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Blood-based NfL : A biomarker for differential diagnosis of parkinsonian disorder

Hansson, Oskar LU ; Janelidze, Shorena LU ; Hall, Sara LU ; Magdalinou, Nadia; Lees, Andrew J; Andreasson, Ulf; Norgren, Niklas; Linder, Jan; Forsgren, Lars and Constantinescu, Radu, et al. (2017) In Neurology 88(10). p.930-937
Abstract

Objective: To determine if blood neurofilament light chain (NfL) protein can discriminate between Parkinson disease (PD) and atypical parkinsonian disorders (APD) with equally high diagnostic accuracy as CSF NfL, and can therefore improve the diagnostic workup of parkinsonian disorders. Methods: The study included 3 independent prospective cohorts: the Lund (n = 278) and London (n = 117) cohorts, comprising healthy controls and patients with PD, progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), and multiple system atrophy (MSA), as well as an early disease cohort (n = 109) of patients with PD, PSP, MSA, or CBS with disease duration ≤3 years. Blood NfL concentration was measured using an ultrasensitive single molecule... (More)

Objective: To determine if blood neurofilament light chain (NfL) protein can discriminate between Parkinson disease (PD) and atypical parkinsonian disorders (APD) with equally high diagnostic accuracy as CSF NfL, and can therefore improve the diagnostic workup of parkinsonian disorders. Methods: The study included 3 independent prospective cohorts: the Lund (n = 278) and London (n = 117) cohorts, comprising healthy controls and patients with PD, progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), and multiple system atrophy (MSA), as well as an early disease cohort (n = 109) of patients with PD, PSP, MSA, or CBS with disease duration ≤3 years. Blood NfL concentration was measured using an ultrasensitive single molecule array (Simoa) method, and the diagnostic accuracy to distinguish PD from APD was investigated. Results: We found strong correlations between blood and CSF concentrations of NfL (ρ ≥ 0.73-0.84, p ≤ 0.001). Blood NfL was increased in patients with MSA, PSP, and CBS (i.e., all APD groups) when compared to patients with PD as well as healthy controls in all cohorts (p < 0.001). Furthermore, in the Lund cohort, blood NfL could accurately distinguish PD from APD (area under the curve [AUC] 0.91) with similar results in both the London cohort (AUC 0.85) and the early disease cohort (AUC 0.81). Conclusions: Quantification of blood NfL concentration can be used to distinguish PD from APD. Blood-based NfL might consequently be included in the diagnostic workup of patients with parkinsonian symptoms in both primary care and specialized clinics. Classification of evidence: This study provides Class III evidence that blood NfL levels discriminate between PD and APD.

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published
subject
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Neurology
volume
88
issue
10
pages
8 pages
publisher
American Academy of Neurology
external identifiers
  • scopus:85014848691
  • wos:000397343300008
ISSN
0028-3878
DOI
10.1212/WNL.0000000000003680
language
English
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yes
id
b33a9a25-7f5d-4625-aa3c-45f4779265f0
date added to LUP
2017-04-10 14:40:17
date last changed
2017-09-18 13:31:53
@article{b33a9a25-7f5d-4625-aa3c-45f4779265f0,
  abstract     = {<p>Objective: To determine if blood neurofilament light chain (NfL) protein can discriminate between Parkinson disease (PD) and atypical parkinsonian disorders (APD) with equally high diagnostic accuracy as CSF NfL, and can therefore improve the diagnostic workup of parkinsonian disorders. Methods: The study included 3 independent prospective cohorts: the Lund (n = 278) and London (n = 117) cohorts, comprising healthy controls and patients with PD, progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), and multiple system atrophy (MSA), as well as an early disease cohort (n = 109) of patients with PD, PSP, MSA, or CBS with disease duration ≤3 years. Blood NfL concentration was measured using an ultrasensitive single molecule array (Simoa) method, and the diagnostic accuracy to distinguish PD from APD was investigated. Results: We found strong correlations between blood and CSF concentrations of NfL (ρ ≥ 0.73-0.84, p ≤ 0.001). Blood NfL was increased in patients with MSA, PSP, and CBS (i.e., all APD groups) when compared to patients with PD as well as healthy controls in all cohorts (p &lt; 0.001). Furthermore, in the Lund cohort, blood NfL could accurately distinguish PD from APD (area under the curve [AUC] 0.91) with similar results in both the London cohort (AUC 0.85) and the early disease cohort (AUC 0.81). Conclusions: Quantification of blood NfL concentration can be used to distinguish PD from APD. Blood-based NfL might consequently be included in the diagnostic workup of patients with parkinsonian symptoms in both primary care and specialized clinics. Classification of evidence: This study provides Class III evidence that blood NfL levels discriminate between PD and APD.</p>},
  author       = {Hansson, Oskar and Janelidze, Shorena and Hall, Sara and Magdalinou, Nadia and Lees, Andrew J and Andreasson, Ulf and Norgren, Niklas and Linder, Jan and Forsgren, Lars and Constantinescu, Radu and Zetterberg, Henrik and Blennow, Kaj},
  issn         = {0028-3878},
  language     = {eng},
  month        = {03},
  number       = {10},
  pages        = {930--937},
  publisher    = {American Academy of Neurology},
  series       = {Neurology},
  title        = {Blood-based NfL : A biomarker for differential diagnosis of parkinsonian disorder},
  url          = {http://dx.doi.org/10.1212/WNL.0000000000003680},
  volume       = {88},
  year         = {2017},
}