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Article History

Received: 14 September 2025

Accepted: 9 March 2026

First Online: 1 April 2026

Declarations

:

: Open access funding provided by Karolinska Institute. The study is funded by Novo Nordisk A/S under a research collaboration agreement (Dnr KI 4-3128/2022). M.E. was supported by the Swedish Research Council (2024-03599), the Swedish Brain Foundation (FO2024-0339), the regional agreement on medical training and clinical research between the Stockholm County council and the Karolinska Institutet (ALF), PREDEM (Vinnova grant 2021-02680), the Center for Innovative medicine, and the Paulsson foundation. H.Z. is a Wallenberg Scholar and a Distinguished Professor at the Swedish Research Council supported by grants from the Swedish Research Council (#2023-00356, #2022-01018 and #2019-02397), the European Union’s Horizon Europe research and innovation programme under grant agreement No 101053962, and Swedish State Support for Clinical Research (#ALFGBG-71320), the Alzheimer Drug Discovery Foundation (ADDF), USA (201809-2016862), the AD Strategic Fund and the Alzheimer’s Association (ADSF-21-831376-C, ADSF-21-831381-C, ADSF-21-831377-C, and ADSF-24-1284328-C), the European Partnership on Metrology, co-financed from the European Union’s Horizon Europe Research and Innovation Programme and by the Participating States (NEuroBioStand, 22HLT07), the Bluefield Project, Cure Alzheimer’s Fund, the Olav Thon Foundation, the Erling-Persson Family Foundation, Familjen Rönströms Stiftelse, Familjen Beiglers Stiftelse, Stiftelsen för Gamla Tjänarinnor, Hjärnfonden, Sweden (FO2022-0270), the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement 860197 (MIRIADE), the European Union Joint Programme—Neurodegenerative Disease Research (JPND2021-00694), the National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, the UK Dementia Research Institute at UCL (UKDRI-1003), and an anonymous donor. S.K. was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALFGBG-1005471, ALFGBG-965923, ALFGBG-81392, ALFGBG-771071), the Alzheimerfonden (AF-842471, AF-737641, AF-929959, AF-939825), the Swedish Research Council (2019-02075, 2019-02075_15), Stiftelsen Psykiatriska Forskningsfonden, and the Swedish Brain Foundation (FO2024-0097). LJ is funded by the Innovative Health Initiative Joint Undertaking under grant agreement 101112145, PREDEM (Vinnova grant 2021-02680), the Swedish Research Council for Health, Working Life and Welfare, and Novo Nordisk.

: ME has served as speaker and/or consultant for BioArctic AB, Roche, Eli Lilly, Biogen/Eisai and Novo Nordisk and given lectures in symposia sponsored by Roche. HZ has served at scientific advisory boards and/or as a consultant for Abbvie, Acumen, Alector, Alzinova, ALZpath, Amylyx, Annexon, Apellis, Artery Therapeutics, AZTherapies, Cognito Therapeutics, CogRx, Denali, Eisai, Enigma, LabCorp, Merck Sharp & Dohme, Merry Life, Nervgen, Novo Nordisk, Optoceutics, Passage Bio, Pinteon Therapeutics, Prothena, Quanterix, Red Abbey Labs, reMYND, Roche, Samumed, ScandiBio Therapeutics AB, Siemens Healthineers, Triplet Therapeutics, and Wave, has given lectures sponsored by Alzecure, BioArctic, Biogen, Cellectricon, Fujirebio, LabCorp, Lilly, Novo Nordisk, Oy Medix Biochemica AB, Roche, and WebMD, is a co-founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program, and is a shareholder of MicThera (outside submitted work). SK has served at scientific advisory boards, speaker and/or as consultant for Roche, Eli Lilly, Geras Solutions, Optoceutics, Biogen, Eisai, Merry Life, Triolab, Novo Nordisk and BioArctic. LJ has received consulting fees from H. Lundbeck A/S, Novo Nordisk A/S and TEVA Inc, and license fees for the Resource Utilization in Dementia (RUD) instrument and has given lectures sponsored by Eli Lilly and Novo Nordisk. LJ is an Editorial Board Member of PharmacoEconomics. He was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Others report no conflicts of interest pertinent to this work.

: The study was approved by the Swedish Ethical Review Authority (DNR: 2024-07272-02).

: In accordance with Swedish regulations, we are unable to share the data used in this study. Researchers can access the Swedish registers after receiving ethical approvals from ethical review authorities and approvals from the register holders.

: LJ conceptualized the study. XX designed the study, analyzed data, and drafted and revised the manuscript. LJ received funding for this study. LJ, ME, HZ, SK, and TS contributed to data acquisition. All co-authors (ME, AC, NB, JG, PP, NS, HZ, SK, TS, and LJ) have reviewed the manuscript, provided critical feedback, and approved the submission of the manuscript for publication.

: We cannot share raw data used in the current study following Swedish laws. However, SveDemdata are accessible after ethical approvals and approvals from the SveDem steering group.

: Analytical codes for this study will be shared upon request.

: Participants were informed of the registration of their data in SveDem and had the right to decline the registration. Written informed consent is not required for register-based research in Sweden.

: Not applicable.