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Table 2 Summary of Alzheimer's Biomarkers Standardization Initiative recommendations for Alzheimer's disease biomarker testing

From: Fluid biomarkers for diagnosing dementia: rationale and the Canadian Consensus on Diagnosis and Treatment of Dementia recommendations for Canadian physicians

Alzheimer's Biomarkers Standardization Initiative recommendations
1 Computed tomography or MRI performed before LP LP should not be performed in cases where there is high intracranial pressure or where there is a mass lesion in the brain
2 Concomitant medication LP should not be performed in patients treated with anticoagulants (for example, warfarin). Treatment with platelet aggregation inhibitors is not a contraindication
3 Diurnal variation No diurnal variation
4 CSF gradient/volume No gradient observed. No requirement for a certain fraction. Minimum volume of 1.5 ml
5 Meal consumption No need for fasting
6 Position LP may be performed with the patient either sitting or lying down. The position of the patient does not affect the results
7 Location Vertebral body L3 to L5. The incision point of the needle (L3 to L4 or L4 to L5) does not affect the results
8 Disinfection/anesthesia Disinfection will reduce the risk of local infection. Local anesthetics introduce a risk of adverse effects, but can be given to patients who worry about local pain during LP
9 Needle Use a small diameter (0.7 mm and 22 G), preferably nontraumatic needle. A small-gauge needle will make a smaller hole in the dura, aiding healing, and an atraumatic needle will reduce the chance of blood contamination in the CSF
10 Rest Leave the patient to rest for half an hour after LP. Prolonged bed rest or other procedures will not influence the risk of post-LP headache
11 Tubes and aliquotation (type, volume, homogeneity) Each laboratory should use the same polypropylene tube. Glass or polystyrene tubes should in no circumstances be used. Tubes of the smallest volume should be used, and these should be filled to at least 50% of their volume
12 Documentation of sampling/aliquotation It is important to have carefully recorded and validated details concerning each stored sample so that any investigator when using these samples has a precise history of the sample
  Centrifugation (speed and temperature) Centrifugation only required for visually hemorrhagic samples. Centrifuge as soon as possible - within 2-hours of LP (on site or at nearest laboratory). Speed has no effect; however, recommend 2,000 × g for 10-minutes at room temperature (controlled)
13 Time and temperature before storage Samples may be sent by regular post (transport 5 days).
14 Method of freezing (liquid nitrogen, dry ice, slow freezing at -20°C or -80°C Freezing at -80°C for storage. No difference between methods of freezing
15 Length of storage (when frozen) Storage at -20°C for less than 2 months. Note: no evidence of any effect for up to 2 years at -80°C.
16 Number of freeze/thaw cycles Limit the number of freeze/thaw cycles to one or two
17 Interfering substances (hemolysis) Traumatic LP: Discard first 1 to 2 ml. Samples with an erythrocyte count of 500/ml should not be used without centrifugation
  1. Summary of Alzheimer's Biomarkers Standardization Initiative recommendations for pre-analytical and analytical aspects for Alzheimer's disease biomarker testing in cerebrospinal fluid. Adapted from [7]. CSF, cerebrospinal fluid; LP, lumbar puncture; MRI, magnetic resonance imaging.