NEW ORLEANS (June 24, 2025)—Education, body mass index (BMI), and hypertension play a role in the spread of tau tangles, a hallmark of Alzheimer's disease, according to longitudinal PET imaging data presented at the 2025 Society of Nuclear Medicine and Molecular Imaging Annual Meeting. For patients, timely modification of these risk factors could slow down disease progression.
In 2024, The Lancet reported that modification of 14 risk factors could prevent nearly half of all dementia cases. It was suggested that these factors may be intrinsically linked to the onset of Alzheimer's disease and could contribute to the accelerated progression of its underlying pathology.
"To further investigate the role these risk factors play in developing Alzheimer's disease, our team tested the influence of four modifiable risk factors, genetic determinants, and initial pathological burden on the spread of tau tangles," stated Merle Hoenig, PhD, postdoctoral researcher at the Juelich Research Center in Juelich, Germany.
The study included 162 amyloid-positive participants: 77 cognitively unimpaired, 55 with mild cognitive impairment, and 30 with Alzheimer's disease, all of whom had received longitudinal 18F-AV-1451 PET scans. The scans were intensity-standardized and converted to volume maps. Based on these volume maps, tau spread over time was assessed in terms of tau-speed (spatial distribution) and tau-level-rise (local amplification). Researchers tested the interactive effects between these two measures of tau spread and modifiable risk factors (BMI, education, hypertension, neuropsychiatric symptom severity), baseline amyloid or tau burden, genetic determinants, clinical stage, sex, and age.
Risk factors such as higher BMI, lower education, and severe hypertension appeared to be related to higher tau-level-rise. Genetic factors (female sex and ApoE4 carriership), on the other hand, seemed to assert their effects more on tau-speed.
"It's clear from the research that modifying these risk factors towards a healthier lifestyle can help delay Alzheimer's disease progression," said Hoenig. "Consideration of the two aspects of tau spread—tau-speed and tau-level-rise—may provide more refined means to study treatment effects of currently tested Alzheimer's disease drugs."
She continued, "Theoretically, the differential consideration of the spatial distribution and local amplification is feasible for every PET compound. This idea may also be transferable to cancer research in nuclear medicine."
Abstract 251040. "The speed limits of tau pathology progression in Alzheimer's disease," Merle Hoenig, Juelich Research Center, Juelich, Germany, and Verena Dzialas, Elena Doering, Thilo van Eimeren, and Alexander Drzezga, University of Cologne, Cologne, Germany.
