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<jats:title>INTRODUCTION<\/jats:title>\n                    <jats:p>Little is known about how Alzheimer's disease (AD) plasma biomarkers relate to cerebral small vessel disease (cSVD) neuroimaging biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The study involved 251 Wake Forest Multi\u2010Ethnic Study of Atherosclerosis (MESA) Exam 6 participants with plasma AD biomarkers, magnetic resonance imaging, amyloid positron emission tomography (PET), and adjudicated cognitive status. Multivariable models examined cross\u2010sectional relationships between plasma and neuroimaging biomarkers, considering comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Lower amyloid beta (A\u03b2) 42\/A\u03b240 and higher glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and phosphorylated tau at threonine 217 (p\u2010tau217) were associated with greater neurodegeneration. Lower plasma A\u03b242\/A\u03b240 and higher p\u2010tau217 and p\u2010tau231 were associated with greater A\u03b2 PET deposition. NfL was positively associated with white matter hyperintensities (WMH) and white matter (WM) free water. P\u2010tau measures were positively associated with WM free water. Lower A\u03b242\/A\u03b240 was associated with the presence of microbleeds. GFAP was positively associated with WMH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>We observed expected associations of plasma biomarkers with cognitive status and imaging biomarkers. GFAP, NfL, p\u2010tau181, p\u2010tau217, and p\u2010tau231 are associated with cSVD in addition to AD\u2010related pathology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.71131","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T08:27:37Z","timestamp":1770107257000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Plasma and neuroimaging biomarkers of small vessel disease and Alzheimer's disease in a diverse cohort: MESA"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0893-5420","authenticated-orcid":false,"given":"Samuel N.","family":"Lockhart","sequence":"first","affiliation":[{"name":"Wake Forest University School of Medicine Medical Center Boulevard  Winston\u2010Salem North Carolina USA"},{"name":"Perceptive Inc., 55 Network Dr  Burlington Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney L.","family":"Sutphen","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine Medical Center Boulevard  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Tanley","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine Medical Center Boulevard  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Gonzalez\u2010Ortiz","sequence":"additional","affiliation":[{"name":"University of Gothenburg Universitetsplatsen 1  Gothenburg Sweden"},{"name":"Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Przemys\u0142aw R.","family":"Kac","sequence":"additional","affiliation":[{"name":"University of Gothenburg Universitetsplatsen 1  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Habes","sequence":"additional","affiliation":[{"name":"University of Texas Health Science Center  San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan R.","family":"Heckbert","sequence":"additional","affiliation":[{"name":"University of Washington 1410 NE Campus Pkwy  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Ashton","sequence":"additional","affiliation":[{"name":"University of Gothenburg Universitetsplatsen 1  Gothenburg Sweden"},{"name":"King's College London, Strand  London UK"},{"name":"NIHR Maudsley Biomedical Research Centre  London UK"},{"name":"Banner Sun Health Research Institute  Sun City Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle M.","family":"Mielke","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine Medical Center Boulevard  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Koeppe","sequence":"additional","affiliation":[{"name":"University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc D.","family":"Rudolph","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine Medical Center Boulevard  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran K. 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