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The role of CSF biomarkers in the diagnostic work-up of mixed vascular-degenerative dementia

  • Sebastiaan Engelborghs
    Correspondence
    Corresponding author at: Reference Centre for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, BE-2610 Antwerp, Belgium. Tel.: +32 3 265 23 94; fax: +32 3 265 26 18.
    Affiliations
    Reference Centre for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, BE-2610 Antwerp, Belgium

    Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, BE-2020 Antwerp, Belgium
    Search for articles by this author
  • Nathalie Le Bastard
    Affiliations
    Reference Centre for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, BE-2610 Antwerp, Belgium
    Search for articles by this author
Published:September 04, 2012DOI:https://doi.org/10.1016/j.jns.2012.08.003

      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.

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