{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T08:41:31Z","timestamp":1788684091249,"version":"build-2803163510"},"reference-count":65,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"\n Importance<\/jats:title>\n Traumatic brain injury (TBI) is a risk factor for dementia and is known to impact levels of several Alzheimer disease (AD) blood biomarkers. The plasma phosphorylated tau 217 (p-tau217)\/amyloid-\u03b2 42 (A\u03b242) ratio has been reported to be 90% accurate for the detection of brain amyloid in civilian cohorts.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the accuracy of emerging AD blood biomarkers in veterans with and without a TBI history.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional cohort study of a diagnostic test assessed the performance of the US Food and Drug Administration\u2013approved plasma p-tau217\/A\u03b242 ratio and plasma levels of p-tau217 and A\u03b242\/40 ratio for detecting brain A\u03b2 positivity (eg, amyloid\u2013positron emission tomography [PET] consensus visual read). The accuracy of biomarkers was compared in veterans without TBI, those with TBI with loss of consciousness (LOC) for 0 to 5 minutes, and those with TBI with LOC for greater than 5 minutes. Existing data and banked plasma from the Alzheimer Disease Neuroimaging Initiative Department of Defense (ADNI-DOD) study were used. Years of enrollment were 2013 to 2020. Included in this study were Vietnam War veterans without dementia (cognitively unimpaired and those with mild cognitive impairment) who had amyloid-PET and concurrently collected banked plasma available for analysis. Plasma biomarker analysis took place from 2024 to 2025, and data analysis was performed from July 2025 to February 2026.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n AD blood biomarkers and TBI history.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n p-Tau217\/A\u03b242 accuracy in the detection of amyloid-PET consensus visual read positivity across groups with\/without TBI exposure.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In 272 participants, mean (SD) age was 70 (4.5) years, 270 were male (99.3%), and 83 (30.5%) were amyloid-PET positive. The plasma p-tau217\/A\u03b242 ratio was highly accurate in veterans with no TBI (90%; 95% CI, 84%-96%) but not in veterans with TBI with LOC for 0 to 5 minutes (78% accuracy; 95% CI, 69%-87%;\n P<\/jats:italic>\n \u2009=\u2009.03 vs no TBI), nor in veterans with TBI with LOC greater than 5 minutes (63% accuracy; 95% CI, 53%-73%;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001 vs no TBI). Results were similar for plasma p-tau217 alone and plasma A\u03b242\/40 ratio. Results were also similar after excluding veterans with TBI within the past 10 years or when amyloid-PET positivity was defined using a quantitative threshold rather than consensus visual read.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Results of this cross-sectional cohort study of a diagnostic test suggest that among individuals who are cognitively unimpaired or have mild cognitive impairment and a TBI history, the p-tau217\/A\u03b242 ratio test may miss over half of amyloid-PET\u2013positive cases. Caution is advised in interpreting AD blood test results in this context.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaneurol.2026.2042","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T15:34:33Z","timestamp":1782747273000},"page":"759","source":"Crossref","is-referenced-by-count":1,"title":["Prior Traumatic Brain Injury and Alzheimer Disease Blood Biomarkers"],"prefix":"10.1001","volume":"83","author":[{"given":"Yael","family":"Rosen-Lang","sequence":"first","affiliation":[{"name":"Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat-Gan, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agathe","family":"Vrillon","sequence":"additional","affiliation":[{"name":"University of California, San Francisco"},{"name":"Edward and Pearl Fein Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shlomit","family":"Pasternak","sequence":"additional","affiliation":[{"name":"Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat-Gan, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganna","family":"Blazhenets","sequence":"additional","affiliation":[{"name":"University of California, San Francisco"},{"name":"Edward and Pearl Fein Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David N.","family":"Soleimani-Meigooni","sequence":"additional","affiliation":[{"name":"University of California, San Francisco"},{"name":"Edward and Pearl Fein Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gil D.","family":"Rabinovici","sequence":"additional","affiliation":[{"name":"Edward and Pearl Fein Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco"},{"name":"Department of Radiology and Biomedical Imaging, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Weiner","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging, University of California, San Francisco"},{"name":"Department of Neurology, University of California, San Francisco"},{"name":"Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, California"},{"name":"Department of Medicine, University of California, San Francisco"},{"name":"Department of Psychiatry and Behavioral Sciences, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Hantke","sequence":"additional","affiliation":[{"name":"Division of Mental Health & Clinical Neurosciences, Veterans Affairs Portland Health Care System, Portland, Oregon"},{"name":"Department of Neurology, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa C.","family":"Silbert","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health & Science University, Portland"},{"name":"NIA-Layton Aging & Alzheimer\u2019s Disease Research Center, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel L.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"NIA-Layton Aging & Alzheimer\u2019s Disease Research Center, Oregon Health & Science University, Portland"},{"name":"Advanced Imaging Research Center, Department of Emergency Medicine, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Livny-Ezer","sequence":"additional","affiliation":[{"name":"Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat-Gan, Israel"},{"name":"C. 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