title: CSF neurofilament light chain and tau differentiate multiple system atrophy from Parkinson's disease.
abstract: BACKGROUND
  In early disease stages it can be clinically difficult to differentiate idiopathic Parkinson's disease (IPD) from patients with multiple system atrophy predominated by parkinsonism (MSA-P).
  
  
  METHODS
  In CSF of 31 patients with IPD, 19 patients with MSA-P, we analyzed tau, neurofilament light chain (NFL) and heavy chain (NFHp35) and the noradrenergic metabolite 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG).
  
  
  RESULTS
  CSF levels of NFL, NFHp35, and tau were significantly increased in MSA-P (all p<0.0001), whereas, MHPG levels were significantly decreased in MSA-P (p<0.0001). Optimal discriminative cut-off values for the differentiation between MSA-P and IPD were calculated resulting in high sensitivity (76-94%) and specificity (83-97%) levels. Multivariate logistic regression resulted in the combination of NFL and tau as independent contributors in differentiating between MSA-P and IPD.
  
  
  CONCLUSIONS
  Higher CSF levels of axonal biomarkers could reflect advanced axonal degeneration in MSA-P. Differentiating MSA-P from IPD could be accurately possible with CSF analysis of a combination of axonal and neurotransmitter biomarkers.
authors: Department of Neurology, Radboud University, Nijmegen Medical Centre, The Netherlands. f.abdo@neuro.umcn.nl
authors: W Farid
authors: WF
authors: Abdo
authors: Bastiaan R
authors: BR
authors: Bloem
authors: Wieneke J
authors: WJ
authors: Van Geel
authors: Rianne A J
authors: RA
authors: Esselink
authors: Marcel M
authors: MM
authors: Verbeek