Relationships of Cognitive Measures with Cerebrospinal Fluid but Not Imaging Biomarkers of Alzheimer Disease Vary between Black and White Individuals

Samuele Bonomi, Ruijin Lu, Suzanne E. Schindler, Quoc Bui, James J. Lah, David Wolk, Carey E. Gleason, Reisa Sperling, Erik D. Roberson, Allan I. Levey, Leslie Shaw, Carol Van Hulle, Tammie Benzinger, Morgann Adams, Cecelia Manzanares, Deqiang Qiu, Jason Hassenstab, Krista L. Moulder, Joyce E. Balls-Berry, Keith JohnsonSterling C. Johnson, Charles F. Murchison, Jingqin Luo, Emily Gremminger, Folasade Agboola, Elizabeth A. Grant, Russ Hornbeck, Parinaz Massoumzadeh, Sarah Keefe, Donna Dierker, Julia Gray, Rachel L. Henson, Marissa Streitz, Dawn Mechanic-Hamilton, John C. Morris, Chengjie Xiong

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: Biomarkers of Alzheimer disease vary between groups of self-identified Black and White individuals in some studies. This study examined whether the relationships between biomarkers or between biomarkers and cognitive measures varied by racialized groups. Methods: Cerebrospinal fluid (CSF), amyloid positron emission tomography (PET), and magnetic resonance imaging measures were harmonized across four studies of memory and aging. Spearman correlations between biomarkers and between biomarkers and cognitive measures were calculated within each racialized group, then compared between groups by standard normal tests after Fisher's Z-transformations. Results: The harmonized dataset included at least one biomarker measurement from 495 Black and 2,600 White participants. The mean age was similar between racialized groups. However, Black participants were less likely to have cognitive impairment (28% vs 36%) and had less abnormality of some CSF biomarkers including CSF Aβ42/40, total tau, p-tau181, and neurofilament light. CSF Aβ42/40 was negatively correlated with total tau and p-tau181 in both groups, but at a smaller magnitude in Black individuals. CSF Aβ42/40, total tau, and p-tau181 had weaker correlations with cognitive measures, especially episodic memory, in Black than White participants. Correlations of amyloid measures between CSF (Aβ42/40, Aβ42) and PET imaging were also weaker in Black than White participants. Importantly, no differences based on race were found in correlations between different imaging biomarkers, or in correlations between imaging biomarkers and cognitive measures. Interpretation: Relationships between CSF biomarkers but not imaging biomarkers varied by racialized groups. Imaging biomarkers performed more consistently across racialized groups in associations with cognitive measures. ANN NEUROL 2024;95:495–506.

Original languageEnglish
Pages (from-to)495-506
Number of pages12
JournalAnnals of neurology
Issue number3
StatePublished - Mar 2024


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