article · Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring
Alzheimer's disease manifests differently across ancestral groups, with African populations showing distinct fluid biomarker levels, neuroimaging patterns, and <i>post mortem</i> pathology. These differences may compromise diagnostic accuracy and exacerbate health disparities. This systematic review, examined studies published from 2015 to 2025 assessing amyloid-β and tau via fluid assays and neuroimaging. Findings reveal ancestry-linked variation where African populations exhibit lower cerebrospinal fluid/plasma Aβ42/Aβ40 and p-tau181 ratios, with neuroimaging showing broadly similar reduced positron emission tomography patterns but slightly elevated amyloid and reduced tau signals. Limited <i>post mortem</i> data suggest reduced plaque and tangle densities despite comparable dementia severity. Genetic, environmental, and sociocultural factors contribute to these disparities. Diagnostic thresholds derived from non-African cohorts risk underdiagnosing AD in African individuals. There is an urgent need to recalibrate and validate biomarker protocols to ensure equitable and accurate dementia diagnosis across diverse populations.
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DOI: 10.1002/dad2.70263
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