09/10/2026
A neuropathological validation study in Acta Neuropathologica examined how well fluid biomarkers track actual brain pathology. In 250 autopsy-confirmed participants with ante-mortem cerebrospinal fluid (n = 230) or plasma (n = 101), sampled a median of 1.5 and 1 month before death, CSF Aβ42/Aβ40 fell as early as the second quartile of amyloid burden and reached an AUC of 0.984 at low-to-intermediate amyloid load, while CSF p-tau181 and p-tau217 rose only from the third quartile. Plasma p-tau217 and p-tau217/Aβ42 increased only in the highest burden quartiles (AUCs 0.893 to 0.928). The results indicate current fluid markers do not capture the earliest phase of amyloid deposition. https://doi.org/10.1007/s00401-026-03076-5