Ikanga Jean, Jean Kharine, Medina Priscilla, Patel Saranya Sundaram, Schwinne Megan, Epenge Emmanuel, Gikelekele Guy, Tshengele Nathan, Kavugho Immaculee, Mampunza Samuel, Mananga Lelo, Teunissen Charlotte E, Stringer Anthony, Rojas Julio C, Chan Brandon, Lago Argentina Lario, Boxer Adam L, Jeromin Andreas, Hanseeuw Bernard, Gross Alden L, Alonso Alvaro
Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA.
School of Medicine, Kinshasa, Department of Psychiatry, University of Kinshasa and Catholic University of Congo, Kinshasa, Democratic Republic of Congo.
J Alzheimers Dis. 2025 Sep;107(2):628-640. doi: 10.1177/13872877251360697. Epub 2025 Sep 1.
BackgroundHippocampal atrophy is a key feature of Alzheimer's disease (AD), but neuroimaging is often inaccessible in low-resource settings. Blood-based biomarkers such as amyloid-β (Aβ), phosphorylated tau-181 (p-tau181), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) may offer a practical alternative, though their utility in African populations remains understudied.ObjectiveThis study investigated the ability of plasma biomarkers of AD and AD-related dementias-Aβ, p-tau181, NfL, and GFAP-to predict hippocampal atrophy in older adults in Kinshasa, Democratic Republic of Congo.MethodsEighty-five adults aged over 65 (40 healthy; 45 suspected AD) were recruited. Core AD (Aβ, p-tau181) and non-specific (NfL, GFAP) biomarkers were analyzed. Hippocampal volumes were measured using MRI. Linear and logistic regressions assessed biomarker differences by age, sex, and neurological status, and predicted hippocampal atrophy.ResultsElevated p-tau181 was associated with left hippocampal (LH) atrophy (p = 0.020), with 4.2-fold increased odds [OR = 4.2 (1.5-18.4)] of LH atrophy per standard deviation increase. The areas under the curve of plasma biomarkers without clinical covariates to discriminate LH, right hippocampal (RH), and total hippocampal (TH) atrophy ranged from 90%-94%, 76%-82%, and 85%-87%, respectively. Models including clinical covariates and biomarkers improved discrimination to 94%-96% (LH), 81%-84% (RH), and 88%-90% (TH).ConclusionsConsistent with findings from other settings, core AD plasma biomarkers can effectively predict hippocampal atrophy in a Sub-Saharan African population, supporting their potential for scalable dementia screening where imaging is limited.
