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Current Role for Biomarkers in Clinical Diagnosis of Alzheimer Disease and Frontotemporal Dementia

  • Dementia (J Pillai, Section Editor)
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Abstract

Purpose of review Alzheimer’s disease (AD) and frontotemporal dementia can often be diagnosed accurately with careful clinical history, cognitive testing, neurological examination, and structural brain MRI. However, there are certain circumstances wherein detection of specific biomarkers of neurodegeneration or underlying AD pathology will impact the clinical diagnosis or treatment plan. We will review the currently available biomarkers for AD and frontotemporal dementia (FTD) and discuss their clinical importance.

Recent findings With the advent of 18F-labeled tracers that bind amyloid plaques, amyloid PET is now clinically available for the detection of amyloid pathology and to aid in a biomarker-supported diagnosis of AD or mild cognitive impairment (MCI) due to AD. It is not yet possible to test for the specific FTD pathologies (tau or TDP-43); however, a diagnosis of FTD may be “imaging supported” based upon specific MRI or FDG-PET findings. Cerebrospinal fluid measures of amyloid-beta, total-tau, and phospho-tau are clinically available and allow detection of both of the cardinal pathologies of AD: amyloid and tau pathology.

Summary It is appropriate to pursue biomarker testing in cases of MCI and dementia when there remains diagnostic uncertainty and the result will impact diagnosis or treatment. Practically speaking, due to the rising prevalence of amyloid positivity with advancing age, measurement of biomarkers in cases of MCI and dementia is most helpful in early-onset patients, patients with atypical clinical presentations, or when considering referral for AD clinical trials.

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Authors and Affiliations

  1. Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, UK

    Nasim Sheikh-Bahaei MD, MRCP, FRCR

  2. Department of Neurology, University of California, UC Irvine Health, 1100 Medical Plaza Drive, Irvine, CA, 92697, USA

    Seyed Ahmad Sajjadi MD, PhD, MRCP & Aimee L. Pierce MD

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  1. Nasim Sheikh-Bahaei MD, MRCP, FRCR
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Correspondence to Aimee L. Pierce MD.

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N.S.-B. and S.A.S. each declare no potential conflicts of interest.

A.L.P. reports contracts from Avid Radiopharmaceuticals, Eli Lilly, Transition Therapeutics (previously Elan), Stemedica, Biogen, Janssen, Axovant, and Roche/Genentech, as well as personal fees from Lundbeck, outside the submitted work.

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Sheikh-Bahaei, N., Sajjadi, S.A. & Pierce, A.L. Current Role for Biomarkers in Clinical Diagnosis of Alzheimer Disease and Frontotemporal Dementia. Curr Treat Options Neurol 19, 46 (2017). https://doi.org/10.1007/s11940-017-0484-z

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