Article

The cerebrospinal fluid (CSF) biomarkers beta-amyloid1-42 (Abeta1-42), total tau
protein (T-tau) and hyperphosphorylated tau (P-tau181P) are well-validated and
are increasingly used in clinical practice as an affirmative diagnostic tool for
Alzheimer's disease (AD). These biomarkers have also been implemented in the
revised diagnostic criteria of AD. The combination of the CSF biomarkers
Abeta1-42, T-tau and P-tau181P results in high levels of sensitivity, specificity
and diagnostic accuracy for discriminating AD from controls (including
psychiatric disorders like depression). These biomarkers can be applied for
diagnosing AD in the prodromal phase of the disease (mild cognitive impairment).
In case of doubt between vascular dementia (VaD) or mixed AD-VaD pathology in
dementia patients, the determination of CSF Abeta1-42, T-tau and P-tau181P levels
is of help to confirm or exclude the AD component in the pathophysiology of the
dementia syndrome. However, their discriminatory power for the differential
diagnosis of dementia is suboptimal. Other CSF biomarkers like Abeta1-40, and
those that are reflective of the pathology of non-AD dementias, could improve the
accuracy of differential dementia diagnosis. The added differential diagnostic
value of the CSF biomarkers Abeta1-42, T-tau and P-tau181P could lie within those
cases in which the routine clinical diagnostic work-up is not able to
discriminate between AD or non-AD dementias. In summary, the CSF biomarkers
Abeta1-42, T-tau and P-tau181P can be used in clinical practice to discriminate
AD from healthy aging (including psychiatric disorders like depression), to
diagnose AD in its prodromal phase or in atypical forms with prominent non-memory
impairment, to identify AD in patients with mixed pathologies and in case of an
ambiguous (AD versus non-AD) dementia diagnosis.
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