Eratne Dhamidhu, Collins Steven, Nestor Peter J, Pond Dimity, Velakoulis Dennis, Yates Mark, Masters Colin L
Neuropsychiatry Centre, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
National Dementia Diagnostics Laboratory, The Florey Institute, The University of Melbourne, Melbourne, VIC, Australia.
Front Psychiatry. 2024 Dec 5;15:1488494. doi: 10.3389/fpsyt.2024.1488494. eCollection 2024.
Cerebrospinal fluid (CSF) biomarkers are currently the only clinically validated biofluid diagnostic test for Alzheimer's Disease (AD) available in Australia. Testing of CSF biomarkers via lumbar puncture (LP), including quantification of amyloid-β peptide, total tau protein, and phosphorylated tau, can give insight into underlying pathophysiological changes and provide greater certainty in confirming or excluding the presence of Alzheimer's disease changes compared to standard clinical and radiological assessments. Despite CSF analysis being a safe and cost-effective diagnostic method, the use of CSF biomarkers in the evaluation of potential AD remains limited in Australian clinical practice due to a variety of factors, including regional access challenges, concerns over the perceived invasiveness of LP and a lack of confidence among clinicians in interpreting the results. The advent of disease-modifying therapies as a potential new treatment strategy to reduce the rate of progression in people with AD will drive the demand for early diagnosis of AD. This perspective argues for broader adoption of CSF biomarker testing by providing evidence-based, clinically informed expert guidance on when and why to consider CSF biomarker testing.
脑脊液（CSF）生物标志物是目前澳大利亚唯一经过临床验证的用于阿尔茨海默病（AD）的生物流体诊断测试。通过腰椎穿刺（LP）检测脑脊液生物标志物，包括淀粉样β肽、总tau蛋白和磷酸化tau的定量分析，与标准临床和放射学评估相比，能够深入了解潜在的病理生理变化，并在确认或排除阿尔茨海默病变化方面提供更高的确定性。尽管脑脊液分析是一种安全且具有成本效益的诊断方法，但由于多种因素，包括区域获取挑战、对腰椎穿刺侵入性的担忧以及临床医生对解读结果缺乏信心，脑脊液生物标志物在澳大利亚临床实践中对潜在AD的评估中的应用仍然有限。作为一种潜在的新治疗策略，疾病修饰疗法的出现旨在降低AD患者的疾病进展速度，这将推动对AD早期诊断的需求。本文观点主张通过提供基于证据、临床知情的专家指导，说明何时以及为何考虑进行脑脊液生物标志物检测，以更广泛地采用脑脊液生物标志物检测。
