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Abstract
Objective To examine whether plasma neurofilament light chain (NfL) levels were associated with motor and cognitive progression in Parkinson disease (PD).
Methods This prospective follow-up study enrolled 178 participants, including 116 with PD, 22 with multiple system atrophy (MSA), and 40 healthy controls. We measured plasma NfL levels with electrochemiluminescence immunoassay. Patients with PD received evaluations of motor and cognition at baseline and at a mean follow-up interval of 3 years. Changes in the Unified Parkinson's Disease Rating Scale (UPDRS) part III motor score and Mini-Mental State Examination score were used to assess motor and cognition progression.
Results Plasma NfL levels were significantly higher in the MSA group than in the PD and healthy groups (35.8 ± 6.2, 17.6 ± 2.8, and 10.6 ± 2.3 pg/mL, respectively, p < 0.001). In the PD group, NfL levels were significantly elevated in patients with advanced Hoehn-Yahr stage and patients with dementia (p < 0.001). NfL levels were modestly correlated with UPDRS part III scores (r = 0.42, 95% confidence interval 0.46–0.56, p < 0.001). After a mean follow-up of 3.4 ± 1.2 years, a Cox regression analysis adjusted for age, sex, disease duration, and baseline motor or cognitive status showed that higher baseline NfL levels were associated with higher risks for either motor or cognition progression (p = 0.029 and p = 0.015, respectively).
Conclusions Plasma NfL levels correlated with disease severity and progression in terms of both motor and cognitive functions in PD.
Classification of evidence This study provides Class III evidence that plasma NfL level distinguishes PD from MSA and is a surrogate biomarker for PD progression.
Glossary
- APS=
- atypical parkinsonism syndromes;
- CI=
- confidence interval;
- HR=
- hazard ratio;
- MCI=
- mild cognitive impairment;
- MMSE=
- Mini-Mental State Examination;
- MSA=
- multiple system atrophy;
- NfL=
- neurofilament light chain;
- PD=
- Parkinson disease;
- PDD=
- PD with dementia;
- ROC=
- receiver operating characteristic curve;
- UPDRS=
- Unified Parkinson's Disease Rating Scale
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 471
Class of Evidence: NPub.org/coe
- Received June 29, 2018.
- Accepted in final form June 4, 2019.
- © 2019 American Academy of Neurology
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- Author response: Blood NfL: A biomarker for disease severity and progression in Parkinson disease
- Reader response: Blood NfL: A biomarker for disease severity and progression in Parkinson disease
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