Abstract
Decreased β-amyloid1-42 and increased phospho-tau protein levels in the cerebrospinal fluid (CSF) are currently the most accurate chemical neurodiagnostics of sporadic Alzheimer disease (AD). A report (2007) of the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (2006) recommended that biological markers should not be currently requisitioned by primary care physicians in the routine investigation of subjects with memory complaints. Consideration for such testing should prompt patient referral to a specialist engaged in dementia evaluations or a Memory Clinic. The specialist should consider having CSF biomarkers (β-amyloid1-42 and phospho-tau) measured at a reputable facility in restricted cases presenting with atypical features and diagnostic confusion, but not as a routine procedure in all individuals with typical sporadic AD phenotypes. We submit that developments in the field of AD biomarker discovery since publication of the 3rd CCCDTD consensus data do not warrant revision of the 2007 recommendations.
Highlights
The advent of a biological marker that reliably indicates the presence of Alzheimer disease (AD) and distinguishes the latter from other dementing disorders would greatly assist the medical management of this common neurodegenerative condition
The successful integration of such a marker in routine clinical practice would confer the following benefits: (1) the accurate and expeditious diagnosis of sporadic AD, (2) curtailment of ancillary biochemical and imaging studies currently employed to exclude other causes of dementia, (3) the capacity to recognize AD in subjects with major affective disorders, clouded sensorium, depressed levels of consciousness, and other illnesses that often preclude assignment of a dementia diagnosis by conventional means, (4) possible surveillance of AD severity, progression, and impact of therapeutic interventions, (5) prognostication of conversion to incipient AD in individuals with mild cognitive impairment (MCI), and (6) treatment arm assignment and stratification of volunteers enrolled in clinical trials
We review criteria for ideal biomarkers of sporadic AD, chemical biomarkers currently in vogue, and a national perspective on the clinical use of AD biomarkers in Canada based on the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia [1]
Summary
The advent of a biological marker that reliably indicates the presence of Alzheimer disease (AD) and distinguishes the latter from other dementing disorders would greatly assist the medical management of this common neurodegenerative condition. The successful integration of such a marker in routine clinical practice would confer the following benefits: (1) the accurate and expeditious diagnosis of sporadic AD, (2) curtailment of ancillary biochemical and imaging studies currently employed to exclude other causes of dementia, (3) the capacity to recognize AD in subjects with major affective disorders, clouded sensorium, depressed levels of consciousness, and other illnesses that often preclude assignment of a dementia diagnosis by conventional means, (4) possible surveillance of AD severity, progression, and impact of therapeutic interventions, (5) prognostication of conversion to incipient AD in individuals with mild cognitive impairment (MCI), and (6) treatment arm assignment and stratification of volunteers enrolled in clinical trials. We review criteria for ideal biomarkers of sporadic AD, chemical biomarkers currently in vogue, and a national perspective on the clinical use of AD biomarkers in Canada based on the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia [1]
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