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Use of Alzheimer’s Disease Cerebrospinal Fluid Biomarkers in A Tertiary Care Memory Clinic

Published online by Cambridge University Press:  13 April 2021

Michael Stiffel
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
David Bergeron*
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
Karim Mourabit Amari
Affiliation:
Laboratoire de biochimie, CHU de Québec, and Faculté de Médecine, Département de biochimie, Université Laval, Québec, QC, Canada
Élizabeth Poulin
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
Xavier Roberge
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
Synthia Meilleur-Durand
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
Leila Sellami
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
Pierre Molin
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
Yannick Nadeau
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
Marie-Pierre Fortin
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
Stéphanie Caron
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
Stéphane Poulin
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
Louis Verret
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
Rémi W. Bouchard
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
Charlotte Teunissen
Affiliation:
Department of Clinical Chemistry, Neurochemistry Laboratory and Biobank, Amsterdam Neuroscience, VU University Medical Center Amsterdam, The Netherlands.
Robert Jr Laforce
Affiliation:
Clinique Interdisciplinaire de Mémoire (CIME), Département des Sciences Neurologiques du CHU de Québec, and Faculté de Médecine, Université Laval, Québec, QC, Canada
*
Correspondence to: David Bergeron, Département des Sciences Neurologiques, Université Laval, CHU de Québec, 1401, 18ième rue, Québec, Canada, G1J 1Z4. Email : david.bergeron.5@ulaval.ca

Abstract:

Introduction:

Alzheimer’s disease (AD) cerebrospinal fluid (CSF) biomarkers are promising tools to help identify the underlying pathology of neurocognitive disorders. In this manuscript, we report our experience with AD CSF biomarkers in 262 consecutive patients in a tertiary care memory clinic.

Methods:

We retrospectively reviewed 262 consecutive patients who underwent lumbar puncture (LP) and CSF measurement of AD biomarkers (Aβ1–42, total tau or t-tau, and p-tau181). We studied the safety of the procedure and its impact on patient’s diagnosis and management.

Results:

The LP allowed to identify underlying AD pathology in 72 of the 121 patients (59%) with early onset amnestic mild cognitive impairment (aMCI) with a high probability of progression to AD; to distinguish the behavioral/dysexecutive variant of AD from the behavioral variant of frontotemporal dementia (bvFTD) in 25 of the 45 patients (55%) with an atypical neurobehavioral profile; to identify AD as the underlying pathology in 15 of the 27 patients (55%) with atypical or unclassifiable primary progressive aphasia (PPA); and to distinguish AD from other disorders in 9 of the 29 patients (31%) with psychiatric differential diagnoses and 19 of the 40 patients (47%) with lesional differential diagnoses (normal pressure hydrocephalus, encephalitis, prion disease, etc.). No major complications occurred following the LP.

Interpretation:

Our results suggest that CSF analysis is a safe and effective diagnostic tool in select patients with neurocognitive disorders. We advocate for a wider use of this biomarker in tertiary care memory clinics in Canada.

Résumé :

RÉSUMÉ :

Utilisation dans une clinique de la mémoire des biomarqueurs du liquide cérébrospinal dans des cas de patients atteints de la maladie d’Alzheimer.

Introduction :

Dans le cas de la maladie d’Alzheimer (MA), les biomarqueurs du liquide cérébrospinal (LCS) constituent des outils prometteurs pour identifier la pathologie sous-jacente des troubles neurocognitifs. Dans cet article, nous voulons faire état de notre expérience avec ces biomarqueurs chez 262 patients vus consécutivement dans une clinique de la mémoire.

Méthodes :

Nous avons ainsi passé en revue rétrospectivement les dossiers de 262 patients qui avaient subi une ponction lombaire (PL) et chez qui l’on avait quantifié les biomarqueurs du LCS (protéine amyloïde A1-42, protéine Tau totale et protéine Tau 181). Nous avons aussi évalué la sécurité de cette procédure ainsi que son impact sur la prise en charge des patients et sur leur diagnostic.

Résultats :

Les PL ont permis d’identifier une pathologie sous-jacente à la MA chez 72 patients sur 121 (59 %), à savoir des troubles cognitifs légers (TCL) de nature amnésique apparaissant à un stade précoce et dont la probabilité de progresser vers la MA était élevée. Qui plus est, cet examen a permis de distinguer la variante comportementale/dysexécutive de la MA de la variante comportementale de la démence fronto-temporale chez 25 patients sur 45 (55 %) dont le profil neurocomportemental était atypique. Il a également permis d’identifier la MA comme pathologie sous-jacente chez 15 patients sur 27 (55 %) atteints d’aphasie primaire progressive atypique ou inclassable et de distinguer la MA d’autres troubles chez 9 patients sur 29 (31 %) ayant reçu un diagnostic psychiatrique différentiel et chez 19 patients sur 40 (47 %) ayant reçu des diagnostics différentiels de lésions (hydrocéphalie à pression normale, encéphalite, maladies à prions, etc.). Il est à noter qu’aucune complication majeure n’est survenue à la suite de PL.

Interprétation :

Nos résultats donnent à penser que des analyses menées au moyen des PL sont des outils diagnostics sécuritaires chez certains patients atteints de troubles neurocognitifs. Nous plaidons donc pour une utilisation plus large des biomarqueurs du LCS dans les cliniques de la mémoire au Canada.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Canadian Journal of Neurological Sciences Inc

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Footnotes

Michael Stiffel and David Bergeron contributed equally to this work.

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