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Dementia in MS complicated by coexistent Alzheimer disease: Diagnosis premortem and postmortem

Eoin P Flanagan1, David S Knopman1, B Mark Keegan1

  • 1Department of Neurology, Mayo Clinic, Rochester, MN.

Neurology. Clinical Practice
|August 12, 2014
PubMed

Insights

Diagnosing Alzheimer disease (AD) dementia coexisting with multiple sclerosis (MS) is challenging. New AD biomarkers aid in diagnosing AD dementia in MS patients with severe cognitive impairment.

Area of Science:

  • Neuroscience
  • Neurology
  • Immunology

Background:

  • Differentiating dementia in multiple sclerosis (MS) from coexisting neurodegenerative dementia is clinically challenging.
  • Advancements in Alzheimer disease (AD) biomarkers, including amyloid-beta and neurodegeneration markers, have improved premortem AD diagnosis.

Purpose of the Study:

  • To describe the diagnostic utility of Alzheimer disease (AD) biomarkers in patients with coexisting multiple sclerosis (MS) and AD dementia.
  • To evaluate the role of novel AD biomarkers in differentiating MS-related cognitive decline from superimposed AD.

Main Methods:

  • Case series describing three patients with MS and coexisting AD.
  • Utilized autopsy findings for one patient and premortem diagnostics for two patients.
  • Premortem diagnostics included cerebrospinal fluid (CSF) amyloid-beta (Aβ)1-42/tau index, magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET).

Main Results:

  • One patient diagnosed with MS and AD dementia via autopsy prior to widespread biomarker availability.
  • Two patients diagnosed premortem using a combination of decreased CSF Aβ1-42/tau index, characteristic MRI findings, and FDG-PET patterns suggestive of AD.
  • These biomarkers were crucial in distinguishing AD dementia from MS-related cognitive impairment.

Conclusions:

  • Alzheimer disease (AD) biomarkers demonstrate significant diagnostic value in select patients presenting with severe dementia and multiple sclerosis (MS).
  • Premortem diagnosis of coexisting AD in MS patients is feasible with advanced biomarker analysis.
  • Further research is warranted to establish the role of AD biomarkers in managing MS-related cognitive decline.

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