Association of Cerebrospinal Fluid Neurofilament Light Concentration With Alzheimer Disease Progression

脑脊液 痴呆 萎缩 内科学 医学 神经退行性变 四分位间距 认知功能衰退 白质 阿尔茨海默病 病理 队列 阿尔茨海默病神经影像学倡议 失智症 肿瘤科 胃肠病学 心理学 疾病 磁共振成像 放射科
作者
Henrik Zetterberg,Tobias Skillbäck,Niklas Mattsson,John Q. Trojanowski,Erik Portelius,Leslie M. Shaw,Michael W. Weiner,Kaj Blennow
出处
期刊:JAMA Neurology [American Medical Association]
卷期号:73 (1): 60-60 被引量:399
标识
DOI:10.1001/jamaneurol.2015.3037
摘要

Importance

The extent to which large-caliber axonal degeneration contributes to Alzheimer disease (AD) progression is unknown. Cerebrospinal fluid (CSF) neurofilament light (NFL) concentration is a general marker of damage to large-caliber myelinated axons.

Objective

To test whether CSF NFL concentration is associated with cognitive decline and imaging evidence of neurodegeneration and white matter change in AD.

Design, Setting, and Participants

A commercially available immunoassay was used to analyze CSF NFL concentration in a cohort of patients with AD (n = 95) or mild cognitive impairment (MCI) (n = 192) and in cognitively normal individuals (n = 110) from the Alzheimer’s Disease Neuroimaging Initiative. The study dates were January 2005 to December 2007. The NFL analysis was performed in November 2014.

Main Outcomes and Measures

Correlation was investigated among baseline CSF NFL concentration and longitudinal cognitive impairment, white matter change, and regional brain atrophy within each diagnostic group.

Results

Cerebrospinal fluid NFL concentration (median [interquartile range]) was higher in the AD dementia group (1479 [1134-1842] pg/mL), stable MCI group (no progression to AD during follow-up; 1182 [923-1687] pg/mL), and progressive MCI group (MCI with progression to AD dementia during follow-up; 1336 [1061-1693] pg/mL) compared with control participants (1047 [809-1265] pg/mL) (P < .001 for all) and in the AD dementia group compared with the stable MCI group (P = .01). In the MCI group, a higher CSF NFL concentration was associated with faster brain atrophy over time as measured by changes in whole-brain volume (β = −4177,P = .003), ventricular volume (β = 1835,P < .001), and hippocampus volume (β = −54.22,P < .001); faster disease progression as reflected by decreased Mini-Mental State Examination scores (β = −1.077,P < .001) and increased Alzheimer Disease Assessment Scale cognitive subscale scores (β = 2.30,P < .001); and faster white matter intensity change (β = 598.7,P < .001).

Conclusions and Relevance

Cerebrospinal fluid NFL concentration is increased by the early clinical stage of AD and is associated with cognitive deterioration and structural brain changes over time. This finding corroborates the contention that degeneration of large-caliber axons is an important feature of AD neurodegeneration.
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