Alzheimer disease (AD), with amyloid-β neuritic plaques and tau neurofibrillary tangles as hallmark pathologic changes, has diverse clinical manifestations, from typical amnesic disease to atypical variants including a behavioral and dysexecutive variant, posterior cortical atrophy (PCA), logopenic variant primary progressive aphasia (lvPPA), and corticobasal syndrome (CBS).
1 Although fibrillar amyloid plaques are necessary for a pathologic diagnosis of AD,
2 their density and distribution postmortem are weakly associated with clinical features and are not associated with markers of neurodegeneration.
3,4 This finding has been further confirmed in vivo using amyloid positron emission tomographic (PET) imaging.
5 In contrast, postmortem neurofibrillary tangles are closely linked to clinical phenotype and regional neurodegeneration in both typical
3,4 and atypical AD.
6-8 With the recent development of PET ligands specifically labeling the hyperphosphorylated paired helical filament tau pathologic condition present in AD,
9 we can now test the hypotheses regarding associations of tau localization and density with clinical features of AD in vivo.