Neurofilament light helps differentiate between clinically similar neurological conditions

  • Bridel C & al.
  • JAMA Neurol
  • 17 Jun 2019

  • International Clinical Digest
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Takeaway

  • Cerebrospinal fluid levels of neurofilament light (NfL) protein helped to differentiate between neurological conditions having similar clinical presentation.

Why this matters

  • Importance of accurate diagnosis for treatment and prognostication.

Key results

  • NfL levels:
    • Higher in majority of neurological conditions vs healthy controls.
    • Higher in men vs women for one-third of diagnoses, including healthy controls.
    • Rose with age in healthy controls (3.30%/year), majority of neurological conditions.
  • There was overlap of NfL levels in most clinically similar diagnoses, but levels were significantly higher in:
    • Frontotemporal dementia vs other dementias:
      • Alzheimer’s disease (ratio, 2.08).
      • Vascular dementia (1.56).
      • Dementia with Lewy bodies (2.50).
    • HIV with cognitive impairment vs other dementias:
      • Frontotemporal dementia (5.46).
      • Alzheimer’s disease (11.47).
      • Vascular dementia (8.60).
      • Dementia with Lewy bodies (13.63).
    • Atypical parkinsonian syndromes vs Parkinson’s disease:
      • Multiple systems atrophy (3.36).
      • Progressive supranuclear palsy (2.57).
      • Corticobasal syndrome (3.74).

Study design

  • Meta-analysis of individual-level data from 10,059 individuals, including:
    • 2795 with central nervous system inflammatory diseases.
    • 4339 with dementias, predementia.
    • 984 with parkinsonian syndromes.
    • 1332 healthy controls.
  • Main outcome: NfL levels.
  • Funding: Swedish Medical Research Council; National Institutes of Health; others.

Limitations

  • Only studies using a specific NfL assay included.
  • Most diagnoses clinical.
  • Limited data for some conditions.
  • Heterogeneity of dementia subtypes.