Abukuri Daniel Naawenkangua
Department of Psychology, University of Ghana, College of Humanity, Accra, Ghana.
Int J Alzheimers Dis. 2024 May 15;2024:6668159. doi: 10.1155/2024/6668159. eCollection 2024.
Neurodegenerative disorders such as Alzheimer's disease (AD) represent an increasingly significant public health concern. As clinical diagnosis faces challenges, biomarkers are becoming increasingly important in research, trials, and patient assessments. While biomarkers like amyloid- peptide, tau proteins, CSF levels (A, tau, and p-tau), and neuroimaging techniques are commonly used in AD diagnosis, they are often limited and invasive in monitoring and diagnosis. For this reason, blood-based biomarkers are the optimal choice for detecting neurodegeneration in brain diseases due to their noninvasiveness, affordability, reliability, and consistency. This literature review focuses on plasma neurofilament light (NfL) and CSF NfL as blood-based biomarkers used in recent AD diagnosis. The findings revealed that the core CSF biomarkers of neurodegeneration (T-tau, P-tau, and A42), CSF NFL, and plasma T-tau were strongly associated with Alzheimer's disease, and the core biomarkers were strongly associated with mild cognitive impairment due to Alzheimer's disease. Elevated levels of plasma and cerebrospinal fluid NfL were linked to decreased [18F]FDG uptake in corresponding brain areas. In participants with A positivity (A+), NfL correlated with reduced metabolism in regions susceptible to Alzheimer's disease. In addition, CSF NfL levels correlate with brain atrophy and predict cognitive changes, while plasma total tau does not. Plasma P-tau, especially in combination with A42/A40, is promising for symptomatic AD stages. Though not AD-exclusive, blood NfL holds promise for neurodegeneration detection and assessing treatment efficacy. Given the consistent levels of T-tau, P-tau, A42, and NFL in CSF, their incorporation into both clinical practice and research is highly recommended.
阿尔茨海默病（AD）等神经退行性疾病对公众健康的影响日益显著。由于临床诊断面临挑战，生物标志物在研究、试验及患者评估中变得愈发重要。虽然淀粉样肽、tau蛋白、脑脊液水平（A、tau和p-tau）以及神经成像技术等生物标志物常用于AD诊断，但它们在监测和诊断中往往存在局限性且具有侵入性。因此，基于血液的生物标志物因其非侵入性、可负担性、可靠性和一致性，成为检测脑部疾病神经退行性变的最佳选择。这篇文献综述聚焦于血浆神经丝轻链（NfL）和脑脊液NfL，作为近期AD诊断中使用的基于血液的生物标志物。研究结果显示，神经退行性变的核心脑脊液生物标志物（总tau蛋白、磷酸化tau蛋白和Aβ42）、脑脊液NfL和血浆总tau蛋白与阿尔茨海默病密切相关，且这些核心生物标志物与阿尔茨海默病所致的轻度认知障碍密切相关。血浆和脑脊液中NfL水平升高与相应脑区[18F]氟代脱氧葡萄糖（FDG）摄取减少有关。在Aβ阳性（A+）参与者中，NfL与阿尔茨海默病易感区域的代谢降低相关。此外，脑脊液NfL水平与脑萎缩相关，并可预测认知变化，而血浆总tau蛋白则不然。血浆磷酸化tau蛋白，尤其是与Aβ42/Aβ40联合使用时，对有症状的AD阶段具有诊断价值。虽然并非AD所特有，但血液NfL在检测神经退行性变和评估治疗效果方面具有潜力。鉴于脑脊液中总tau蛋白、磷酸化tau蛋白、Aβ42和NfL水平的一致性，强烈建议将它们纳入临床实践和研究中。
