Which CSF biomarkers combined with neuroimaging assist in early diagnosis of Alzheimer disease?

Updated: Apr 12, 2018
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: L Gill Naul, MD  more...
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Answer

The combined use of conventional imaging, such as MRI or fluorodeoxyglucose PET (FDG-PET) scanning, with selected CSF biomarkers can incrementally contribute to the early and specific diagnosis of Alzheimer disease. Low CSF concentrations of the amyloid-β (Aβ1-42) peptide, in combination with high total tau and phosphorylated tau, are sensitive and specific biomarkers highly predictive of progression to Alzheimer disease dementia in patients with mild cognitive impairment. Moreover, selected combinations of imaging and CSF biomarker measures are of importance in monitoring the course of Alzheimer disease and, therefore, are relevant to evaluating clinical trials. [20, 21]

A number of in vivo neuroimaging techniques can be used to noninvasively assess aspects of neuroanatomy, chemistry, physiology, and pathology. Neuroimaging biomarkers may assist in the diagnosis of neurodegenerative dementia and may provide prognostic information. Structural MRI, 18F-FDG PET, and amyloid PET may be useful adjuncts to clinical examination. Novel MRI techniques and new PET radiotracers may further expand diagnostic capability. [4]

Although present therapy for Alzheimer disease involves enhancers of cholinergic function, disease-modifying agents may be available in the future. Emphasis is being placed on detecting the presymptomatic phase of the disease, which can be termed mild cognitive impairment (MCI). Neuroimaging is also used to exclude other causes of dementia, such as normal-pressure hydrocephalus, brain tumors, subdural hematoma, and multiple infarctions. [3, 5]


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