The APOE ɛ4 allele is strongly associated with the typical constellation ADNC (i.e. plaques and tangles),5,44 and both Aβ and tau pathologies typically advance concurrently.45-47 Our investigation reveals that a significant proportion of APOE ɛ4 carriers, encompassing five out of eight cases within the MSA cohort and 50 of 53 cases within the non-MSA cohort, did not manifest the discrepancy between Aβ and tau pathologies. Here, MAPT is linked to multiple system atrophy.