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.

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.

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.

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.

Online tools can be used by people with dementia and their caregivers to self-identify and track troubling symptoms, such as verbal repetition. We aimed to explore verbal repetition behaviors in people with dementia.

Participants were recruited via an online resource for people with dementia and their caregivers. Respondents were instructed to complete information about symptoms that are most important to them for tracking over time. In this cross-sectional study, we analyzed data pertaining to individuals with dementia who had at least three symptoms selected for tracking.

Of the 3,573 participants who began a user profile, 1,707 fulfilled criteria for analysis. Verbal repetition was identified as a treatment target in 807 respondents (47.3%). Verbal repetition was more frequent in individuals with mild dementia compared to those with moderate and severe dementia (57.2% vs. 36.0% and 39.9%, p < 0.01) and in those with Alzheimer's disease versus other dementias (65.2% vs. 29.7%, p < 0.001). Repetitive questioning was the most frequent type of verbal repetition (90.5% of individuals with verbal repetition). Verbal repetition was most strongly associated with difficulties operating gadgets/appliances (OR 3.65, 95%CI: 2.82–4.72), lack of interest and/or initiative (3.52: 2.84–4.36), misplacing or losing objects (3.25: 2.64–4.01), and lack of attention and/or concentration (2.62: 2.12–3.26).

Verbal repetition is a common symptom in people at all stages of dementia but is most commonly targeted for monitoring and treatment effects in its mild stage. Much research is required to further elucidate the underlying mechanisms and the effect of different treatment strategies.