Abstract
The cerebrospinal fluid (CSF) biomarkers β-amyloid1–42 (Aβ1–42), total tau protein (T-tau), and tau phosphorylated at threonine 181 (P-tau181P) are gradually finding their way into routine clinical practice as an affirmative diagnostic tool for Alzheimer’s disease (AD). These biomarkers have also been implemented in the revised diagnostic criteria for AD.
The combination of the CSF biomarkers Aβ1–42, T-tau, and P-tau181P leads to high (around 80%) levels of sensitivity, specificity, and diagnostic accuracy for discrimination between AD and controls (including psychiatric disorders like depression) and can be applied for diagnosing AD in the predementia phases of the disease (mild cognitive impairment). 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 and non-AD dementias. However, their discriminatory power for the differential diagnosis of dementia is suboptimal. Other CSF biomarkers, especially those that are reflective of the pathology of non-AD dementia etiologies, could improve the accuracy of differential dementia diagnosis.
CSF biomarkers will be of help to establish a correct and early AD diagnosis, even in the preclinical stages of the disease, which will be of importance once disease-modifying drugs for AD become available. Variation in biomarker measurements still jeopardize the introduction of CSF biomarkers into routine clinical practice and clinical trials, but several national and international standardization initiatives are ongoing.
Similar content being viewed by others
References
Alzheimer’s Disease International. The global prevalence of dementia. In: Prince M, Jackson J, editors. World Alzheimer report 2009. London: Alzheimer’s Disease International; 2009: 25–46
Alzheimer’s Association, Thies W, Bleiler L. 2011 Alzheimer’s disease facts and figures. Alzheimers Dement 2011 Mar; 7 (2): 208–44.
McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984 Jul; 34 (7): 939–44.
Knopman DS, Dekosky ST, Cummings JL, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001 May; 56 (9): 1143–53.
The Ronald and Nancy Reagan Research Institute of the Alzheimer’s Association and the National Institute on Aging Working Group. Consensus report of the Working Group on: “Molecular and Biochemical Markers of Alzheimer’s Disease” [published erratum appears in Neurobiol Aging 1998 May–Jun; 19 (3): 285]. Neurobiol Aging 1998 Mar; 19 (2): 109–16.
Blennow K, Hampel H. CSF markers for incipient Alzheimer’s disease. Lancet Neurol 2003 Oct; 2 (10): 605–13.
Vanderstichele H, De Meyer G, Shapiro F, et al. Alzheimer’s disease biomarkers: from concept to clinical utility. In: Galimberti D, Scarpini E, editors. Biomarkers for early diagnosis of Alzheimer’s disease. New York: Nova Science Publishers, Inc., 2008: 81–122
Olsson A, Vanderstichele H, Andreasen N, et al. Simultaneous measurement of beta-amyloid(1–42), total tau, and phosphorylated tau (Thr181) in cerebrospinal fluid by the xMAP technology. Clin Chem 2005 Feb; 51 (2): 336–45.
Schoonenboom NS, Pijnenburg YA, Mulder C, et al. Amyloid beta(1–42) and phosphorylated tau in CSF as markers for early-onset Alzheimer disease. Neurology 2004 May; 62 (9): 1580–4.
Engelborghs S, De Vreese K, Van de Casteele T, et al. Diagnostic performance of a CSF-biomarker panel in autopsy-confirmed dementia. Neurobiol Aging 2008; 29: 1143–59.
Sunderland T, Linker G, Mirza N, et al. Decreased beta-amyloid 1–42 and increased tau levels in cerebrospinal fluid of patients with Alzheimer disease. JAMA 2003 Apr; 289 (16): 2094–103.
Hulstaert F, Blennow K, Ivanoiu A, et al. Improved discrimination of AD patients using beta-amyloid(1–42) and tau levels in CSF. Neurology 1999 May; 52 (8): 1555–62.
Andreasen N, Minthon L, Davidsson P, et al. Evaluation of CSF-tau and CSF-Abeta42 as diagnostic markers for Alzheimer disease in clinical practice. Arch Neurol 2001 Mar; 58 (3): 373–9.
Mitchell AJ, Shiri-Feshki M. Rate of progression of mild cognitive impairment to dementia: meta-analysis of 41 robust inception cohort studies. Acta Psychiatr Scand 2009 Apr; 119 (4): 252–65.
Price JL, McKeel Jr DW, Buckles VD, et al. Neuropathology of nondemented aging: presumptive evidence for preclinical Alzheimer disease. Neurobiol Aging 2009 Apr; 30 (7): 1026–36.
Hansson O, Zetterberg H, Buchhave P, et al. Association between CSF biomarkers and incipient Alzheimer’s disease in patients with mild cognitive impairment: a follow-up study. Lancet Neurol 2006 Mar; 5 (3): 228–34.
Mattsson N, Zetterberg H, Hansson O, et al. CSF biomarkers and incipient Alzheimer disease in patients with mild cognitive impairment. JAMA 2009 Jul; 302 (4): 385–93.
Visser PJ, Verhey F, Knol DL, et al. Prevalence and prognostic value of CSF markers of Alzheimer’s disease pathology in patients with subjective cognitive impairment or mild cognitive impairment in the DESCRIPA study: a prospective cohort study. Lancet Neurol 2009 Jul; 8 (7): 619–27.
De Meyer G, Shapiro F, Vanderstichele H, et al. Diagnosis-independent Alzheimer disease biomarker signature in cognitively normal elderly people. Arch Neurol 2010 Aug; 67 (8): 949–56.
Fagan AM, Roe CM, Xiong C, et al. Cerebrospinal fluid tau/beta-amyloid(42) ratio as a prediction of cognitive decline in nondemented older adults. Arch Neurol 2007 Mar; 64 (3): 343–9.
Le Bastard N, De Deyn PP, Engelborghs S. Cerebrospinal fluid biomarkers for the differential diagnosis of dementia. Current Medical Literature — Neurology 2009; 25 (3): 59–68.
Blennow K, Hampel H, Weiner M, et al. Cerebrospinal fluid and plasma biomarkers in Alzheimer disease. Nat Rev Neurol 2010 Mar; 6 (3): 131–44.
Schoonenboom NS, Reesink FE, Verwey NA, et al. Cerebrospinal fluid markers for differential dementia diagnosis in a large memory clinic cohort. Neurology 2012 Jan; 78 (1): 47–54.
Blennow K, Johansson A, Zetterberg H. Diagnostic value of 14-3-3 beta immunoblot and T-tau/P-tau ratio in clinically suspected Creutzfeldt-Jakob disease. Int J Mol Med 2005 Dec; 16 (6): 1147–9.
de Jong D, Jansen RW, Kremer BP, et al. Cerebrospinal fluid amyloid beta42/phosphorylated tau ratio discriminates between Alzheimer’s disease and vascular dementia. J Gerontol A Biol Sci Med Sci 2006 Jul; 61 (7): 755–8.
Le Bastard N, Martin JJ, Vanmechelen E, et al. Added diagnostic value of CSF biomarkers in differential dementia diagnosis. Neurobiol Aging 2010 Nov; 31 (11): 1867–76.
Echavarri C, Caballero MC, Aramendia A, et al. Multiprotein deposits in neurodegenerative disorders: our experience in the tissue brain bank of Navarra. Anat Rec (Hoboken) 2011 Jul; 294 (7): 1191–7.
Ballard C, Ziabreva I, Perry R, et al. Differences in neuropathologic characteristics across the Lewy body dementia spectrum. Neurology 2006 Dec; 67(11): 1931–4.
Maetzler W, Liepelt I, Reimold M, et al. Cortical PIB binding in Lewy body disease is associated with Alzheimer-like characteristics. Neurobiol Dis 2009 Apr; 34 (1): 107–12.
Slaets S, Engelborghs S, Le Bastard N, et al. Influence of AD pathology on CSF biomarkers in autopsy-confirmed dementia with Lewy bodies patients [abstract no. P1–113]. Alzheimers Dement 2011 Jul; 7 (4 Suppl.): S146.
De Reuck J, Deramecourt V, Cordonnier C, et al. Prevalence of small cerebral bleeds in patients with a neurodegenerative dementia: a neuropathological study. J Neurol Sci 2011 Jan; 300 (1–2): 63–6.
Arai T, Mackenzie IR, Hasegawa M, et al. Phosphorylated TDP-43 in Alzheimer’s disease and dementia with Lewy bodies. Acta Neuropathol 2009 Feb; 117(2): 125–36.
Tapiola T, Overmyer M, Lehtovirta M, et al. The level of cerebrospinal fluid tau correlates with neurofibrillary tangles in Alzheimer’s disease. Neuroreport 1997 Dec; 8 (18): 3961–3.
Engelborghs S, Sleegers K, Cras P, et al. No association of CSF biomarkers with APOEepsilon4, plaque and tangle burden in definite Alzheimer’s disease. Brain 2007 Sep; 130 (Pt 9): 2320–6
Strozyk D, Blennow K, White LR, et al. CSF Abeta 42 levels correlate with amyloid-neuropathology in a population-based autopsy study. Neurology 2003 Feb; 60 (4): 652–6.
Buerger K, Ewers M, Pirttila T, et al. CSF phosphorylated tau protein correlates with neocortical neurofibrillary pathology in Alzheimer’s disease. Brain 2006 Nov; 129 (Pt 11): 3035–41.
Iqbal K, Flory M, Khatoon S, et al. Subgroups of Alzheimer’s disease based on cerebrospinal fluid molecular markers. Ann Neurol 2005 Nov; 58 (5): 748–57.
van der Vlies AE, Verwey NA, Bouwman FH, et al. CSF biomarkers in relationship to cognitive profiles in Alzheimer disease. Neurology 2009 Mar; 72 (12): 1056–61.
van Norden AG, van Dijk EJ, de Laat KF, et al. Dementia: Alzheimer pathology and vascular factors. From mutually exclusive to interaction. Biochim Biophys Acta 2012 Mar; 1822 (3): 340–9.
Engelborghs S, Le Bastard N, Feyen B, et al. Overdiagnosis of vascular dementia using structural brain imaging in the context of standard clinical diagnostic criteria. Alzheimers Dement 2011 Jul; 7 (4 Suppl.): S338–9.
Shaw LM, Vanderstichele H, Knapik-Czajka M, et al. Cerebrospinal fluid biomarker signature in Alzheimer’s disease neuroimaging initiative subjects. Ann Neurol 2009 Apr; 65 (4): 403–13.
McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association Workgroups on Diagnostic Guidelines for Alzheimer’s Disease. Alzheimers Dement 2011 May; 7 (3): 263–9.
Albert MS, Dekosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association Workgroups on Diagnostic Guidelines for Alzheimer’s Disease. Alzheimers Dement 2011 May; 7 (3): 270–9.
Sperling RA, Aisen PS, Beckett LA, et al. Toward defining the preclinical stages of Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association Workgroups on Diagnostic Guidelines for Alzheimer’s Disease. Alzheimers Dement 2011 May; 7 (3): 280–92.
Verwey NA, van der Flier WM, Blennow K, et al. A worldwide multicentre comparison of assays for cerebrospinal fluid biomarkers in Alzheimer’s disease. Ann Clin Biochem 2009 May; 46 (Pt 3): 235–40.
Mattsson N, Andreasson U, Persson S, et al. The Alzheimer’s Association external quality control program for cerebrospinal fluid biomarkers. Alzheimers Dement 2011 Jul; 7 (4): 386–95.
Vanderstichele H, Bibl M, Engelborghs S, et al. Standardization of preanalytical aspects of cerebospinal fluid biomarker testing for Alzheimer’s disease diagnosis: a consensus paper of the Alzheimer’s Biomarkers Standardization Initiative. Alzheimers Dement 2012 Jan; 8 (1): 65–73.
Bibl M, Esselmann H, Otto M, et al. Cerebrospinal fluid amyloid beta peptide patterns in Alzheimer’s disease patients and nondemented controls depend on sample pretreatment: indication of carrier-mediated epitope masking of amyloid beta peptides. Electrophoresis 2004 Sep; 25 (17): 2912–8.
Schoonenboom NS, Mulder C, Vanderstichele H, et al. Differences and similarities between two frequently used assays for amyloid beta 42 in cerebrospinal fluid. Clin Chem 2005 Jun; 51 (6): 1057–60.
Lewczuk P, Beck G, Esselmann H, et al. Effect of sample collection tubes on cerebrospinal fluid concentrations of tau proteins and amyloid beta peptides. Clin Chem 2006 Feb; 52 (2): 332–4.
Bjerke M, Portelius E, Minthon L, et al. Confounding factors influencing amyloid beta concentration in cerebrospinal fluid. Int J Alzheimers Dis 2010 Jul 15; pii: 986310.
Perret-Liaudet A, Pelpel M, Tholance Y, et al. Risk of Alzheimer’s disease biological misdiagnosis linked to cerebrospinal collection tubes. J Alzheimers Dis. Epub 2012 Apr 10.
Teunissen CE, Verwey NA, Kester MI, et al. Standardization of assay procedures for analysis of the CSF biomarkers amyloid β((1–42)), tau, and phosphorylated tau in Alzheimer’s disease: report of an international workshop. Int J Alzheimers Dis 2010 Sep 27; pii: 635053.
Acknowledgments
Research performed by the authors was supported by the Special Research Fund of the University of Antwerp; the Foundation for Alzheimer Research (SAO-FRMA); the Institute Born-Bunge; the agreement between the Institute Born-Bunge and the University of Antwerp; the central Biobank facility of the Institute Born-Bunge/University of Antwerp; the Fund for Scientific Research-Flanders (FWO–V); the Interuniversity Attraction Poles (IAP) Program P6/43 of the Belgian Federal Science Policy Office; and the Methusalem Excellence Grant of the Flemish Government, Belgium.
Sebastiaan Engelborghs and Nathalie Le Bastard have served as advisory board members for Innogenetics NV. The authors report no conflicts of interest that are directly relevant to the content of this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Engelborghs, S., Le Bastard, N. The Impact of Cerebrospinal Fluid Biomarkers on the Diagnosis of Alzheimer’s Disease. Mol Diagn Ther 16, 135–141 (2012). https://doi.org/10.1007/BF03262201
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03262201