Vrednovanje određivanja ukupnih i fosforiliranih tau proteina u likvoru radi razlikovanja Alzheimerove bolesti i vaskularne demencije [Evaluation of measurement of total and phosphorylated tau proteins in cerebrospinal fluid for differentiation of Alzheimer's disease and vascular dementia]

Abstract

Dementia is a major public health problem worldwide. The most common primary cause of dementia is Alzheimer's disease (AD) followed by vascular dementia (VaD). AD and VaD are often difficult to distinguish in their early stages in clinical practice. Because VaD can be prevented by acting on risk factors and new medications have emerged that could slow down the progression of AD, early accurate diagnosis is crucial. Available clinical criteria have not shown sufficient sensitivity and specificity in differentiatiating of AD and VaD, and better biological markers are needed. The aim of this study was to evaluate cerebrospinal fluid (CSF) levels of total tau protein, tau phosphorylated at threonine 181 (p-tau181), serine 199 (p-tau199), and threonine 231 (p-tau231) for their use in the early differentiation of AD and VaD. The study included 152 patients with AD (Mini-Mental State Examination, MMSE 15-26), 28 patients with VaD, four patients with "mixed dementia" (VaD + AD) and 18 healthy controls. The diagnostic accuracy of all investigated biomarkers showed that they may differentiate patients with AD and VaD from healthy control subjects. However none could differentiate patients with AD from patients with VaD. Only the compund factor score (FS) of p-tau231 and MMSE distinguished the patients with AD from those with VaD with statistical significance (p < 0.05), with a sensitivity higher than 75%. These data indicate that FS of p-tau231 and MMSE scores has a strong potential to provide early stage distinction between AD and VaD