Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit, De Boelelaan, 1117, Amsterdam, The Netherlands.
Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit, De Boelelaan, 1117, Amsterdam, The Netherlands.
Alzheimers Res Ther. 2021 May 18;13(1):101. doi: 10.1186/s13195-021-00841-4.
Neurofilament light in serum (sNfL) is a biomarker for axonal damage with elevated levels in many neurological disorders, including neurodegenerative dementias. Since within-group variation of sNfL is large and concentrations increase with aging, sNfL's clinical use in memory clinic practice remains to be established. The objective of the current study was to evaluate the clinical use of serum neurofilament light (sNfL), a cross-disease biomarker for axonal damage, in a tertiary memory clinic cohort.
Six neurologists completed questionnaires regarding the usefulness of sNfL (n = 5-42 questionnaires/neurologist). Patients that visited the Alzheimer Center Amsterdam for the first time between May and October 2019 (n = 109) were prospectively included in this single-center implementation study. SNfL levels were analyzed on Simoa and reported together with normal values in relation to age, as part of routine diagnostic work-up and in addition to cerebrospinal fluid (CSF) biomarker analysis.
SNfL was perceived as useful in 53% (n = 58) of the cases. SNfL was more often perceived as useful in patients < 62 years (29/48, 60%, p = 0.05) and males (41/65, 63%, p < 0.01). Availability of CSF biomarker results at time of result discussion had no influence. We observed non-significant trends for increased perceived usefulness of sNfL for patients with the diagnosis subjective cognitive decline (64%), psychiatric disorder (71%), or uncertain diagnosis (67%). SNfL was mostly helpful to neurologists in confirming or excluding neurodegeneration. Whether sNfL was regarded as useful strongly depended on which neurologist filled out the questionnaire (ranging from 0 to 73% of useful cases/neurologist).
Regardless of the availability of CSF biomarker results, sNfL was perceived as a useful tool in more than half of the evaluated cases in a tertiary memory clinic practice. Based on our results, we recommend the analysis of the biomarker sNfL to confirm or exclude neurodegeneration in patients below 62 years old and in males.
血清神经丝轻链（sNfL）是一种轴突损伤的生物标志物，在许多神经退行性疾病中，包括神经退行性痴呆症中，其水平升高。由于 sNfL 在组内的变异较大，并且随着年龄的增长而增加，因此其在记忆诊所实践中的临床应用仍有待确定。本研究的目的是评估血清神经丝轻链（sNfL）在三级记忆诊所队列中的临床应用，sNfL 是一种用于轴突损伤的跨疾病生物标志物。
六名神经病学家完成了有关 sNfL（n = 5-42 份问卷/神经病学家）有用性的问卷。2019 年 5 月至 10 月期间，首次访问阿姆斯特丹阿尔茨海默病中心的患者（n = 109）被前瞻性纳入本单中心实施研究。sNfL 水平在 Simoa 上进行分析，并与年龄相关的正常值一起报告，作为常规诊断工作的一部分，并与脑脊液（CSF）生物标志物分析一起进行。
sNfL 在 53%（n = 58）的病例中被认为是有用的。sNfL 在<62 岁的患者中（29/48，60%，p = 0.05）和男性中（41/65，63%，p < 0.01）更常被认为是有用的。在结果讨论时获得 CSF 生物标志物结果的可用性没有影响。我们观察到 sNfL 的有用性增加的非显著趋势，用于诊断主观认知下降（64%），精神障碍（71%）或不确定诊断（67%）的患者。sNfL 主要有助于神经病学家确认或排除神经退行性变。sNfL 是否被认为有用强烈取决于填写问卷的神经病学家（每个神经病学家有用病例的范围为 0 至 73%）。
无论 CSF 生物标志物结果是否可用，sNfL 在三级记忆诊所实践中评估的病例中，超过一半的病例被认为是有用的工具。根据我们的结果，我们建议分析生物标志物 sNfL，以确认或排除 62 岁以下和男性的神经退行性变。
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