In Reply The Letter to the Editor by Montero-Odasso and colleagues addresses noncognitive manifestations of Alzheimer disease (AD). Their letter discusses a recent article from the Mayo Clinic.¹ Using positron emission tomography biomarkers of amyloidosis (A) and tauopathy (T), the Mayo study¹ examined the age- and sex-specific prevalence of 3 biologically defined entities: amyloidosis (A+) regardless of tau status, A+T−, and A+T+. We compared the age and sex specific prevalence of these 3 biomarker-defined entities with 3 clinical syndromes commonly associated with AD: clinically defined probable AD using the McKhann et al² criteria, mild cognitive impairment, and dementia. We found that the prevalence of biological AD (defined by the A+T+ biomarker profile) is more prevalent than the classic syndrome of clinically defined probable AD² at all ages and roughly 3 times more prevalent at age 85 years in men and women. We attributed this to the fact that brain pathology precedes symptoms by years³; thus, many individuals who have the disease do not have cognitive impairment.

在回复Montero-Odasso 及其同事的致编辑的信中，他谈到了阿尔茨海默病 (AD) 的非认知表现。他们的信讨论了梅奥诊所最近的一篇文章。^{1 Mayo 研究1}使用淀粉样变性 (A) 和 tau 病变 (T) 的正电子发射断层扫描生物标志物检查了 3 种生物学定义实体的年龄和性别特异性患病率：无论 tau 状态如何的淀粉样变性 (A+)、A+T-、和 A+T+。我们比较了这 3 种生物标志物定义实体的年龄和性别特异性患病率与 3 种通常与 AD 相关的临床综合征：使用 McKhann 等人^{2临床定义的可能 AD}标准、轻度认知障碍和痴呆。我们发现，生物学 AD（由 A+T+ 生物标志物谱定义）的患病率在所有年龄段都比临床定义的可能 AD ²的经典综合征更普遍，并且在 85 岁时男性和女性的患病率大约高出 3 倍。我们将此归因于大脑病理在^{第 3}年出现症状之前的事实；因此，许多患有这种疾病的人没有认知障碍。