Differential Diagnosis of Dementia with High Levels of Cerebrospinal Fluid Tau Protein

2016 ◽  
Vol 51 (3) ◽  
pp. 905-913 ◽  
Author(s):  
Lou Grangeon ◽  
Claire Paquet ◽  
Stephanie Bombois ◽  
Muriel Quillard-Muraine ◽  
Olivier Martinaud ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Tau Protein ◽  
Diagnosis Of Dementia ◽  
Differential Diagnosis Of Dementia

Cerebrospinal Fluid: When Is It Worthwhile to Do a Lumbar Puncture?

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S16) ◽  
pp. 25-27
Author(s):  
Elaine R. Peskind
Keyword(s):  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Frontotemporal Dementia ◽  
Lumbar Puncture ◽  
Tau Proteins ◽  
Cns Infection ◽  
Rapid Decline ◽  
Practice Parameters ◽  
Diagnosis Of Dementia ◽  
Differential Diagnosis Of Dementia

Clinicians should have an understanding of a lumbar puncture is indicated in the differential diagnosis of dementia and delirium. In most cases, this procedure is not commonly performed in outpatient practice for the differential diagnosis of dementia. However, in patients who have acute or subacute onset or a very rapid decline—such as in suspected Creutzfeldt-Jakob disease (CJD)—cerebrospinal fluid (CSF) 14-3-3, and tau proteins can be diagnostic for at least sporadic CJD. Practice parameters from the American Academy of Neurology (AAN) suggest performing a spinal tap on patients ≤55 years of age. However, that recommendation may not always be beneficial, particularly in a patient who has a prominent family history of either Alzheimer’s disease (AD) or frontotemporal dementia. Per the AAN practice parameter, lumbar puncture for CSF analysis is indicated in the diagnosis of central nervous system (CNS) infection, carcinomatous meningitis, or CNS vasculitis.Beyond the clinically indicated lumbar puncture, there is utility of CSF biomarkers, including CSF Aβ42, total tau, and phospho-tau, which are the best studied. These biomarkers may be useful for cases involving atypical presentations of dementia, eg, when it is difficult to determine if the patient has AD versus frontotemporal dementia. They may be most useful for cases in which there is an atypical presentation of the fluorodeoxyglucose PET image or PET image features of both AD and frontotemporal dementia.

Event-related Potentials Improve the Efficiency of Cerebrospinal Fluid Biomarkers for Differential Diagnosis of Alzheimer’s Disease

2018 ◽  
Vol 15 (13) ◽  
pp. 1244-1260 ◽  
Author(s):  
Mirjana Babić Leko ◽  
Magdalena Krbot Skorić ◽  
Nataša Klepac ◽  
Fran Borovečki ◽  
Lea Langer Horvat ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Tau Protein ◽  
Strong Correlation ◽  
Event Related Potentials ◽  
P300 Latency ◽  
Protein Biomarkers ◽  
Related Potentials ◽  
T Tau

Introduction: The pathological process of Alzheimer's disease (AD) in the brain likely begins 20-30 years earlier than the emergence of its first clinical symptoms and symptoms of AD often overlap with the symptoms of other primary causes of dementia. Therefore, it is crucially important to improve early and differential diagnosis of the disease. Event-related potentials (ERP) measured non-invasively by electroencephalography have shown diagnostic potential in AD. Aims: The aim of this study was to compare the efficiency of P300 and N200 potentials and reaction time (RT) with commonly used protein biomarkers measured in the cerebrospinal fluid (CSF), including amyloid β peptide (β1-42), total tau (t-tau), tau protein phosphorylated at threonine 181 (p-tau181), tau protein phosphorylated at serine 199 (p-tau199), tau protein phosphorylated at threonine 231 (p-tau231), and visinin-like protein 1 (VILIP-1) in differential diagnosis of AD in mild cognitive impairment (MCI) and AD patients. Subjects: The study involved 49 AD patients, 28 patients with MCI, 4 healthy control subjects and 16 patients with other primary causes of dementia. Results: ERP (P300RT, N200RT, P300 counting and N200 counting) showed a moderate to strong correlation with protein CSF biomarkers. We confirmed previous observations of moderate to strong correlation between ERP and neuropsychological testing and showed that P300 latency and RT are shortened in AD patients on therapy with acetylcholinesterase inhibitors. Using ERP and RT, a predictive model for determination of AD likelihood in MCI patients was developed, detecting 56.3% of MCI patients with high risk for development of AD in our cohort. MCI patients with pathological levels of Aβ1-42 had prolonged P300 latency, indicating that a combination of ERP and CSF protein biomarkers could improve the differential diagnosis of AD in MCI patients. Additionally, the results suggested the potential of P300 latency in differentiating AD and FTD patients. Conclusion: Our data provide possible solutions for improvement of differential diagnosis of AD, and reveal that the diagnostic efficiency of CSF protein biomarkers t-tau, p-tau181, p-tau199, p-tau231 and VILIP-1 could be improved by adding ERP in clinical practice.

Sign in / Sign up

Export Citation Format

Share Document