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Detailed comparison of amyloid PET and CSF biomarkers for identifying early Alzheimer disease
Palmqvist S, Zetterberg H, Mattsson N, Johansson P, Alzheimer's Disease Neuroimaging Initiative, Minthon L, Blennow K, Olsson M et al.. Neurology, 2015-09-09
Topic: Amyloid, tau and blood-test diagnosis
Objective To compare the diagnostic accuracy of CSF biomarkers and amyloid PET for diagnosing early-stage Alzheimer disease (AD). Methods From the prospective, longitudinal BioFINDER study, we included 122 healthy elderly and 34 patients with mild cognitive impairment who developed AD dementia within 3 years (MCI-AD). β-Amyloid (Aβ) deposition in 9 brain regions was examined with [18F]-flutemetamol PET. CSF was analyzed with INNOTEST and EUROIMMUN ELISAs. The results were replicated in 146 controls and 64 patients with MCI-AD from the Alzheimer's Disease Neuroimaging Initiative study. Results The best CSF measures for identifying MCI-AD were Aβ42/total tau (t-tau) and Aβ42/hyperphosphorylated tau (p-tau) (area under the curve [AUC] 0.93-0.94). The best PET measures performed similarly (AUC 0.92-0.93; anterior cingulate, posterior cingulate/precuneus, and global neocortical uptake). CSF Aβ42/t-tau and Aβ42/p-tau performed better than CSF Aβ42 and Aβ42/40 (AUC difference 0.03-0.12, p Conclusions Amyloid PET and CSF biomarkers can identify early AD with high accuracy. There were no differences between the best CSF and PET measures and no improvement when combining them. Regional PET measures were not better than assessing the global Aβ deposition. The results were replicated in an independent cohort using another CSF assay and PET tracer. The choice between CSF and amyloid PET biomarkers for identifying early AD can be based on availability, costs, and doctor/patient preferences since both have equally high diagnostic accuracy. Classification of evidence This study provides Class III evidence that amyloid PET and CSF biomarkers identify early-stage AD equally accurately.
Key findings
- The results were replicated in 146 controls and 64 patients with MCI-AD from the Alzheimer's Disease Neuroimaging Initiative study.
- Results The best CSF measures for identifying MCI-AD were Aβ42/total tau (t-tau) and Aβ42/hyperphosphorylated tau (p-tau) (area under the curve [AUC] 0.93-0.94).
- The results were replicated in an independent cohort using another CSF assay and PET tracer.
Why it matters
In people with mild cognitive impairment who went on to develop Alzheimer's dementia within 3 years, the best spinal-fluid (CSF) measures (Aβ42 divided by total or phosphorylated tau, AUC 0.93–0.94) and amyloid PET (AUC 0.92–0.93) separated them from healthy older adults about equally well; combining the two did not help, and a whole-brain PET reading was as good as regional ones. The findings held in a second cohort using a different assay and tracer, and the authors conclude the choice between CSF and PET "can be based on availability, costs, and doctor/patient preferences". This is a diagnostic comparison that the authors grade as Class III evidence; it says nothing about treatment or prevention, and it was not tested as a screen for people without symptoms.
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Study details
- Study designlongitudinal study
- Participants122
- Effect sizeAUC 0.92-0.93
- Evidence strengthModerate
How this study scored 72/100
Published in a leading specialty journal, and it is a longitudinal study following the same people over time. Scored zero for randomised / blinded because the record does not state it. We have no data on institution's track record, so that was left out: it earned 70 of the 97 points we could judge it on, which is 72 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 longitudinal study following the same 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 | 1 / 5 | 2015 — within 20 year(s) of the newest study here |
| Sample size | 2 / 4 | 122 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 | 6 / 7 | Cited 376 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 28.9 citations a year over 13 year(s) since 2015 |
| Impact for its field and year | 5 / 6 | Cited 22.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 42 other studies in this library |
| Still being cited | 3 / 4 | Cited 110 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Susan E. Molchan: h-index 43 (OpenAlex, whole career) |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 0 institution(s) in 0 countries — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 26354982) |
| Free to read | 2 / 2 | Free to read |
| Points | 70 / 97 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 70 of the 97 points we could judge it on is 72 out of 100. |
| Total | 72 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1212/wnl.0000000000001991
- PubMed: 26354982
- 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
Palmqvist, S., Zetterberg, H., Mattsson, N., Johansson, P., Alzheimer's Disease Neuroimaging Initiative, Minthon, L., et al. (2015). Detailed comparison of amyloid PET and CSF biomarkers for identifying early Alzheimer disease. Neurology. https://doi.org/10.1212/wnl.0000000000001991
Vancouver
Palmqvist S, Zetterberg H, Mattsson N, Johansson P, Alzheimer's Disease Neuroimaging Initiative, Minthon L, et al. Detailed comparison of amyloid PET and CSF biomarkers for identifying early Alzheimer disease. Neurology. 2015. doi:10.1212/wnl.0000000000001991. PMID: 26354982.
BibTeX
@article{palmqvist2015-26354982,
author = {Palmqvist, S. and Zetterberg, H. and Mattsson, N. and Johansson, P. and {Alzheimer's Disease Neuroimaging Initiative} and Minthon, L. and Blennow, K. and Olsson, M. and others},
title = {{Detailed comparison of amyloid PET and CSF biomarkers for identifying early Alzheimer disease}},
journal = {Neurology},
year = {2015},
doi = {10.1212/wnl.0000000000001991},
pmid = {26354982},
url = {https://doi.org/10.1212/wnl.0000000000001991}
}
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