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Neue diagnostische Methoden bei Demenzen

Novel methods for dementia diagnostics

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Zusammenfassung

Neue diagnostische Methoden, wie die liquorbasierte neurochemische Demenzdiagnostik (CSF-NDD) und die [18F]Amyloid-PET, werden zwischenzeitlich von internationalen diagnostischen Leitlinien bei spezifischer Indikationsstellung für die verbesserte Früh- und Differenzialdiagnostik der multigenetischen (sporadischen) Alzheimer-Demenz (AD) empfohlen. Für die CSF-NDD konnten die nationalen neuropsychiatrischen Leitlinien bereits auf dem S3-Niveau evidenzbasiert validiert werden (http://www.DGPPN.de) und die zusätzliche Aufnahme von [18F]Amyloid-PET in die aktuelle Revision der Leitlinien ist zu erwarten. Mittels CSF-NDD und/oder [18F]Amyloid-PET ist auch eine prädiktive Diagnostik der drohenden AD bei Hochrisikopatienten in Prodromalstadien wie der leichten kognitiven Beeinträchtigung („mild cognitive impairment“, MCI) möglich. Ohne begleitende (sekundär-)präventive Therapie der AD wird der Einsatz einer molekular prädiktiven Demenzdiagnostik von den nationalen neuropsychiatrischen Leitlinien jedoch nicht empfohlen (http://www.DGPPN.de). Diese neuen diagnostischen Ansätze einer molekularen Positivdiagnostik der AD haben allerdings schon jetzt einen hohen Stellenwert innerhalb der klinischen Therapieforschung, da auf diese Weise vielversprechende (sekundär-)präventive Therapieansätze im klinischen Modell überprüft werden können. Zwischenzeitlich zeichnet sich zwar ab, dass zukünftig mittels Multiplex-Assays auch eine blutbasierte molekulare Frühdiagnostik der AD etabliert werden könnte. Entsprechende proteomische oder epigenetische Assays konnten bisher jedoch nicht konsistent von unabhängigen Arbeitsgruppen validiert werden.

Summary

Novel diagnostic methods, such as cerebrospinal fluid-based neurochemical dementia diagnostics (CSF-NDD) and [18F] amyloid positron emission tomography (PET) are meanwhile recommended for specific indications by international guidelines for the improved early and differential diagnostics of multigenic (sporadic) Alzheimer’s dementia (AD). In the case of CSF-NDD the German neuropsychiatric guidelines have already been validated on the S3 level of evidence (http://www.DGPPN.de) and the additional consideration of [18F] amyloid-PET in the current update of the guidelines is to be expected. By means of CSF-NDD and/or [18F] amyloid-PET a predictive diagnosis of incipient (preclinical) AD is also possible for patients at high risk for AD who are in prodromal stages, such as mild cognitive impairment (MCI). As accompanying (secondary) preventive therapy of AD cannot be offered a predictive molecular dementia diagnostics is not recommended by the German neuropsychiatric dementia guidelines (http://www.DGPPN.de). However, novel diagnostic approaches, which offer molecular positive diagnostics of AD have already gained high relevance in therapy research as they allow promising preventive treatment avenues to be validated directly in the clinical trial. Moreover, future blood-based dementia diagnostics by means of multiplex assays is becoming increasingly more feasible; however, so far corresponding proteomic or epigenetic assays could not be consistently validated in independent studies.

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Interessenkonflikt. J. Wiltfang gibt an, dass kein Interessenkonflikt besteht.

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  1. Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen (UMG), Von-Siebold-Str. 5, 37075, Göttingen, Deutschland

    J. Wiltfang

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Wiltfang, J. Neue diagnostische Methoden bei Demenzen. Nervenarzt 86, 452–460 (2015). https://doi.org/10.1007/s00115-014-4177-5

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