286094 20260413131505.0 10.1016/j.tjpad.2026.100544 doi pmid:41905188 pmid pmc:PMC13054424 pmc 2274-5807 ISSN 2426-0266 ISSN DZNE-2026-00390 English 610 Cetindag, Arda C 0 Plasma GFAP outperforms CSF GFAP in detecting amyloid pathology and is associated with increased risk of clinical progression in early Alzheimer's disease. [Paris] 2026 Elsevier Masson SAS article DRIVER Output Types/Journal article DataCite Journal Article journal journal PUB:(DE-HGF)16 1776078471_32195 PUB:(DE-HGF) ARTICLE BibTeX JOURNAL_ARTICLE ORCID Journal Article 0 EndNote Early and accurate detection of Alzheimer's disease (AD) is essential for timely intervention and development of disease-modifying treatments. The DZNE-Longitudinal Cognitive Impairment and Dementia Study (DELCODE) provides a deeply phenotyped cohort covering preclinical and early clinical stages, including subjective cognitive decline (SCD) and mild cognitive impairment (MCI). Astrocyte reactivity and its biomarkers, particularly glial fibrillary acidic protein (GFAP), have gained increasing attention in AD research; however, the relationship between GFAP and amyloid in early disease, as well as its potential prognostic value beyond its association with amyloid status, remains insufficiently understood.To evaluate the performance of CSF and plasma GFAP across early disease stages, compare these measures according to amyloid status, and assess the prognostic value of GFAP for clinical progression across diagnostic stages during longitudinal follow-up.This study used data from the multicenter DELCODE cohort in Germany, including participants with available plasma and/or CSF samples and standardized clinical, cognitive, imaging, and biomarker assessments.GFAP concentrations in plasma and CSF were quantified using validated immunoassay platforms. Standard CSF AD biomarkers and ApoE genotype were measured using established assays. Amyloid status was defined by the CSF Aβ42/40 ratio. Longitudinal follow-up occurred annually for up to ∼10 years, with clinical conversion determined according to NIA-AA criteria.Plasma and CSF GFAP increased across the AD continuum, with higher levels in MCI and AD (p < 0.001). Plasma GFAP showed a stronger association with amyloid status than CSF GFAP across all groups. In MCI, plasma GFAP combined with age and ApoE4 yielded an AUC of 0.87. Elevated plasma GFAP predicted increased risk of conversion to MCI (HR = 2.19, p < 0.001; adjusted HR = 1.70, p = 0.0056) and AD dementia (HR = 3.5; adjusted HR = 2.49 both p < 0.001).Plasma GFAP is a sensitive, minimally invasive biomarker with diagnostic relevance for amyloid detection and prognostic relevance for clinical progression in early AD. 353 - Clinical and Health Care Research (POF4-353) G:(DE-HGF)POF4-353 POF4-353 POF IV 0 Dataset connected to CrossRef, PubMed, , Journals: pub.dzne.de Alzheimer’s disease Other Blood biomarkers of Alzheimer’s disease Other Cerebrospinal fluid (CSF) Other Glial fibrillary acidic protein (GFAP) Other Mild cognitive impairment Other Subjective memory decline Other Schipke, Carola G 1 Esselmann, Hermann 2 Kruse, Niels 3 Wiltfang, Jens P:(DE-2719)2811317 4 dzne Schneider, Anja P:(DE-2719)2812035 5 dzne Fliessbach, Klaus P:(DE-2719)2811326 6 dzne Miklitz, Carolin P:(DE-2719)2810438 7 dzne Maier, Franziska 8 Buerger, Katharina P:(DE-2719)2811351 9 dzne Janowitz, Daniel P:(DE-2719)9002557 10 dzne Ewers, Michael P:(DE-2719)9000543 11 Stöcklein, Sophia P:(DE-2719)9003671 12 dzne Perneczky, Robert P:(DE-2719)2812234 13 dzne Rauchmann, Boris Stephan P:(DE-2719)9001808 14 dzne Kurz, Carolin 15 Teipel, Stefan P:(DE-2719)2000026 16 dzne Kilimann, Ingo P:(DE-2719)2810394 17 dzne Goerss, Doreen P:(DE-2719)2812583 18 dzne Laske, Christoph P:(DE-2719)2000055 19 dzne Sodenkamp, Sebastian P:(DE-2719)9003152 20 dzne Najafpour, Elham P:(DE-2719)9003689 21 dzne Wagner, Michael P:(DE-2719)2000057 22 dzne Roeske, Sandra P:(DE-2719)2810395 23 dzne Frommann, Ingo P:(DE-2719)2810481 24 dzne Stark, Melina P:(DE-2719)9001773 25 dzne Brosseron, Frederic P:(DE-2719)2810593 26 dzne Ramirez, Alfredo P:(DE-2719)2812825 27 dzne Kleineidam, Luca P:(DE-2719)2812139 28 dzne Priller, Josef P:(DE-2719)2811122 29 dzne Spruth, Eike Jakob P:(DE-2719)2812446 30 dzne Gemenetzi, Maria P:(DE-2719)9002025 31 dzne Altenstein, Slawek P:(DE-2719)2811720 32 dzne Düzel, Emrah P:(DE-2719)2000005 33 dzne Glanz, Wenzel P:(DE-2719)2811614 34 dzne Incesoy, Enise I P:(DE-2719)9001517 35 dzne Butryn, Michaela P:(DE-2719)9001011 36 dzne Bauer, Chris P:(DE-HGF)0 37 Jessen, Frank P:(DE-2719)2000032 38 dzne Peters, Oliver P:(DE-2719)2811024 39 Last author dzne 10.1016/j.tjpad.2026.100544 Vol. 13, no. 5, p. 100544 - PERI:(DE-600)2782183-3 5 100544 The journal of prevention of Alzheimer's disease 13 2026 2274-5807 http://pub.dzne.de/record/286094/files/DZNE-2026-00390.pdf Restricted http://pub.dzne.de/record/286094/files/DZNE-2026-00390.pdf?subformat=pdfa pdfa Restricted Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 4 P:(DE-2719)2811317 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 5 P:(DE-2719)2812035 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 6 P:(DE-2719)2811326 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 7 P:(DE-2719)2810438 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 9 P:(DE-2719)2811351 External Institute I:(DE-HGF)0 Extern 10 P:(DE-2719)9002557 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 11 P:(DE-2719)9000543 External Institute I:(DE-HGF)0 Extern 12 P:(DE-2719)9003671 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 13 P:(DE-2719)2812234 External Institute I:(DE-HGF)0 Extern 14 P:(DE-2719)9001808 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 16 P:(DE-2719)2000026 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 17 P:(DE-2719)2810394 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 18 P:(DE-2719)2812583 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 19 P:(DE-2719)2000055 External Institute I:(DE-HGF)0 Extern 20 P:(DE-2719)9003152 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 21 P:(DE-2719)9003689 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 22 P:(DE-2719)2000057 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 23 P:(DE-2719)2810395 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 24 P:(DE-2719)2810481 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 25 P:(DE-2719)9001773 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 26 P:(DE-2719)2810593 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 27 P:(DE-2719)2812825 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 28 P:(DE-2719)2812139 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 29 P:(DE-2719)2811122 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 30 P:(DE-2719)2812446 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 31 P:(DE-2719)9002025 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 32 P:(DE-2719)2811720 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 33 P:(DE-2719)2000005 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 34 P:(DE-2719)2811614 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 35 P:(DE-2719)9001517 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 36 P:(DE-2719)9001011 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 38 P:(DE-2719)2000032 Deutsches Zentrum für Neurodegenerative Erkrankungen I:(DE-588)1065079516 DZNE 39 P:(DE-2719)2811024 DE-HGF Gesundheit Neurodegenerative Diseases G:(DE-HGF)POF4-350 G:(DE-HGF)POF4-353 G:(DE-HGF)POF4 G:(DE-HGF)POF4-300 G:(DE-HGF)POF Clinical and Health Care Research 0 DEAL Springer StatID:(DE-HGF)3002 StatID 2025-11-11 ger DEAL Springer StatID:(DE-HGF)3002 StatID 2025-11-11 ger JCR StatID:(DE-HGF)0100 StatID JPAD-J PREV ALZHEIM : 2022 2025-11-11 DBCoverage StatID:(DE-HGF)0200 StatID SCOPUS 2025-11-11 DBCoverage StatID:(DE-HGF)0300 StatID Medline 2025-11-11 DBCoverage StatID:(DE-HGF)0320 StatID PubMed Central 2025-11-11 DBCoverage StatID:(DE-HGF)0199 StatID Clarivate Analytics Master Journal List 2025-11-11 DBCoverage StatID:(DE-HGF)1110 StatID Current Contents - Clinical Medicine 2025-11-11 DBCoverage StatID:(DE-HGF)0160 StatID Essential Science Indicators 2025-11-11 WoS StatID:(DE-HGF)0113 StatID Science Citation Index Expanded 2025-11-11 DBCoverage StatID:(DE-HGF)0150 StatID Web of Science Core Collection 2025-11-11 DBCoverage StatID:(DE-HGF)0501 StatID DOAJ Seal 2025-05-28T09:11:42Z DBCoverage StatID:(DE-HGF)0500 StatID DOAJ 2025-05-28T09:11:42Z Peer Review StatID:(DE-HGF)0030 StatID DOAJ : Anonymous peer review 2025-05-28T09:11:42Z IF >= 5 StatID:(DE-HGF)9905 StatID JPAD-J PREV ALZHEIM : 2022 2025-11-11 Article Processing Charges StatID:(DE-HGF)0561 StatID 2025-11-11 Fees StatID:(DE-HGF)0700 StatID 2025-11-11 I:(DE-2719)5000000 AG Peters Biomarker-Assisted Early Detection of Dementias 0 I:(DE-2719)1410006 AG Wiltfang Molecular biomarkers for predictive diagnostics of neurodegenerative diseases 1 I:(DE-2719)1011305 AG Schneider Translational Dementia Research (Bonn) 2 I:(DE-2719)1011101 Patient Studies (Bonn) Patient Studies (Bonn) 3 I:(DE-2719)1111015 Clinical Research (Munich) Clinical Research (Munich) 4 I:(DE-2719)5000022 AG Dichgans Vascular Cognitive Impairment & Post-Stroke Dementia 5 I:(DE-2719)1510100 AG Teipel Clinical Dementia Research (Rostock /Greifswald) 6 I:(DE-2719)1210000 AG Gasser Parkinson Genetics 7 I:(DE-2719)1240005 ICRU Core ICRU 8 I:(DE-2719)1011201 AG Wagner Neuropsychology 9 I:(DE-2719)1011303 AG Heneka Neuroinflammation, Biomarker 10 I:(DE-2719)5000007 AG Priller Translational Neuropsychiatry 11 I:(DE-2719)5000006 AG Düzel Clinical Neurophysiology and Memory 12 I:(DE-2719)1011102 AG Jessen Clinical Alzheimer’s Disease Research 13 journal EDITORS VDBINPRINT I:(DE-2719)5000000 I:(DE-2719)1410006 I:(DE-2719)1011305 I:(DE-2719)1011101 I:(DE-2719)1111015 I:(DE-2719)5000022 I:(DE-2719)1510100 I:(DE-2719)1210000 I:(DE-2719)1240005 I:(DE-2719)1011201 I:(DE-2719)1011303 I:(DE-2719)5000007 I:(DE-2719)5000006 I:(DE-2719)1011102 UNRESTRICTED