Clinical Scorecard: Linking Blood Neurodegenerative Biomarkers to Cognitive Abilities and Dementia in Older Adults: Insights from India (LASI-DAD) and the United States (HRS)

At a Glance

Key Highlights

• Higher GFAP and NfL levels are associated with worse cognitive function and increased dementia risk in both Indian and US older adults.
• The Aβ42/Aβ40 ratio shows divergent associations: higher ratio linked to worse cognition and dementia in US, but better cognition in Indian population.
• pTau181 generally shows no significant association with cognitive functioning in either country.

Guideline-Based Recommendations

Diagnosis

• Utilize blood-based biomarkers (Aβ42/Aβ40 ratio, GFAP, NfL) as practical tools for early detection of cognitive impairment and dementia.
• Consider cross-national differences in biomarker associations when interpreting results.

Management

• Incorporate blood biomarker testing to monitor neurodegenerative progression and potentially guide treatment decisions.
• Use blood-based biomarkers to complement existing diagnostic modalities, reducing reliance on costly PET scans and CSF analysis.

Monitoring & Follow-up

• Regularly assess GFAP and NfL levels to track cognitive decline and dementia progression, especially in US populations.
• Recognize that biomarker trajectories may differ by population; monitor accordingly.

Risks

• Interpret biomarker levels cautiously due to potential variability influenced by environmental, social, and economic factors.
• Avoid overreliance on pTau181 alone given its limited association with cognitive outcomes in studied populations.

Patient & Prescribing Data

Older adults from diverse socio-economic and environmental backgrounds in India and the United States

Blood-based neurodegenerative biomarkers offer a less invasive, cost-effective method for early detection and monitoring of dementia, facilitating timely intervention and potentially improving outcomes.

Clinical Best Practices

• Employ validated, sensitive blood assays for neurodegenerative biomarkers to ensure reliable cross-population comparisons.
• Integrate biomarker data with clinical and cognitive assessments for comprehensive evaluation.
• Consider environmental and socio-cultural factors that may modify biomarker-cognition relationships when applying findings clinically.

References

• Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD)
• Health and Retirement Study (HRS)