Locus coeruleus integrity is related to tau burden and memory loss in autosomal-dominant Alzheimer’s disease

Abnormally phosphorylated tau, an indicator of Alzheimer’s disease, accumulates in the first decades of life in the locus coeruleus (LC), the brain’s main noradrenaline supply. However, technical challenges in reliable in-vivo assessments have impeded research into the role of the LC in Alzheimer’s disease. We studied participants with or known to be at-risk for mutations in genes causing autosomal-dominant Alzheimer’s disease (ADAD) of early onset, providing a unique window into the pathogenesis of Alzheimer’s largely disentangled from age-related factors. Using high- resolution MRI and tau PET, we revealed lower rostral LC integrity in symptomatic participants. LC integrity was associated with individual differences in tau burden and memory decline. Post- mortem analyses in a separate set of carriers of the same mutation confirmed substantial neuronal loss in the LC. Our findings link LC degeneration to tau burden and memory in Alzheimer’s and highlight a role of the noradrenergic system in this neurodegenerative disease.