Department of Pathology, Institution of Clinical Sciences, Lund University, Sweden.
Alzheimers Dement. 2010 Mar;6(2):104-9. doi: 10.1016/j.jalz.2009.12.005.
Clinical dementia diagnoses are not always consistent with neuropathological findings. As correct diagnosis is important for treatment and care, new diagnostic possibilities for dementia are in demand. Cerebrospinal fluid biomarkers should ideally be able to identify ongoing processes in the brain, but need to be further compared with neuropathological findings for evaluation of their diagnostic validity.
This study included 43 patients with a clinical dementia disorder. All patients were neuropathologically examined at the University Hospital in Lund, Sweden, during the years 2001-2008, and all had a lumbar puncture carried out as part of the clinical investigation during the time of cognitive impairment.
Of eight patients, five with Alzheimer's disease had elevated total tau protein (T-tau) and decreased amyloid beta 1-42 protein (Abeta42), while both values for the other three patients were normal. Slightly elevated T-tau and/or decreased Abeta42 were also seen in several patients with other dementia diagnoses such as Lewy body disease, frontotemporal lobar degeneration and vascular dementia. Furthermore, T-tau levels did not differ markedly between patients with morphologically tau-positive and tau-negative frontotemporal lobar degeneration. Also, seven of nine patients with Creutzfeldt-Jacob disease exhibited pronounced elevation in T-tau concentration.
From this rather limited study, being the first of its kind in Sweden, we may conclude that there is no perfect concordance between cerebrospinal fluid biomarker levels and pathological findings, which should be taken into account in the clinical diagnostic setting.
临床痴呆诊断并不总是与神经病理学发现一致。由于正确的诊断对治疗和护理很重要，因此需要新的痴呆诊断方法。脑脊液生物标志物理想情况下应能够识别大脑中的进行性过程，但需要进一步与神经病理学发现进行比较，以评估其诊断有效性。
本研究纳入了 43 例有临床痴呆障碍的患者。所有患者均于 2001 年至 2008 年在瑞典隆德大学医院接受神经病理学检查，并且所有患者在认知障碍期间均进行了腰椎穿刺作为临床研究的一部分。
8 例患者中有 5 例阿尔茨海默病患者的总 tau 蛋白（T-tau）升高，淀粉样蛋白β 1-42 蛋白（Abeta42）降低，而另外 3 例患者的这两种值均正常。在其他痴呆诊断（如路易体病、额颞叶变性和血管性痴呆）的患者中，也观察到稍高的 T-tau 和/或降低的 Abeta42。此外，形态学上 tau 阳性和 tau 阴性额颞叶变性患者之间的 T-tau 水平没有明显差异。另外，9 例克雅氏病患者中有 7 例 T-tau 浓度显著升高。
从这项瑞典首例的研究中，我们可以得出结论，脑脊液生物标志物水平与病理发现之间没有完全一致，这在临床诊断中应加以考虑。
