Leslie M Shaw1, Jalayne Arias2, Kaj Blennow3, Douglas Galasko4, Jose Luis Molinuevo5, Stephen Salloway6, Suzanne Schindler7, Maria C Carrillo8, James A Hendrix9, April Ross8, Judit Illes10, Courtney Ramus10, Sheila Fifer11. 1. Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, PA, USA. 2. Department of Neurology, University of California, San Francisco, CA, USA. 3. Department of Psychiatry and Neurochemistry, University of Gothenberg, Molndal, Sweden. 4. Department of Neuroscience, University of California, San Diego, CA, USA. 5. Barcelonabeta Brain Research Center, Barcelona, Spain. 6. Butler Hospital Memory and Aging Program, The Warren Alpert Medical School of Brown University, Brown University, Providence, RI, USA. 7. Department of Neurology, Washington University St. Louis. 8. Alzheimer's Association, Chicago, IL, USA. 9. Alzheimer's Association, Chicago, IL, USA. Electronic address: jhendrix@alz.org. 10. Avalere Health, Washington, DC, USA. 11. Fifer Associates, San Francisco, CA, USA.
Abstract
INTRODUCTION: The Alzheimer's Association convened a multidisciplinary workgroup to develop appropriate use criteria to guide the safe and optimal use of the lumbar puncture procedure and cerebrospinal fluid (CSF) testing for Alzheimer's disease pathology detection in the diagnostic process. METHODS: The workgroup, experienced in the ethical use of lumbar puncture and CSF analysis, developed key research questions to guide the systematic review of the evidence and developed clinical indications commonly encountered in clinical practice based on key patient groups in whom the use of lumbar puncture and CSF may be considered as part of the diagnostic process. Based on their expertise and interpretation of the evidence from systematic review, members rated each indication as appropriate or inappropriate. RESULTS: The workgroup finalized 14 indications, rating 6 appropriate and 8 inappropriate. DISCUSSION: In anticipation of the emergence of more reliable CSF analysis platforms, the manuscript offers important guidance to health-care practitioners and suggestions for implementation and future research.
INTRODUCTION: The Alzheimer's Association convened a multidisciplinary workgroup to develop appropriate use criteria to guide the safe and optimal use of the lumbar puncture procedure and cerebrospinal fluid (CSF) testing for Alzheimer's disease pathology detection in the diagnostic process. METHODS: The workgroup, experienced in the ethical use of lumbar puncture and CSF analysis, developed key research questions to guide the systematic review of the evidence and developed clinical indications commonly encountered in clinical practice based on key patient groups in whom the use of lumbar puncture and CSF may be considered as part of the diagnostic process. Based on their expertise and interpretation of the evidence from systematic review, members rated each indication as appropriate or inappropriate. RESULTS: The workgroup finalized 14 indications, rating 6 appropriate and 8 inappropriate. DISCUSSION: In anticipation of the emergence of more reliable CSF analysis platforms, the manuscript offers important guidance to health-care practitioners and suggestions for implementation and future research.
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