Peripheral Serum Metabolomic Profiles Inform Antecedent Central Cognitive Impairment in Older Adults

The incidence of Alzheimer’s disease (AD) increases with age and is a significant cause of worldwide morbidity and mortality. However, the metabolic perturbations behind the onset of AD remains unclear. In this study, we performed metabolite profiling in both brain (n = 109) and matching serum samples (n = 566) to identify differentially expressed metabolites and metabolic pathways associated with neuropathology and cognitive performance and to identify individuals at high risk of developing cognitive impairment. The abundances of six metabolites, GLCA, petroselinic acid, linoleic acid, myristic acid, palmitic acid, and palmitoleic acid as well as the DCA/CA ratio, along with the dysregulation scores of three metabolic pathways, primary bile acid biosynthesis, fatty acid biosynthesis, and biosynthesis of unsaturated fatty acids showed significant differences in diagnostic groups across both brain and serum (-value < 0.05).Significant associations were observed between the levels of differential metabolites/pathways and cognitive performance, neurofibrillary tangles, and neuritic plaque burden. Metabolites abundances and personalized metabolic pathways scores were used to derive machine learning models that could be used to differentiate cognitively impaired persons from those without cognitive impairment (median of AUC = 0.772 for the metabolite level model; median of AUC = 0.731 for the pathway level model). Utilizing these two models on the entire baseline control group, we identified those who experienced cognitive decline (AUC = 0.804, sensitivity = 0.722, specificity = 0.749 for the metabolite level model; AUC = 0.778, sensitivity = 0.633, specificity = 0.825 for the pathway level model) and demonstrated their pre-AD onset prediction potentials. Our study provides a proof-of-concept that it is possible to discriminate antecedent cognitive impairment in older adults before the onset of overt clinical symptoms using metabolomics. Our findings, if validated in future studies, could enable the earlier detection and intervention of cognitive impairment that may halt its progression.