Zahinoor Ismail, MD, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, presents his work investigating the cross-sectional and longitudinal associations of mild behavioral impairment (MBI) with plasma p-tau181 in dementia-free older adults. MBI describes the onset of emergent and persistent neuropsychiatric symptoms (NPS) in later life and represents an at-risk state for incident cognitive decline and dementia. Over 570 dementia-free participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort were studied. At baseline, p-tau181 levels were higher in those with persistent NPS compared to those without. When assessing the associations of MBI with risk of Alzheimer’s disease, it was shown that persistent NPS were associated with a 3.42 times greater risk of dementia, compared to no NPS. Since p-tau181 has been shown to accurately predict Alzheimer’s pathology, these data suggest MBI is a clinically relevant syndrome that is associated with the pathophysiological processes underling Alzheimer’s disease. Dr Ismail comments on how MBI could be used in addition to cognitive status to better predict dementia risk prior to symptom onset. In this way, high risk populations can be identified for clinical trial enrolment and public health interventions. This interview took place at the Alzheimer’s Association International Conference (AAIC) 2022 in San Diego, CA.