Abstract
BACKGROUND: Event-based modeling (EBM) traces sequential progression of events in complex processes like neurodegenerative diseases, adept at handling uncertainties. This study validated an EBM for Alzheimer's disease (AD) staging designed by EuroPOND, an EU-funded Horizon 2020 project, using research and real-world datasets, a crucial step towards application in multi-center trials. METHODS: The training dataset comprised 1737 subjects from ADNI-1/GO/2, using the EuroPOND EBM toolbox. Testing datasets included a research cohort from University of Antwerp (controls, CN (n = 46), subjective cognitive decline, SCD (n = 10), mild cognitive impairment, MCI (n = 47), AD dementia, ADD (n = 16)) and a real-world cohort from 9 Belgian Dementia Council memory clinics (CN (n = 91), SCD (n = 66), (non-amnestic) naMCI (n = 54), aMCI (n = 255), and ADD (n = 220). Biomarkers included: 2 clinical scores (Mini Mental State Examination (MMSE), Rey Auditory Verbal Learning Test (RAVLT)); 3 CSF-biomarkers (Aβ(1-42), P-tau(181), total-Tau); and 4 magnetic resonance imaging (MRI) biomarkers (volumes of the hippocampi, temporal, parietal, and frontal cortices) computed with icobrain dm. The naMCI and aMCI groups were compared by EBM stage proportions, and the model's effectiveness at patient level was evaluated. RESULTS: The research cohort's maximum likelihood event sequence comprised CSF Aβ(1-42), P-tau(181), T-tau, RAVLT, MMSE, and cortical volumes. The clinical cohort's order was frontal cortex volume, MMSE, and remaining cortical regions. aMCI subjects showed higher staging than naMCI, with 54% in the two most advanced stages compared to 38% in naMCI. In the research cohort, 10 outliers were identified with potential mismatches between assigned stages and clinical or biomarker profiles, with CN (n = 4) and SCD (n = 2) subjects assigned in stage 4, one control in stage 9 with abnormal imaging, and three aMCI cases in stage 0 despite clinical or volumetric signs of impairment. CONCLUSIONS: This study highlights the generalizability of EuroPOND's AD EBM model across research and real-world clinical datasets, supporting its use in multi-center trials. aMCI subjects generally reside in more advanced stages than naMCI, who may not necessarily have AD, demonstrating utility for precision recruitment/screening.