Authors: Alessandro Stefani Livia Brusa Enrica Olivola Mariangela Pierantozzi Alessandro Martorana
Publish Date: 2012/05/24
Volume: 119, Issue: 7, Pages: 861-875
Abstract
Dementia has become a relevant problem associated with the elderly in our countries Increased interest in the field has yielded a copious literature so far mostly centered on Alzheimer’s dementia Cerebrospinal fluid CSF analysis combined with neuropsychology even in absence of neuroimaging represents the gold standard to reach a diagnosis when cortical cognitive impairment prevails In view of this low levels of CSF amyloid peptides β Aβ and high tau/Aβ protein ratio despite prominent impairment of executive functions or concomitant vascular burden facilitate the diagnosis of Alzheimer’s disease Conversely an early cognitive impairment occurring in patients suffering from Parkinson’s disease PD or Lewy body disorders LBDs both diagnoses posed on pure clinical grounds remains quite elusive in term of biomarkers or neuropsychological assessment Whether PD with dementia PDD and dementia with Lewy bodies DLB represent further steps along with a continuum of the same progressive degeneration due to Lewy bodies deposition rather then the association of Lewy bodies and Aβ pathology remains a challenging issue Aim of this work is to set a stateoftheart on the neuropsychological profiles of both or DLB Then we will focus on the ongoing controversies about the specificity of the standard CSF biomarkers if applied to extrapyramidal disorders Our conclusions are that the CSF pattern in PDD and DLB can certainly be distinct from that in AD though mechanisms leading to dementia could be shared among them It is possible that by combining imaging tracers neuropsychologically careful assessment and renewed CSF biomarkers DLB can be better distinguished in subgroups depending on the presence or absence of a relevant amyloid burden However more complete data possibly collected in fieri during the progressive derangement of cognitive abilities are needed to improve our ability to decipher and treat these entities
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