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The prevalence and detailed biomarkers’ characteristic of rapidly progressive Alzheimer's disease (rpAD) remain incompletely understood.    Methods  A total of 312 mild AD patients from the Alzheimer's Disease Neuroimaging Initiative database were chosen and dichotomized into rpAD and non‐rpAD groups. We performed the prevalence and comprehensive biomarker evaluation.    Results  The prevalence of rpAD was 17.6% in mild AD. Compared with non‐rpAD, there were no differences in  APOE  ε4/ε4,  APOE  ε3/ε4, and  APOE  ε2/ε4 genotype distribution, cerebrospinal fluid tau, phosphorylated tau (p‐tau), amyloid‐β, hippocampus volume, and amyloid deposition in rpAD. Yet, a lower p‐tau/tau ratio was observed in rpAD ( P  = .04). rpAD showed region‐specific hypometabolism ([18F]fluorodeoxyglucose‐positron emission tomography [FDG‐PET]) ( P  = .001). Receiver‐operating characteristic analysis of FDG‐PET demonstrated that left angular and left temporal cortices were the regions with higher area under the curve and predictive value for identifying clinical at‐risk rpAD.    Discussion  We identified that rpAD commonly existed in mild AD. Cerebral hypometabolism could provide potential clinical differential value for rpAD in the short‐term follow‐up period.

The prevalence and biomarkers’ characteristic of rapidly progressive Alzheimer's disease from the Alzheimer's Disease Neuroimaging Initiative database