{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:54:56Z","timestamp":1792029296936,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Assess the performance of serum phosphorylated tau 217 (p\u2010tau217) and neurofilament light chain (NfL) in predicting risk of cognitive impairment or phenoconversion to dementia in individuals with iRBD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We measured serum p\u2010tau217 and NfL levels by electrochemiluminescence across 4 polysomnographically confirmed iRBD cohorts (n\u2009=\u2009300), including individuals who phenoconverted to Parkinson's disease (PD) (n\u2009=\u200951), dementia with Lewy bodies (DLB) (n\u2009=\u200922), and multiple system atrophy (MSA) (n\u2009=\u20095).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Serum p\u2010tau217 levels were increased in individuals with iRBD and cognitive impairment (CI) on testing defined as Montreal Cognitive Assessment &lt;26 or subthreshold parkinsonism. p\u2010Tau217 differentiated individuals with iRBD who developed PD with CI (PD\u2010CI) or DLB from PD phenoconverters with normal cognition (area under curve [AUC]\u2009=\u20090.82; 95% confidence interval, 0.70\u20130.93) and from iRBD non\u2010phenoconverters with normal cognition (AUC\u2009=\u20090.83; 95% confidence interval, 0.77\u20130.89). NfL levels did not correlate with cognitive or motor scores and marginally improved p\u2010tau217 performance (AUC\u2009=\u20090.85; 95% confidence interval, 0.78\u20130.92), but were notably elevated in iRBD individuals who phenoconverted to MSA. Individuals with p\u2010tau217 in the top quartile were 8 times more likely to phenoconvert to PD\u2010CI or DLB compared to the bottom quartile (hazard ratio\u2009=\u20098.30; 95% confidence interval, 2.49\u201327.65).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Serum p\u2010tau217, but not NfL, is a useful biomarker of cognitive impairment in iRBD that could be integrated into a multimodal prognostic indicator when stratifying risk of phenoconversion. 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