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  • Review Article
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Biological fluid biomarkers in neurodegenerative parkinsonism

Nature Reviews Neurology volume 5, pages 561–570 (2009)Cite this article

Abstract

Patients with parkinsonian symptoms can present either to primary care physicians or to neurologists. In both contexts, differential diagnosis is problematic, particularly early in the disease when only subtle bradykinesia, rigidity or tremor is present. Adjunctive tests should help substantially to improve the accuracy of early clinical diagnosis. This Review appraises cerebrospinal fluid (CSF), plasma and urine biomarkers that have been studied in the differential diagnosis of neurodegenerative parkinsonism. CSF biomarkers seem to hold the most promise because of their intimacy with the degenerating neurons. Most assays are still in the early stages of development, but CSF measures of α-synuclein (specific for Parkinson disease) and tau fragments (specific for progressive supranuclear palsy) have been refined. Universal approval of these assays will depend on larger clinical trials and establishment of normal ranges. Other blood and CSF biomarkers have shown exceptional specificity and sensitivity when analyzed in combination, although these findings require verification. A host of potential biomarkers have, however, produced disappointing results, either because of poor specificity or low assay reproducibility. Despite such difficulties, improved technology, in conjunction with advances in nosology and pathology, means that biomarkers are poised to enter routine clinical practice to aid the differentiation of parkinsonian disorders.

Key Points

  • Clinical differentiation between parkinsonian disorders can be difficult, if not impossible, in the early disease stages

  • Adjunctive biological markers with high specificity would aid early diagnosis

  • Many biomarkers to date have suffered from poor reproducibility and low specificity

  • Measurements of α-synuclein and tau forms in cerebrospinal fluid seem to be the most promising assays when used in the appropriate clinical context (Parkinson disease versus progressive supranuclear palsy)

  • Diagnostic accuracy might be further improved by combining these assays with other biomarker modalities

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Figure 1: Frequencies of various causes of parkinsonism.
Figure 2: Pathological lesions used in postmortem diagnosis of neurodegenerative parkinsonism.

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Acknowledgements

Dr. Michael Eller was funded through the Rasmussen Bequest. We would like to thank Tania McKenny for her assistance in the preparation of this manuscript.

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  1. Department of Neurosciences, Alfred Hospital, Melbourne, Vic, Australia

    Michael Eller

  2. Van Cleef Roet Centre for Nervous Diseases, Monash University, Melbourne, Vic, Australia

    David R. Williams

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Eller, M., Williams, D. Biological fluid biomarkers in neurodegenerative parkinsonism. Nat Rev Neurol 5, 561–570 (2009). https://doi.org/10.1038/nrneurol.2009.135

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