Abstract
<jats:p>INTRODUCTION: The growing number of assay platforms measuring blood-based biomarkers (BBMs) for Alzheimer's disease (AD) has introduced challenges in interpretability and comparability across assays. Differences across studies also limit comparability of data. To address these challenges, a systematic evaluation of harmonization methods is needed to support BBM data integration within or across studies. METHODS: Two multisite studies, Alzheimer's Disease Neuroimaging Initiative (ADNI, n = 219) and Human Connectome Project (HCP, n = 111), were used to evaluate harmonization methods for mitigating assay and cohort effects in plasma p-tau217 measurements. Methods includes various normalization, regression, and standardization approaches, including the recently developed CentiMarker. Assay effects were evaluated using repeated-measures data across assay platforms within each cohort, whereas cohort effects were assessed using pooled ADNI and HCP data. Harmonization performance was evaluated using distributional statistics and downstream modeling of p-tau217. RESULTS: Quantile normalization and quantile mapping methods were most effective for mitigating assay effects, whereas conditional quantile mapping performed best for pooled multi-cohort data. These methods also preserved biological variability. In contrast, simple means adjustment and reference-based z-score standardization were least effective for mitigating assay effects, while simple means adjustment, z-score standardization, and quantile normalization were least effective for mitigating cohort effects. CentiMarker had minimal impact on assay or cohort effects. DISCUSSION: Based on our evaluation, we recommend (conditional) quantile mapping for p-tau217 studies integrating data across multiple assays or cohorts. In contrast, we caution against using CentiMarker and z-score-based methods, as they limit comparability and do not effectively mitigate technical variability.</jats:p>