Feasibility of Lumbar Puncture in the Study of Cerebrospinal Fluid Biomarkers for Alzheimer's Disease: A Multicenter Study in Spain

Article type: Research Article

Authors: Alcolea, Daniel^{a; b; 1} | Martínez-Lage, Pablo^{b; c; 1} | Izagirre, Andrea^c | Clerigué, Montserrat^c | Carmona-Iragui, María^{a; b} | Alvarez, Rosa María^d | Fortea, Juan^{a; b} | Balasa, Mircea^d | Morenas-Rodríguez, Estrella^{a; b} | Lladó, Albert^d | Grau, Oriol^d | Blennow, Kaj^e | Lleó, Alberto^{a; b; *} | Molinuevo, José L.^d

Affiliations: [a] Department of Neurology, Inst. Investigacions Biomèdiques-Hospital Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain | [b] Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, CIBERNED, Spain | [c] Department of Neurology, Center for Research and Advanced Therapies, Fundación CITA-Alzheimer Fundazioa, San Sebastián, Spain | [d] Department of Neurology, Alzheimer's Disease and other Cognitive Disorders Unit, Hospital Clínic, Barcelona, Spain | [e] Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, University of Göteborg, Göteborg, Sweden

Correspondence: [*] Correspondence to: Alberto Lleó, MD, PhD, Department of Neurology, Hospital Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain. Tel.: +34935565986; Fax: +34935565602; E-mail: alleo@santpau.es.

Note: [1] These authors contributed equally to this manuscript.

Abstract: Background:Lumbar puncture (LP) is increasingly performed in memory units due to the usefulness of cerebrospinal fluid (CSF) biomarkers in the diagnosis of Alzheimer’s disease. The feasibility of this procedure in this context, however, is controversial. Objective:Our aim was to analyze the incidence of complications and their associated factors so as to determine the impact of LP in the study of CSF biomarkers of Alzheimer’s disease. Methods:In the context of a larger international initiative, we prospectively collected data from 689 participants who underwent LP in three memory units in Spain. Data included demographic factors, headache history, subjective attitude toward the procedure, patient positioning, needle characteristics, volume of CSF extracted, attempts needed, and resting time after CSF acquisition. Five to seven days after the procedure, we asked participants about complications through a semi-structured telephone interview. Results:No adverse events were reported in 441 (64.0%) participants. The most frequent complication was headache, reported by 171 (24.8%) subjects. It was severe in only 17 (2.5%). Headache was more frequent in younger participants and when a cutting-edge needle was used. Back pain was present in 111 (16.1%) cases, and it was associated with female gender, cutting-edge needles, increased number of attempts, and longer resting time after LP. No major complications were reported. The use of pen-point needles showed a trend toward a higher frequency of hematic CSF. Conclusion:LP can be safely performed to study CSF biomarkers. The main complication is headache, associated with younger age and use of cutting-edge needles.

Keywords: Alzheimer's disease, biomarkers, cerebrospinal fluid, dementia, lumbar puncture, post-lumbar puncture headache

DOI: 10.3233/JAD-131334

Journal: Journal of Alzheimer's Disease, vol. 39, no. 4, pp. 719-726, 2014