Using cerebrospinal fluid biomarkers to diagnose Alzheimer's disease: an Australian perspective

Dhamidhu Eratne; Steven Collins; Peter J Nestor; Dimity Pond; Dennis Velakoulis; Mark Yates; Colin L Masters

doi:10.3389/fpsyt.2024.1488494

Using cerebrospinal fluid biomarkers to diagnose Alzheimer's disease: an Australian perspective

Front Psychiatry. 2024 Dec 5:15:1488494. doi: 10.3389/fpsyt.2024.1488494. eCollection 2024.

Authors

Dhamidhu Eratne^{1

2

3}, Steven Collins^{2

4}, Peter J Nestor^{5

6}, Dimity Pond⁷, Dennis Velakoulis¹, Mark Yates^{8

9}, Colin L Masters²

Affiliations

¹ Neuropsychiatry Centre, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
² National Dementia Diagnostics Laboratory, The Florey Institute, The University of Melbourne, Melbourne, VIC, Australia.
³ Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.
⁴ Department of Medicine The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.
⁵ Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia.
⁶ Mater Public Hospital, South Brisbane, QLD, Australia.
⁷ Wicking Dementia Research and Teaching Centre, University of Tasmania, Hobart, TAS, Australia.
⁸ Grampians Health, Ballarat, VIC, Australia.
⁹ Deakin University, Burwood, VIC, Australia.

Abstract

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.

Keywords: Alzheimer’s disease; CSF biomarkers; amyloid; dementia; diagnosis; tau.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The services of a medical writer were funded by Roche Diagnostics to support the development of this publication. The funder was not involved in the study design, collection, analysis, interpretation of data, writing of this article, or the decision to submit it for publication.