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We aimed to characterize this subgroup using [<jats:sup>18<\/jats:sup>F]flortaucipir PET visual read (VR), as this is important for prognosis and selection for therapies.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A\u03b2\u2010positive VR tau\u2010PET\u2010negative AD dementia patients (AD A+T\u2212) were compared to tau\u2010PET\u2010positive AD patients (AD A+T+) and control groups (CU A\u2212T\u2212; CU A+T\u2212) included from the Amsterdam\u2010based cohort and Alzheimer's Disease Neuroimaging Initiative (ADNI). We compared [<jats:sup>18<\/jats:sup>F]flortaucipir binding in an early\u2010 and late\u2010stage tau ROI, atrophy, cognition, and co\u2010pathologies.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>AD A+T\u2212 were older,\u00a0showed less hippocampal atrophy and slower cognitive decline compared to AD A+T+. In ADNI, AD A+T\u2212 showed higher early\u2010stage tau binding compared to both control groups and more late\u2010stage tau compared to CU A\u2212T\u2212, but no tau accumulation over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>DISCUSSION<\/jats:title><jats:p>VR tau\u2010PET\u2010negative AD patients show neurodegenerative and cognitive processes consistent with the AD trajectory, but milder progression compared to tau\u2010PET\u2010positive AD patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Highlights<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>We used the novel Food and Drug Administration (FDA)\u2010approved VR method for defining tau\u2010PET positivity.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>AD A+T\u2212 patients were older and showed less atrophy and cognitive decline than AD A+T+.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>We did not find convincing evidence of tau accumulation in AD A+T\u2212 or copathologies.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>The group of AD A+T\u2212 patients is likely very heterogeneous.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/alz.14423","type":"journal-article","created":{"date-parts":[[2025,4,12]],"date-time":"2025-04-12T05:38:25Z","timestamp":1744436305000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Characterizing visual read tau\u2010PET\u2010negative participants with Alzheimer's disease dementia"],"prefix":"10.1002","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1357-2572","authenticated-orcid":false,"given":"Roos M.","family":"Rikken","sequence":"first","affiliation":[{"name":"Radiology &amp; Nuclear Medicine Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc  Amsterdam The Netherlands"},{"name":"Amsterdam Neuroscience, Brain Imaging, Amsterdam UMC location VUmc  Amsterdam The Netherlands"},{"name":"Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma M.","family":"Coomans","sequence":"additional","affiliation":[{"name":"Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc  Amsterdam The Netherlands"},{"name":"Amsterdam Neuroscience, Neurodegeneration Amsterdam UMC location VUmc  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lotte A.","family":"de Koning","sequence":"additional","affiliation":[{"name":"Radiology &amp; Nuclear Medicine Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc  Amsterdam The Netherlands"},{"name":"Amsterdam Neuroscience, Brain Imaging, Amsterdam UMC location VUmc  Amsterdam The Netherlands"},{"name":"Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Visser","sequence":"additional","affiliation":[{"name":"Radiology &amp; Nuclear Medicine Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc  Amsterdam The Netherlands"},{"name":"Amsterdam Neuroscience, Brain Imaging, Amsterdam UMC location VUmc  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eline","family":"Neutelings","sequence":"additional","affiliation":[{"name":"Radiology &amp; Nuclear Medicine Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anouk","family":"den Braber","sequence":"additional","affiliation":[{"name":"Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc  Amsterdam The Netherlands"},{"name":"Amsterdam Neuroscience, Neurodegeneration Amsterdam UMC location VUmc  Amsterdam The Netherlands"},{"name":"Biological Psychiatry Vrije Universiteit Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyduine E.","family":"Collij","sequence":"additional","affiliation":[{"name":"Radiology &amp; Nuclear Medicine Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc  Amsterdam The Netherlands"},{"name":"Amsterdam Neuroscience, Brain Imaging, Amsterdam UMC location VUmc  Amsterdam The Netherlands"},{"name":"Clinical Memory Research Unit, Clinical Sciences Malm\u00f6, Faculty of Medicine Lund University, Sk\u00e5nes Universitetssjukhus, VE Minnessjukdomar  Malm\u00f6 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep S. 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