Comparison of CSF phosphorylated tau 181 and 217 for cognitive decline

Michelle M. Mielke, Jeremiah A. Aakre, Alicia Algeciras-Schimnich, Nicholas K. Proctor, Mary M. Machulda, Udo Eichenlaub, David S. Knopman, Prashanthi Vemuri, Jonathan Graff-Radford, Clifford R. Jack, Ronald C. Petersen, Jeffrey L. Dage

Research output: Contribution to journalArticlepeer-review


Introduction: The prognostic utility of cerebrospinal fluid (CSF) phosphorylated tau 217 (p-tau217) and p-tau181 is not understood. Methods: Analyses included 753 Mayo Clinic Study on Aging participants (median age = 71.6; 57% male). CSF amyloid beta (Aβ)42 and p-tau181 were measured with Elecsys immunoassays. CSF p-tau181 and p-tau217 were also measured with Meso Scale Discovery (MSD). We used Cox proportional hazards models for risk of mild cognitive impairment (MCI) and linear mixed models for risk of global and domain-specific cognitive decline and cortical thickness. Analyses were stratified by elevated brain amyloid based on CSF Aβ42 or amyloid positron emission tomography for those with imaging. Results: CSF p-tau217 was superior to p-tau181 for the diagnosis of Alzheimer's disease (AD) pathology. CSF MSD p-tau181 and p-tau217 were associated with risk of MCI among amyloid-positive individuals. Differences between CSF p-tau measures predicting cortical thickness were subtle. Discussion: There are subtle differences for CSF p-tau217 and p-tau181 as prognostic AD markers.

Original languageEnglish (US)
Pages (from-to)602-611
Number of pages10
JournalAlzheimer's and Dementia
Issue number4
StatePublished - Apr 2022


  • biomarker
  • cerebrospinal fluid
  • cognitive decline
  • dementia
  • mild cognitive impairment
  • phosphorylated tau
  • prognosis

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Developmental Neuroscience
  • Clinical Neurology
  • Geriatrics and Gerontology
  • Cellular and Molecular Neuroscience
  • Psychiatry and Mental health


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