NfL is a better marker for neurodegeneration than T-tau

Presented by

Mr Jordan Marks, Mayo Clinic, MN, USA

Conference

AAN 2021

Compared with plasma total tau (T-tau), elevated neurofilament light chain (NfL) plasma level is a better prognostic biomarker, more strongly associated over time with cognitive decline and neuroimaging changes. This was the conclusion of a study comparing both biomarkers cross-sectionally and longitudinally. T-tau adds cross-sectional value to NfL with the combination being useful in diagnostic settings.

Plasma T-tau and NfL were directly compared in a study to better establish which marker can best be applied in which clinical trials and to evaluate their utility in the diagnosis and prognosis of cognitive decline in daily clinical practice [1]. Included were 995 participants without dementia at baseline of whom plasma NfL and T‐tau, cognitive status, and neuroimaging data were available. For a median 6.2 years, follow up was performed approximately every 15 months. The study results were presented by Mr Jordan Marks (Mayo Clinic, MN, USA).

Elevated baseline plasma NfL levels were more strongly associated with cognitive and neuroimaging outcomes than plasma T-tau in all analyses: cross-sectional and longitudinal, global- and domain-specific, both for cognitive degeneration and neuroimaging outcomes. Cross-sectional differences between both biomarkers were small, whereas the longitudinal differences were more pronounced. Over time, baseline NfL levels were strongly associated with cognitive decline, decreasing cortical thickness and hippocampal volume, and an increased number of infarcts. On the other hand, the combination of NfL and T-tau levels in the top quartile at baseline was associated with lower memory and global cognitive z-scores, decreased temporal lobe thickness, and a higher number of infarcts.

Mr Marks concluded that plasma NfL may be a useful marker of neurodegenerative changes and has a prognostic value, whereas the combination of NfL and T-tau may be useful in a diagnostic setting. The replicability of these findings across community-based and clinical cohorts lends further credibility to their feasibility in clinical practice.

Marks J, et al. Comparison of Neurofilament Light and Total Tau as Blood-Based Biomarkers of Neurodegeneration: Associations with Cognition and Neuroimaging Outcomes. ES.001, AAN 2021 Virtual Congress, 17-22 April.

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