Predicting future regional tau accumulation in asymptomatic and early Alzheimer’s disease

The earliest stages of Alzheimer’s disease (AD) involve interactions between multiple pathophysiological processes. Although these processes are well studied, we still lack robust tools to predict individualised trajectories of disease progression. Here, we employ a robust and interpretable machine learning approach to combine multimodal biological data and predict future tau accumulation, translating predictive information from deep phenotyping cohorts at early stages of AD to cognitively normal individuals. In particular, we use machine learning to quantify interactions between key pathological markers (β-amyloid, medial temporal atrophy, tau and APOE 4) at early and asymptomatic stages of AD. We next derive a predictive index that stratifies individuals based on future pathological tau accumulation, highlighting two critical features for optimal clinical trial design. First, future tau accumulation provides a better outcome measure compared to changes in cognition. Second, stratification based on multimodal data compared to β-amyloid alone reduces the sample size required to detect a clinically meaningful change in tau accumulation. Further, we extend our machine learning approach to derive individualised trajectories of future pathological tau accumulation in early AD patients and accurately predict regional future rate of tau accumulation in an independent sample of cognitively unimpaired individuals. Our results propose a robust approach for fine scale stratification and prognostication with translation impact for clinical trial design at asymptomatic and early stages of AD.