The Role Of Cerebrospinal Fluid Markers In The Diagnosis Of Sporadic Creutzfeldt-Jakob Disease

Objective To evaluate the value of cerebrospinal fluid markers expecially T-tau?P-tau in diagnosis and differentiation of sporadic Creutzfeldt-Jakob diseaseMethods sCJD(2009 Brain criteria,2018 Neurology amended criteria),AD(2011 NIA-AA criteria)and other patients without cognitive impairment,matched for sex and age,in Neurology Department in Peking Union Medical College Hospital from 2018 to 2019 were enrolled.Cerebrospinal fluid(CSF)specimens were collected,stored according to standards.The level of ?-amyloid(A ?)?total-tau(T-tau)protein and phosphorylated-tau protein(P-tau)were measured by ELISA.The clinical datas of CJD patients were recorded.Moreover,specimens of sCJD patients were sent to Centers for Disease Control and Prevention(CDC)test 14-3-3 protein and PRNP genotypeResults Twelve sCJD patients,49 AD patients and 14 normal controls were enrolled.Using Mann-Whitney Test,We find T-tau concentrations are higher in patients with sCJD(1 211(448,2 227)pg/ml)than in AD patients(549(314,1 078)pg/ml;P=0.0349,U=178),and both groups have higher T-tau than the control group The level of A? in AD(481.2(599,753.6)pg/ml)decreased than Control.The level of P-tau is significantly increased in AD(72.41(57.7,108.9)pg/ml,P<0.01,U=82),but not in sCJD or control group.The T-tau/P-tau ratio is higher in sCJD(29.77(20.01,54.53))than AD(7.446(4.793,10.43);P<0.01,U=87).Twelve sCJD patients have cortical hyperintensive in diffusion weighted imaging and five have periodic three-phase waves in electroencephalogram.Nine sCJD patients,whose blood samples were tested in CDC,carried an MM genotype at codon 129 and EE at codon 219.Four in nine patients,cerebrospinal fluid 14-3-3 protein tests positive.Conclusions The CSF Tau level and T-tau/P-tau ratio are significantly increased in sCJD.In routine clinical setting,they may promote the diagnosis and differentiation of sCJD.