Performance and complications of lumbar puncture in memory clinics: Results of the multicenter lumbar puncture feasibility study

Flora H Duits; Pablo Martinez-Lage; Claire Paquet; Sebastiaan Engelborghs; Alberto Lleó; Lucrezia Hausner; José L Molinuevo; Erik Stomrud; Lucia Farotti; Inez H G B Ramakers; Magda Tsolaki; Constance Skarsgård; Ragnar Åstrand; Anders Wallin; Martin Vyhnalek; Marie Holmber-Clausen; Orestes V Forlenza; Laura Ghezzi; Martin Ingelsson; Erik I Hoff; Gerwin Roks; Alexandre de Mendonça; Janne M Papma; Andrea Izagirre; Mariko Taga; Hanne Struyfs; Daniel A Alcolea; Lutz Frölich; Mircea Balasa; Lennart Minthon; Jos W R Twisk; Staffan Persson; Henrik Zetterberg; Wiesje M van der Flier; Charlotte E Teunissen; Philip Scheltens; Kaj Blennow

doi:10.1016/j.jalz.2015.08.003

Performance and complications of lumbar puncture in memory clinics: Results of the multicenter lumbar puncture feasibility study

Alzheimers Dement. 2016 Feb;12(2):154-163. doi: 10.1016/j.jalz.2015.08.003. Epub 2015 Sep 11.

Authors

Flora H Duits¹, Pablo Martinez-Lage², Claire Paquet³, Sebastiaan Engelborghs⁴, Alberto Lleó⁵, Lucrezia Hausner⁶, José L Molinuevo⁷, Erik Stomrud⁸, Lucia Farotti⁹, Inez H G B Ramakers¹⁰, Magda Tsolaki¹¹, Constance Skarsgård¹², Ragnar Åstrand¹³, Anders Wallin¹⁴, Martin Vyhnalek¹⁵, Marie Holmber-Clausen¹⁶, Orestes V Forlenza¹⁷, Laura Ghezzi¹⁸, Martin Ingelsson¹⁹, Erik I Hoff²⁰, Gerwin Roks²¹, Alexandre de Mendonça²², Janne M Papma²³, Andrea Izagirre², Mariko Taga³, Hanne Struyfs²⁴, Daniel A Alcolea⁵, Lutz Frölich⁶, Mircea Balasa⁷, Lennart Minthon⁸, Jos W R Twisk²⁵, Staffan Persson²⁶, Henrik Zetterberg²⁷, Wiesje M van der Flier²⁸, Charlotte E Teunissen²⁹, Philip Scheltens³⁰, Kaj Blennow²⁶

Affiliations

¹ Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
² Department of Neurology, Fundacion CITA-Alzheimer Fundazioa, San Sebastián, Spain.
³ INSERM, U942, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UMRS 942, Paris, France; Research Memory Center Paris North AP-HP, Hopital Lariboisière, Paris, France.
⁴ Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium; Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium.
⁵ Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.
⁶ Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany.
⁷ Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic i Universitari and Pasqual Maragall Foundation, Barcelona, Spain.
⁸ Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
⁹ Centro Disturbi della Memoria, Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy.
¹⁰ Alzheimer Center Limburg, Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
¹¹ 3rd Department of Neurology, Aristotle University of Thessaloniki, Macedonia, Greece.
¹² The Department of Geriatrics, Kalmar County Hospital, Kalmar, Sweden.
¹³ Department of Cognitive Medicine, Karlstad Central Hospital, Karlstad, Sweden.
¹⁴ Memory Clinic at Department of Neuropsychiatry, Sahlgrenska University Hospital, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.
¹⁵ Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
¹⁶ Department of Geriatrics, Minnesmottagningen, Eskilstuna, Sweden.
¹⁷ Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
¹⁸ Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione Ca' Grandam IRCCS Ospedale Policlinico, Milan, Italy.
¹⁹ Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
²⁰ Department of Neurology, Atrium Medical Center Parkstad, Heerlen, The Netherlands.
²¹ Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands.
²² Department of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
²³ Department of Neurology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
²⁴ Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
²⁵ Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
²⁶ Department of Clinical Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal Sweden.
²⁷ Department of Clinical Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal Sweden; UCL Institute of Neurology, Department of Molecular Neuroscience, London, UK.
²⁸ Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
²⁹ Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
³⁰ Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: p.scheltens@vumc.nl.

PMID: 26368321
DOI: 10.1016/j.jalz.2015.08.003

Abstract

Introduction: Lumbar puncture (LP) is increasingly performed in memory clinics. We investigated patient-acceptance of LP, incidence of and risk factors for post-LP complications in memory clinic populations.

Methods: We prospectively enrolled 3868 patients (50% women, age 66 ± 11 years, mini mental state examination 25 ± 5) at 23 memory clinics. We used logistic regression analysis using generalized estimated equations to investigate risk factors for post-LP complications, such as typical postlumbar puncture headache (PLPH) and back pain.

Results: A total of 1065 patients (31%) reported post-LP complaints; 589 patients (17%) reported back pain, 649 (19%) headache, of which 296 (9%) reported typical PLPH. Only few patients needed medical intervention: 11 (0.3%) received a blood patch, 23 (0.7%) were hospitalized. The most important risk factor for PLPH was medical history of headache. An atraumatic needle and age >65 years were preventive. Gender, rest after LP, or volume of cerebrospinal fluid had no effect.

Discussions: The overall risk of complications is relatively low. If risk factors shown in this study are taken into account, LPs can be safely performed in memory clinics.

Keywords: Alzheimer's disease; Cognitive disorders; Lumbar puncture; Memory clinic; Multicenter study on LP feasibility; Post-LP complications; Post-LP headache.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Ambulatory Care Facilities*
Cognition Disorders / cerebrospinal fluid
Dementia / cerebrospinal fluid
Feasibility Studies
Female
Humans
Incidence
Male
Memory / physiology*
Middle Aged
Post-Dural Puncture Headache / epidemiology
Post-Dural Puncture Headache / etiology
Prospective Studies
Risk Factors
Spinal Puncture / adverse effects*
Spinal Puncture / methods