Bocancea et al. conducted a longitudinal study in a cohort diagnosed with mild cognitive impairment or Alzheimer’s disease, investigating how demographic, biological and brain structural factors influenced the impact of accumulating tau pathology—measured with PET radiotracing—on the rate of cognitive decline and cortical thinning over time.2 Consistent with prior research, younger age, higher educational attainment and greater intracranial volume were associated with elevated cross-sectional cognitive and structural integrity at comparable levels of tau burden. Here, MAPT is linked to Alzheimer disease.