163 Longitudinal change in biomarkers ATN biomarkers over time We first examined changes in A, T and N biomarkers individually. Figure 1 shows changes in biomarker status over time. Several individuals changed from negative to positive status (A: n=10 (11%); T: n=6 (14%); N: n=7 (9%)). For A and N but not for T, a smaller number of individuals changed from a positive to a negative status (A: n=5 (5%); N: n=4 (5%)). Figure 1. Changes in biomarker status for A, T and N biomarker groups 68 (74%) 24 (26%) 38 (90%) 4 (10%) 67 (85%) 12 (15%) 63 (68%) 29 (32%) 30 (71%) 12 (29%) 64 (81%) 15 (19%) 58 5 Baseline Follow-up 19 10 30 4 0 8 60 8 4 7 A - + T - + N - + n=92 n=42 n=79 Visualization of longitudinal changes in biomarker status for A, T, and N biomarker groups. For individuals with complete biomarker information for A, T and N at two time points (n=39), Figure 2 visualizes the trajectory of ATN profiles from baseline to followup . During follow-up, 17 (44%) changed to another ATN profile. The percentage of individuals with normal AD biomarkers changed from 62% at baseline to 46% at 7

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