Abstract
Low average specificity levels of 48% for clinical diagnosis of possible Alzheimer's
disease (AD) reflect the overlap of clinical profiles between AD and non-AD dementias.
Should diagnostic errors occur, they most likely involve one of the other primary
dementias, mixed pathologies that include a vascular component, or uncertainties that
are associated with early diagnosis. Vascular dementia (VaD) is overdiagnosed when
a routine brain MRI or CT scan is used in the context of standard clinical diagnostic
criteria, meanwhile denying significant neurodegenerative co-pathology.
A promising approach for increasing diagnostic accuracy is the use of biochemical
markers (biomarkers) that are present in the cerebrospinal fluid (CSF). The CSF biomarkers
ß-amyloid protein of 42 amino acids (Aß1–42), total tau protein (T-tau), and tau phosphorylated at threonine 181 (P-tau181P) are well validated. A combined analysis of these biomarkers is of help to discriminate
AD from non-AD dementias (including VaD), reaching sensitivity and specificity levels
that exceed 80%. Moreover, the added value of CSF biomarkers could lie within those
cases in which the clinical diagnostic work-up is not able to discriminate between
AD or a non-AD dementia. In case of doubt between VaD or mixed AD–VaD pathology in
dementia patients, the determination of CSF Aß1–42, T-tau and P-tau181P levels is of help to confirm or exclude the AD component in the pathophysiology of
the dementia syndrome.
Keywords
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Article info
Publication history
Published online: September 04, 2012
Accepted:
August 7,
2012
Received:
February 13,
2012
Identification
Copyright
© 2012 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
