. S., Cruchaga, C., et al. (2019). Assessment of Racial Disparities in Biomarkers for Alzheimer Disease. JAMA neurology. https://doi.org/10.1001/jamaneurol.2018.4249
Vancouver
Morris JC, Schindler SE, McCue LM, Moulder KL, Benzinger TLS, Cruchaga C, et al. Assessment of Racial Disparities in Biomarkers for Alzheimer Disease. JAMA neurology. 2019. doi:10.1001/jamaneurol.2018.4249. PMID: 30615028.
BibTeX
@article{morris2019-30615028,
author = {Morris, J. C. and Schindler, S. E. and McCue, L. M. and Moulder, K. L. and Benzinger, T. L. S. and Cruchaga, C. and Fagan, A. M. and Grant, E. and others},
title = {{Assessment of Racial Disparities in Biomarkers for Alzheimer Disease}},
journal = {JAMA neurology},
year = {2019},
doi = {10.1001/jamaneurol.2018.4249},
pmid = {30615028},
url = {https://doi.org/10.1001/jamaneurol.2018.4249}
}
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