Abstract
Dementia is mainly a neurodegenerative disorder involved in several systems, including central nervous system, endocrinology/metabolism system and circulatory system. Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) are the most common forms of the dementia, accounting for 60% - 80% and 10% - 20% of all cases, respectively. DLB is defined by widespread neocortical, limbic and brainstem Lewy bodies but frequently accompanied by variable levels of AD pathology. This pathological and clinical overlap makes their differential diagnosis complicated. Recent advances in the identification of disease bio-markers now make it possible to detect and distinguish their pathology in the early or preclinical stage of the diseases, even in cognitively normal individuals. In addition to the key biomarkers (amyloid β or Aβ, tau and α-synuclein), neurotrophins such as cocaine- and amphetamine-regulated transcript (CART) have also drawn attention due to their expressions and functions. This article summarizes the progress in the definition, pathology and diagnosis of dementia, with a focus on potential biochemical markers in the cere-brospinal fluid (CSF) in the differential diagnosis of the main forms of dementia. To prediction or early diagnosis of dementia, the role of specific and sensitive CSF biomarkers seems to be crucial in a routine clinical setting. The concerns and challenges in the biomarker field are also discussed.
Highlights
Dementia is a multi-system related neurodegenerative disorder
The results suggest that reduced cerebrospinal fluid (CSF) cocaineand amphetamine-regulated transcript (CART) is a sign of hypothalamic dysfunction in dementia with Lewy bodies (DLB) and that it may serve as a new biomarker for this DLB patient group
It has been recognized that the core biomarkers reflect Alzheimer’s disease (AD) pathology, and are candidate markers for predicting future cognitive decline in healthy individuals and progression to dementia in patients who are cognitively impaired [73]
Summary
Dementia is a multi-system related neurodegenerative disorder. Strategic α-synuclein aggregates, neuronal loss, and variable degrees of amyloid deposition constitute the key pathological features [1,3,4,5]. These pathological features overlap with AD, and make their differential diagnosis difficult. The disease progression and treatment of DLB are different from AD the differential diagnosis is a basic procedure in clinical practice. I attempt to highlight the progress in pathology and diagnosis of dementia, with a focus on the cerebrospinal fluid (CSF) biomarkers in the main forms of dementia, AD and DLB, including their possible correlations with CART peptide. This review provides valuable information that may help to identify new clues and targets for the etiology, diagnosis, prevention and treatment of dementia
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