In vivo Alzheimer’s disease diagnosis and staging is traditionally based on clinical features. However, the agreement between clinical and pathological Alzheimer’s disease diagnosis, whose diagnosis assessment includes amyloid and Braak histopathological tau staging, is not completely convergent. The development of positron emission tomography (PET) tracers targeting neurofibrillary tangles offers prospects for advancing the staging of Alzheimer’s disease from both biological and clinical perspectives. Recent advances in radiochemistry made it possible to apply the postmortem Braak staging framework to tau-PET images obtained in vivo. Here, our aim is to provide a narrative review of the current literature on the relationship between Alzheimer’s disease clinical features and the PET-based Braak staging framework. Overall, the available studies support the stepwise increase in disease severity following the advance of PET-based Braak stages, with later stages being associated with worse cognitive and clinical symptoms. In line with this, there is a trend for unimpaired cognition, mild cognitive impairment, and Alzheimer’s disease dementia to be compatible with early, intermediate, and late patterns of tau deposition based on PET-based Braak stages. Moreover, neuropsychiatric symptom severity seems to be linked to the extent of tau-PET signal across Braak areas. In sum, this framework seems to correspond well with the clinical progression of Alzheimer’s disease, which is an indication of its potential utility in research and clinical practice, especially for detecting preclinical tau levels in individuals without symptoms. However, further research is needed to improve the generalizability of these findings and to better understand the applications of this staging framework.

阿尔茨海默病的体内诊断和分期传统上基于临床特征。然而，阿尔茨海默病的临床和病理诊断（其诊断评估包括淀粉样蛋白和 Braak 组织病理学 tau 分期）之间的一致性并不完全一致。针对神经原纤维缠结的正电子发射断层扫描（PET）示踪剂的开发为从生物学和临床角度推进阿尔茨海默病的分期提供了前景。放射化学的最新进展使得将死后 Braak 分期框架应用于体内获得的 tau-PET 图像成为可能。在此，我们的目的是对有关阿尔茨海默病临床特征与基于 PET 的 Braak 分期框架之间关系的当前文献进行叙述性回顾。总体而言，现有研究支持随着基于 PET 的 Braak 分期的进展，疾病严重程度逐步增加，而后期分期与更差的认知和临床症状相关。与此相一致的是，未受损认知、轻度认知障碍和阿尔茨海默病痴呆有与基于 PET 的 Braak 分期的早期、中期和晚期 tau 沉积模式相一致的趋势。此外，神经精神症状的严重程度似乎与 Braak 区域 tau-PET 信号的程度有关。总之，该框架似乎与阿尔茨海默氏病的临床进展很好地对应，这表明其在研究和临床实践中的潜在用途，特别是在检测无症状个体的临床前 tau 水平方面。然而，需要进一步的研究来提高这些发现的普遍性并更好地理解这个分期框架的应用。