The edition · Neurology
A blood test moves Alzheimer's diagnosis forward, and thrombectomy earns its place past 80
Phosphorylated tau 217 blood testing is entering routine Alzheimer's diagnosis, plasma biomarkers shift in complex ways on lecanemab, skin nerve loss tracks cognition in Parkinson's, and endovascular therapy helps even the oldest patients with large strokes.
The edition in brief
Today's neurology edition leads with a review of fluid biomarkers in Alzheimer's disease, where blood phosphorylated tau 217 for Alzheimer's and neurofilament light for frontotemporal dementia and ALS are now moving into clinical practice, timely as amyloid-targeting drugs arrive, though several markers are needed to capture copathology. A longitudinal cohort of 197 patients on lecanemab found plasma biomarkers move in four distinct directions, with p-tau217, MAPT and GFAP partially normalising while inflammatory markers such as TREM2 behave abnormally, suggesting different markers may suit monitoring versus prognosis. A cross-sectional study links lower intraepidermal nerve fibre density to worse cognition and frontal-insular atrophy in Parkinson's disease, pointing to a peripheral-central axis. A clinic pearl warns against abruptly stopping dopaminergic therapy. The edition closes on a pooled analysis of 270 patients aged 80 or older with large ischaemic stroke, where endovascular treatment improved 90-day function (common odds ratio 2.83) and lowered mortality despite more intracranial haemorrhage, with no attenuation by age.
Blood biomarkers are entering everyday Alzheimer's diagnosis
Consider blood p-tau217 as an emerging first-line aid in suspected Alzheimer's, interpreted alongside clinical assessment and local criteria.
On lecanemab, plasma biomarkers move in several directions at once
Expect plasma biomarkers to move in divergent directions on lecanemab; none is yet a validated measure for monitoring response.
Skin nerve loss tracks cognition in Parkinson's disease
Note skin small-fibre loss as a possible marker of central neurodegeneration in Parkinson's, but do not use skin biopsy to assess cognition yet.
Never stop dopaminergic therapy abruptly in Parkinson's
Keep Parkinson's medication on its home schedule in hospital and never stop it abruptly; avoid dopamine-blocking antiemetics.
Age alone should not deny thrombectomy in large ischaemic stroke
Do not deny endovascular therapy to patients 80 or older with large ischaemic stroke on age alone; weigh it individually, counselling on bleeding risk.
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