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Historical Background
CSF has been widely investigated in parkinsonian disorders and is considered to offer the most promising insights into the disease process. Historically, because of dopaminergic abnormalities in parkinsonism, the first compounds to be tested as potential markers were dopamine and other monoamines and their metabolites. In the 1960s and 1970s, reduced CSF monoamine concentrations (homovanillic acid and 5-hydroxyindoleacetic acid) were found in patients with parkinsonism and dementia. A study conducted at the National Hospital, Queen Square, London, assessed the effect of levodopa treatment in CSF homovanillic acid concentration of PD patients. Before levodopa treatment, homovanillic acid concentration was low in all patients, while after treatment it rose to a level that correlated significantly with the levodopa dose.
As these metabolic results were prone to be influenced by a multitude of other factors, the quest went further to investigate a priori defined compounds, such as α-Syn and tau. These were tested in patients and in healthy controls, looking for differences, patterns and associations. Even though several promising candidates exist, there is still no reliable biomarker.
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