. Racial Disparity in Cerebrospinal Fluid Amyloid and Tau Biomarkers and Associated Cutoffs for Mild Cognitive Impairment. JAMA Netw Open. 2019 Dec 2;2(12):e1917363. PubMed.


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  1. I was pleased to see that the Emory ADRC’s Brain Stress Hypertension and Aging Research Program (B-SHARP) apparently was able to obtain CSF from 152 African Americans. If all 152 indeed contributed CSF, then this is the largest such sample of African American research volunteers with CSF. Hence, the authors’ replication of lower CSF levels of t-tau and p-tau help to strengthen the findings reported earlier by Howell et al. in William Hu’s group and by our Knight ADRC (Howell et al., 2017; Morris et al., 2019).

    The major concern I have with this paper is that it does not include APOE4 status in the analyses, whereas we reported that the lower CSF t-tau and p-tau values in African Americans could be mediated by this variable. It would be informative to know whether Garrett et al. could or could not replicate this finding. 

    Another concern is that, while the authors explored the relationship of their findings with cardiovascular risk factors such as Type 2 diabetes and hypertension, they did not document cerebrovascular disease, which would be readily examined from the brain MRIs to determine whether such findings were associated with their results. As shown in Table 1, rates of these cardiovascular factors were significantly higher among the African American participants, suggesting that cerebrovascular disease could have contributed both to their cognitive impairment and to their higher CSF Aβ42 values.


    . Race modifies the relationship between cognition and Alzheimer's disease cerebrospinal fluid biomarkers. Alzheimers Res Ther. 2017 Nov 2;9(1):88. PubMed.

    . Assessment of Racial Disparities in Biomarkers for Alzheimer Disease. JAMA Neurol. 2019 Jan 7; PubMed.

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