The diagnostic utility of cerebrospinal fluid alpha-synuclein analysis in dementia with Lewy bodies - a systematic review and meta-analysis

Abstract

Background: Dementia with Lewy Bodies (DLB) can be difficult to distinguish clinically from other dementias.

Objective: To investigate the diagnostic utility of CSF alpha-synuclein in differentiating between DLB and other dementias.

Methods: Electronic databases were systematically searched for studies investigating reproducible alpha synuclein quantification methods. Random effects model was used to calculate weighted mean difference (WMD) and 95% confidence intervals between DLB and other groups.

Results: A total of 13 studies, comprising 2728 patients were included. Mean CSF alpha-synuclein concentration was significantly lower in DLB patients compared to those with Alzheimers disease (AD) [WMD -0.24; 95% CI, -0.45, -0.03; p = 0.02]. No significant difference was found between patients with DLB compared to Parkinsons disease [WMD 0.05; 95% CI, -0.17, 0.28; p = 0.65] or other neurodegenerative conditions.

Conclusion: CSF alpha synuclein may be of diagnostic use in differentiating between DLB and AD. We propose several recommendations to guide better design of future studies.

Keywords: Alpha-synuclein; Biomarker; Cerebrospinal fluid; Dementia; Dementia with Lewy bodies.