Aim: To examine the associations between blood biomarkers of AD and longitudinal changes in markers of brain atrophy and cerebrovascular burden in community-dwelling, cognitively unimpaired, older adults.

Results: 1) High levels of p-tau217 were associated with volume loss only in AD-specific regions; i.e., faster shrinkage of hippocampus and amygdala and faster increase in medial temporal lobe atrophy (MTA) score. 2) High levels of NfL and GFAP were associated with widespread volume loss; i.e., faster shrinkage of hippocampus and amygdala and faster increase in MTA score, but also faster total brain tissue volume (TBTV) loss and faster ventricular enlargement. 3) High levels of NfL were also associated with accumulation of microvascular pathology; i.e., faster accumulation of white matter hyperintensities (WMH).

Conclusions: Blood biomarkers of Alzheimer’s disease (AD) may capture different structural brain changes already at early stages, even in absence of clinical symptoms.