Clinical Evaluation of the Revised Biological and Clinical Staging Criteria for Alzheimer Disease in China - PubMed

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The study evaluated the 2024 revised criteria for staging Alzheimer disease (AD) in a Chinese cohort from a tertiary memory clinic, including 1,214 participants with amyloid-PET and tau-PET imaging.
Among 818 amyloid-positive participants, 50.4% were typical (concordant clinical and biological stages), 40.3% were susceptible (clinical stage > biological stage), and 9.3% were resilient (clinical stage < biological stage).
Plasma p-tau217 levels increased progressively with advancing tau PET stages, showing significant differences between stages and supporting its use as a blood-based marker for tau pathology severity.
Resilient individuals had better cognitive performance (e.g., higher MMSE scores), higher education, and greater cortical thickness and volume in AD-signature regions compared to typical individuals.
Susceptible individuals showed poorer cognitive scores, reduced cortical thickness and volume in AD-signature regions, and a higher burden of vascular risk factors.
The findings indicate that clinical-biological stage discordance is common in amyloid-positive individuals and support the clinical relevance of the revised AD staging framework for informing diagnostic guidelines.

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