Lumbar Puncture Procedure May Rule Out Alzheimer’s Disease

  • An Alzheimer’s Association group suggests lumbar puncture and CSF analysis as a means to diagnose the disease.
  • Six “appropriate” and eight “inappropriate” criteria were developed for key patients.
  • While these procedures are not yet accepted in the US, the group believes that in the coming years, it will become a standard procedure.

A workgroup from an Alzheimer’s research association recommended lumbar puncture and cerebral spinal fluid (CSF) to be integrated into the diagnosis and care for Alzheimer’s disease. While the procedure is not yet available in the market, hopefully, it will be in the near future as more tests are approved, according to Dr. James Hendrix, the association’s Director of Global Science Initiatives.

In an email to Reuters Health, Hendrix says that despite the procedure being accepted in Europe, there is much concern about these tests in the U.S. However, he anticipates that the tests may eventually become standard procedure in the near future. That is why learning curves and the interpretation of its results will be publicized to aid health-care practitioners to be familiar with the criteria now.

In an online report in Alzheimer’s and Dementia on Oct. 10, a systematic review of the evidence and clinical parameters for the procedures for certain patients were presented by the workgroup. Of the developed markers, six were assigned as “appropriate” while eight were rated as “inappropriate”.

“Appropriate use” includes patients who have subjective cognitive decline with an increased risk for AD based on indicators such as:

  • persistent, progressive and unexplained mild cognitive impairment (MCI)
  • has symptoms suggestive of AD
  • early onset of MCI or dementia at less than age 65
  • meet core clinical criteria for AD with the typical age of onset (after 65) of which dominant symptoms are behavioral changes like delusion and delirium.

On the other hand, inappropriate use includes:

  • patient not cognitively impaired
  • has subjective cognitive decline but not at a high risk for AD
  • has symptoms suggestive of Parkinson’s disease and Lewy body dementia
  • to test the seriousness of a disease in patients already with AD
  • in place of early-onset disease genotyping test

In terms of valuable biological parameters, specific analytes were not recommended rather they focused on CSF amyloid.

Now, the Alzheimer’s community plans to test drugs on patients in the early stages of AD to determine if progression can be slowed or halted. But due to the lack of symptoms in the early-onset AD, it would be challenging to find such patients.

Meanwhile, Dr. Malaz Boustani, Regenstrief Institute investigator said he disagrees with most of the workgroup’s recommendations.  In an email to Reuters Health, he argued that the accuracy of data for biomarkers for AD detection in lumbar puncture procedures is not very high.

Aside from being a costly procedure, he also stressed that without known treatments to reverse AD, “the benefit/harms ratio of lumbar puncture is too close to call.”

In conclusion, Boustani said that what is needed is a study to validate a much more generalized population capable of producing added value to patients.

Source: Psych Congress



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