Trajectory of clinical symptoms in relation to amyloid chronicity

INTRODUCTION: While it is generally appreciated that amyloid precedes symptomatic Alzheimer's disease (AD) by decades, a greater understanding of this timeline may increase prognostic accuracy, planning, and care of persons who are on the AD continuum. METHODS: We examined trajectories of Clinical Dementia Rating–Sum of Boxes (CDR‐SB) relative to estimated years of amyloid positivity (A+) in n = 123 participants who were all A+ based on [C‐11]Pittsburgh compound B positron emission tomography. RESULTS: The average amyloid chronicity at CDR‐SB of 2.5 was 20.1 years. The average trajectory of CDR‐SB accelerated after 10 years of elevated amyloid and varied greatly between 10 and 30 years. Exploratory analyses suggested that older age and higher volume of white matter hyperintensities shortened the interval between amyloid onset and cognitive impairment. DISCUSSION: The recontextualization of amyloid burden into the time domain will facilitate studies of disease progression, the influence of co‐pathology, and factors that hasten or slow cognitive impairment.