The neutrophil to lymphocyte ratio associates with markers of Alzheimer’s disease pathology in cognitively unimpaired elderly people

Tovia Jacobs, Sean R. Jacobson, Juan Fortea, Jeffrey S. Berger, Alok Vedvyas, Karyn Marsh, Tianshe He, Eugenio Gutierrez-Jimenez, Nathanael R. Fillmore, Moses Gonzalez, Luisa Figueredo, Naomi L. Gaggi, Chelsea Reichert Plaska, Nunzio Pomara, Esther Blessing, Rebecca Betensky, Henry Rusinek, Henrik Zetterberg, Kaj Blennow, Lidia GlodzikThomas M. Wisniweski, Mony J. de Leon, Ricardo S. Osorio, Jaime Ramos-Cejudo

Research output: Contribution to journalArticlepeer-review

Abstract

Background: An elevated neutrophil–lymphocyte ratio (NLR) in blood has been associated with Alzheimer’s disease (AD). However, an elevated NLR has also been implicated in many other conditions that are risk factors for AD, prompting investigation into whether the NLR is directly linked with AD pathology or a result of underlying comorbidities. Herein, we explored the relationship between the NLR and AD biomarkers in the cerebrospinal fluid (CSF) of cognitively unimpaired (CU) subjects. Adjusting for sociodemographics, APOE4, and common comorbidities, we investigated these associations in two cohorts: the Alzheimer’s Disease Neuroimaging Initiative (ADNI) and the M.J. de Leon CSF repository at NYU. Specifically, we examined associations between the NLR and cross-sectional measures of amyloid-β42 (Aβ42), total tau (t-tau), and phosphorylated tau181 (p-tau), as well as the trajectories of these CSF measures obtained longitudinally. Results: A total of 111 ADNI and 190 NYU participants classified as CU with available NLR, CSF, and covariate data were included. Compared to NYU, ADNI participants were older (73.79 vs. 61.53, p < 0.001), had a higher proportion of males (49.5% vs. 36.8%, p = 0.042), higher BMIs (27.94 vs. 25.79, p < 0.001), higher prevalence of hypertensive history (47.7% vs. 16.3%, p < 0.001), and a greater percentage of Aβ-positivity (34.2% vs. 20.0%, p = 0.009). In the ADNI cohort, we found cross-sectional associations between the NLR and CSF Aβ42 (β = -12.193, p = 0.021), but not t-tau or p-tau. In the NYU cohort, we found cross-sectional associations between the NLR and CSF t-tau (β = 26.812, p = 0.019) and p-tau (β = 3.441, p = 0.015), but not Aβ42. In the NYU cohort alone, subjects classified as Aβ + (n = 38) displayed a stronger association between the NLR and t-tau (β = 100.476, p = 0.037) compared to Aβ- subjects or the non-stratified cohort. In both cohorts, the same associations observed in the cross-sectional analyses were observed after incorporating longitudinal CSF data. Conclusions: We report associations between the NLR and Aβ42 in the older ADNI cohort, and between the NLR and t-tau and p-tau in the younger NYU cohort. Associations persisted after adjusting for comorbidities, suggesting a direct link between the NLR and AD. However, changes in associations between the NLR and specific AD biomarkers may occur as part of immunosenescence.

Original languageEnglish (US)
Article number32
JournalImmunity and Ageing
Volume21
Issue number1
DOIs
StatePublished - Dec 2024

Keywords

  • Alzheimer’s disease
  • Amyloid-β
  • CSF
  • Neutrophil to lymphocyte ratio
  • NLR
  • P-tau
  • T-tau

ASJC Scopus subject areas

  • Immunology
  • Aging

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