Blodtest – fönster till hjärnan vid Alzheimers sjukdom
Blennow, Kaj LU and Hansson, Oskar LU
(2024)
In Lakartidningen
121.
- Abstract
Technical developments have paved the way for the development of ultrasensitive analytical methods that allow for precise quantification of brain-specific proteins in blood samples. Plasma levels of amyloid β, specifically the Aβ42/40 ratio, are reduced in Alzheimer's disease (AD) and show concordance with brain amyloidosis assessed by PET, but the overlap with normal elderly may be too large for reliable use in clinical applications. Plasma phosphorylated tau (P-tau), especially a variant called P-tau217, is markedly increased in the early symptomatic stages of AD but remains normal in other neurodegenerative disorders. Total tau (T-tau) is measurable in blood and shows most promise as a biomarker for acute neuronal injury (e.g. acute... (More)
Technical developments have paved the way for the development of ultrasensitive analytical methods that allow for precise quantification of brain-specific proteins in blood samples. Plasma levels of amyloid β, specifically the Aβ42/40 ratio, are reduced in Alzheimer's disease (AD) and show concordance with brain amyloidosis assessed by PET, but the overlap with normal elderly may be too large for reliable use in clinical applications. Plasma phosphorylated tau (P-tau), especially a variant called P-tau217, is markedly increased in the early symptomatic stages of AD but remains normal in other neurodegenerative disorders. Total tau (T-tau) is measurable in blood and shows most promise as a biomarker for acute neuronal injury (e.g. acute traumatic or hypoxic brain injury), where T-tau shows a fast and dramatic increase but does not work well as an AD biomarker due to contributions to blood levels from peripheral tissues. Instead, a novel method for tau protein produced only in the CNS called brain-derived tau (BD-tau) shows promise as a biomarker for AD-type neurodegeneration. Neurofilament light (NFL) levels in blood correlate tightly with levels in CSF and reflect axonal injury irrespective of the underlying cause. Increased blood NFL concentration is found in several neurodegenerative disorders, including AD, but even more so in disorders such as motor neuron disease and frontotemporal dementia. Glial fibrillary acidic protein (GFAP) is expressed with activation of astrocytes, and is mildly increased in AD, but is also very high also in acute brain disorders. These blood tests show promise as tools to identify AD pathophysiology in the first assessment of patients with early cognitive symptoms, also in primary care, to guide clinical management and possible admission to the specialist clinic. A two-step model will result in a very high accuracy to either predict or exclude brain amyloidosis of the Alzheimer type.
(Less)
- author
- Blennow, Kaj
LU
and Hansson, Oskar
LU
- organization
- alternative title
- Blood biomarkers open a window to brain pathophysiology in Alzheimer's disease
- publishing date
- 2024-05-31
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Lakartidningen
- volume
- 121
- publisher
- Swedish Medical Association
- external identifiers
-
- scopus:85194995950
- pmid:38818759
- ISSN
- 0023-7205
- language
- Swedish
- LU publication?
- yes
- id
- a0089945-2d96-46d1-9a6e-78b7ea5bacc9
- alternative location
- https://lakartidningen.se/klinik-och-vetenskap-1/artiklar-1/klinisk-oversikt/2024/05/blodtest-fonster-till-hjarnan-vid-alzheimers-sjukdom/
- date added to LUP
- 2024-08-21 14:21:55
- date last changed
- 2025-07-10 20:43:39
@article{a0089945-2d96-46d1-9a6e-78b7ea5bacc9,
abstract = {{<p>Technical developments have paved the way for the development of ultrasensitive analytical methods that allow for precise quantification of brain-specific proteins in blood samples. Plasma levels of amyloid β, specifically the Aβ42/40 ratio, are reduced in Alzheimer's disease (AD) and show concordance with brain amyloidosis assessed by PET, but the overlap with normal elderly may be too large for reliable use in clinical applications. Plasma phosphorylated tau (P-tau), especially a variant called P-tau217, is markedly increased in the early symptomatic stages of AD but remains normal in other neurodegenerative disorders. Total tau (T-tau) is measurable in blood and shows most promise as a biomarker for acute neuronal injury (e.g. acute traumatic or hypoxic brain injury), where T-tau shows a fast and dramatic increase but does not work well as an AD biomarker due to contributions to blood levels from peripheral tissues. Instead, a novel method for tau protein produced only in the CNS called brain-derived tau (BD-tau) shows promise as a biomarker for AD-type neurodegeneration. Neurofilament light (NFL) levels in blood correlate tightly with levels in CSF and reflect axonal injury irrespective of the underlying cause. Increased blood NFL concentration is found in several neurodegenerative disorders, including AD, but even more so in disorders such as motor neuron disease and frontotemporal dementia. Glial fibrillary acidic protein (GFAP) is expressed with activation of astrocytes, and is mildly increased in AD, but is also very high also in acute brain disorders. These blood tests show promise as tools to identify AD pathophysiology in the first assessment of patients with early cognitive symptoms, also in primary care, to guide clinical management and possible admission to the specialist clinic. A two-step model will result in a very high accuracy to either predict or exclude brain amyloidosis of the Alzheimer type.</p>}},
author = {{Blennow, Kaj and Hansson, Oskar}},
issn = {{0023-7205}},
language = {{swe}},
month = {{05}},
publisher = {{Swedish Medical Association}},
series = {{Lakartidningen}},
title = {{Blodtest – fönster till hjärnan vid Alzheimers sjukdom}},
url = {{https://lakartidningen.se/klinik-och-vetenskap-1/artiklar-1/klinisk-oversikt/2024/05/blodtest-fonster-till-hjarnan-vid-alzheimers-sjukdom/}},
volume = {{121}},
year = {{2024}},
}