IntroductionAlthough previous studies have shown that specific platelet indices had correlations with cognitive impairment, the associations between platelet indices and cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD) pathology remain unclear.MethodsOur study included 1,047 cognitively normal participants from the Chinese Alzheimer's Biomarker and LifestylE (CABLE) study. The total participants had an average age of 58.33 years, a female proportion of 41.5% and average educational attainment of 9.58 years. Multiple linear regression models were used to analyze the associations of five platelet indices (plateletcrit [PCT], platelet count [PLT], mean platelet volume [MPV], platelet distribution width [PDW], and platelet large cell ratio [PLCR]) with CSF AD biomarkers after adjusting for age, gender, education and APOE epsilon 4 allele status. Furthermore, the interactive, stratified and sensitivity analyses were further conducted to verify their relationships.ResultsIn the total participants, we found higher PCT levels were significantly correlated with higher CSF P-tau/A beta 42 (beta = 0.102, P = 0.008) and T-tau/A beta 42 (beta = 0.102, P = 0.008), as well as lower CSF A beta 42 (beta = -0.089, P = 0.018) and A beta 42/A beta 40 (beta = -0.093, P = 0.018). Moreover, other four platelet indices (PLT, MPV, PDW, PLCR) demonstrated moderate correlations with CSF AD biomarkers. The interaction analyses revealed that age affected the correlations between PCT and PLT with CSF A beta 42. Importantly, the associations between PCT and the aforementioned CSF AD biomarkers became more significant in the late-life group, but turned non-significant in the mid-life group. Besides, sensitivity analyses confirmed the robustness of our findings.ConclusionsOur study provided preliminary evidence suggesting potential associations between platelet indices (especially PCT) and CSF AD biomarkers in cognitively intact adults. Nonetheless, more studies are needed to further validate these findings.