Clinical Experience with Cerebrospinal Fluid Aβ(42), Total and Phosphorylated Tau in the Evaluation of 1,016 Individuals for Suspected Dementia

BACKGROUND: Elevated total tau (tTau), 181-phosphorylated phosphorylated tau (pTau), and low amyloid-β(42) (Aβ(42)) in cerebrospinal fluid (CSF) represent a diagnostic biomarker for Alzheimer’s disease (AD). OBJECTIVE: The goal was to determine the overall accuracy of CSF Aβ(42), tTau, pTau, and the Aβ(42)/total tau index (ATI) in a non-research, clinical setting for the diagnosis of AD. METHODS: From medical records in 1,016 patients that had CSF studies for dementia over a 12-year period (2005 to 2017), we calculated the sensitivity and specificity of CSF Aβ(42), tTau, and pTau and the ATI in relation to the final clinical diagnosis. RESULTS: Compared with non-demented patients and patients with other dementias or mild cognitive impairment (MCI), the sensitivity and specificity of the recommended ATI and pTau cut-offs (ATI < 1.0 and pTau >61 pg/ml) for the diagnosis of AD were 0.88 and 0.72, respectively. Similar results were obtained comparing AD with non-demented patients only (0.88, 0.82) and AD with other types of dementia (0.81, 0.77). A subgroup of patients with presumed normal pressure hydrocephalus (n = 154) were biopsied at the time of shunt placement. Using the pathological manifestations of AD as the standard, the sensitivity was 0.83 while the specificity was 0.72. CONCLUSIONS: In a non-research setting, CSF biomarkers for AD showed a high sensitivity in accordance with previous studies, but modest specificity differentiating AD from other types of dementia or MCI. This study of unselected patients provides a valid and realistic assessment of the diagnostic accuracy of these CSF biomarkers in clinical practice.