A terrific article was published recently on CSF (cerebrospinal fluid) biomarkers in parkinsonian conditions such as PSP, CBD (both tauopathies), MSA, DLB, and Parkinson’s Disease (all three are synucleinopathies). CSF is procured through a lumbar puncture (spinal tap). Researchers have been looking into whether we can diagnose something with any neurological disorder based on what proteins or compounds are evident in an individual’s CSF. The thought is that the CSF should reflect what’s going on in the brain.
As the abstract says:
Parkinsonian diseases comprise a heterogeneous group of neurodegenerative disorders, which show significant clinical and pathological overlap. Accurate diagnosis still largely relies on clinical acumen; pathological diagnosis remains the gold standard. There is an urgent need for biomarkers to diagnose parkinsonian disorders, particularly in the early stages when diagnosis is most difficult.
The authors review the strengths and limitations of the most promising CSF markers in parkinsonian conditions. Here’s a summary of where we are with CSF biomarkers:
Summary Points: CSF Biomarkers in Parkinsonism
Aβ42 has a role in predicting cognitive decline in Parkinson’s disease (PD)
t-α-Syn: most promising marker; differentiates synucleinopathies from other neurodegenerative diseases and controls but is not specific
t-tau and p-tau: inconsistent data, can help differentiate PD from AD and can be useful in combination with other markers
NF-L: useful in differentiating PD from atypical parkinsonian conditions
4R-tau: possible marker of disease progression in PSP
DJ1: potential role in discriminating MSA from PD
Oxidative stress/inflammatory/metabolic markers: promising initial results, requiring further validation
Progress is slow but there is progress. Perhaps the answers for both alpha-synuclein and tau will come in a combination of imaging and biomarkers.
The full article is available for free from PubMed:
www.ncbi.nlm.nih.gov/pmc/articles/PMC4173749/
Cerebrospinal Fluid Biomarkers in Parkinsonian Conditions: An Update and Future Directions
Nadia Magdalinou, Andrew J Lees, Henrik Zetterberg
Journal of Neurology, Neurosurgery, and Psychiatry. 2014;85(10):1065-1075.
Robin