RESUMEN
Differential diagnosis of AD is still a challenge due to overlapping features with other types of dementia. Biomarkers for the differential diagnosis of AD can improve the diagnostic value of the disease and ensure an appropriate treatment of patients. The aim of this study was to evaluate the potential of two neo-epitope fragments of Tau as serum biomarkers for differential diagnosis of AD. The neo-epitope fragments of Tau were assessed in a cross-sectional cohort of subjects with AD, MCI, other dementias or subjects with non-dementia related memory complaints. The two Tau neo-epitope fragments were an ADAM10-generated fragment (Tau-A) and a caspase-3-generated fragment (Tau-C). The serum levels of the fragments were measured by two competitive ELISAs detecting Tau-A and Tau-C, respectively. Tau-A and Tau-C were able to separate subjects with AD and MCI from those with other dementias (p<0.0042 and p<0.05), and Tau-A could also discriminate between AD and MCI patients and subjects with non-dementia related memory complaints (p<0.05). Tau-A showed a significantly greater discrimination between AD and MCI subjects and patients with other dementias when compared to CSF biomarkers t-Tau and p-Tau. The ability of Tau-A to differentiate between AD and MCI from other dementias was comparable with CSF Aß1-42, t-Tau/Aß1-42 and p-Tau/Aß1-42. The separation between the diagnostic groups was significantly improved when the CSF biomarkers as well as age and BMI were used in combination with Tau-A (AUC=0.87, 95% CI: 0.75-0.94) (p<0.0001). In conclusion, this study shows that a neoepitope fragment of Tau detected in serum can provide guidance on the differential diagnosis of AD.
Asunto(s)
Enfermedad de Alzheimer/sangre , Enfermedad de Alzheimer/diagnóstico , Proteínas tau/sangre , Anciano , Envejecimiento/sangre , Envejecimiento/líquido cefalorraquídeo , Enfermedad de Alzheimer/líquido cefalorraquídeo , Péptidos beta-Amiloides/líquido cefalorraquídeo , Área Bajo la Curva , Biomarcadores/sangre , Biomarcadores/líquido cefalorraquídeo , Índice de Masa Corporal , Disfunción Cognitiva/sangre , Disfunción Cognitiva/diagnóstico , Estudios Transversales , Diagnóstico Diferencial , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/líquido cefalorraquídeo , Curva ROC , Proteínas tau/líquido cefalorraquídeoRESUMEN
Following iotrolan cervical myelography 14 consecutive patients were evaluated with respect to intracranial contrast distribution and elimination, side effects, EEG-changes and psychometric assessments. The contrast medium is distributed in the subarachnoid space, in the ventricles and finally extracellularly in the cortex. Headache was the most prevalent side effect, occurring in half of the patients, 43% of "severe" grade. Eight patients showed mild nonspecific EEG-changes and all patients showed neuropsychologic disturbances.
Asunto(s)
Encéfalo/efectos de los fármacos , Medios de Contraste/efectos adversos , Electroencefalografía/efectos de los fármacos , Mielografía , Ácidos Triyodobenzoicos/efectos adversos , Encéfalo/metabolismo , Femenino , Cefalea/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Pruebas Psicológicas , Factores de TiempoRESUMEN
Cervical myelography (CM) was taken from 14 cases with cervical root-compression symptoms. Prior to myelography, there was complete cranial CT registration to assess the subarachnoid, intraventricular, subcortical and periventricular densities. Control scans at 3,6,24 and 48 h following myelography disclosed intracranial contrast medium at level of basal cisterns, the fourth ventricle and fissura Sylvii. Nine and 11 patients, respectively, had enhancement in the third and lateral ventricles. All patients had subcortical enhancement, and 9 patients had periventricular enhancement; at the 3-h control CT after myelography a minor subcortical edema was disclosed, which declined during the following hours. Two days after myelography, a minimal residual contrast was disclosed subcortically at the level of fissura Sylvii and in the subarachnoid space at the level of fissura Sylvii and the convexity. Hence, we recommend, that diagnostic cranial CT is performed before or postponed until 3 days after cervical myelography. The patients were questioned about adverse effects, and they underwent psychometric assessment and EEG-recordings: 11 had adverse effects, chiefly mild and exclusively transient, without sequelae. Three patients had no side effect. The psychometric assessment, however, disclosed pronounced deterioration in all patients at test 28 h after myelography, especially marked in the verbal paired associates test, however these disturbances were totally absent at retest one week later. No EEG-abnormalities developed; consistently, no patient had seizures. In conclusion, following CM iohexol is taken up by the brain parenchyma, gradually disappearing within 48 h, during which time a brain CT will be disturbed. During the same period some deterioration of psychometric tests may be found.