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CSF total tau and phosphorylated tau proteins in the differential diagnosis of dementia

Alzheimer&#8217; s disease (AD) and frontotemporal dementia (FTD) represent an important differential diagnostic problem in clinical practice. The identification for new biomarkers that would help establishing the diagnosis and primary cause of the dementia is therefore of great relevance. The aim of this study was to investigate the diagnostic accuracy of three potential CSF biomarkers, total tau protein (t-tau), tau protein phosphorylated at threonine 181 (p-tau181) and tau protein phosphorylated at serine 199 (p-tau199), in the differential diagnosis of AD and FTD patients in relatively young age groups. The concentrations of these three CSF biomarkers were measured in 25 FTD patients, 27 AD patients and 25 control subjects. The CSF concentrations of all three markers were significantly higher in AD than in FTD patients (p<0.001) or control subjects (p<0.001). No difference was observed in FTD patient group compared to controls, except for p-tau181 (p=0.028).When sensitivity was set at 85% or higher, specificity in differentiation between FTD and AD patients reached 40% for t-tau, 37.5% for p-tau181 and 56% for p-tau199. Improvement of the diagnostic accuracy upon logistic regression analysis with t-tau and p-tau199 as independent variables showed that 22 out of 25 FTD patients could be correctly classified. In conclusion, none of the markers per se fulfilled the criteria for the &#8220; ideal&#8221; marker (sensitivity and specificity higher than 85%). However, combination of t-tau and p-tau199 detected correctly 88% of FTD patients, thus largely satisfying practical requirements.

aging; Alzheimer's disease; cerebrospinal fluid; dementia; early diagnosis; ELISA; neurofibrillary degeneration; tau protein

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