NfL as a biomarker for neurodegeneration and survival in Parkinson disease.

Bäckström, David; Linder, Jan; Mo, Susanna Jakobson; Riklund, Katrine; Zetterberg, Henrik; Blennow, Kaj; Forsgren, Lars; Lenfeldt, Niklas

OBJECTIVE To determine if Neurofilament Light chain protein in cerebrospinal fluid (cNfL); a sensitive biomarker of neuroaxonal damage, reflects disease severity or can predict survival in Parkinson's disease (PD). METHODS We investigated if disease severity, phenotype or survival in patients with new-onset PD correlates with cNfL concentrations around the time of diagnosis in the population-based NYPUM study cohort (n = 99). A second, larger new-onset PD cohort (n = 194) was used for independent validation. Association of brain pathology with the cNfL concentration was examined using striatal dopamine transporter imaging and repeated diffusion tensor imaging, at baseline, 1 and 3 years. RESULTS Higher cNfL in the early phase of PD was associated with greater severity of all cardinal motor symptoms except tremor, in both cohorts, and with shorter survival and impaired olfaction. cNfL concentrations above the median of 903 ng/L conferred an overall 5.8 times increased hazard of death, during follow-up. After adjustment for age and sex, higher cNfL correlated with striatal dopamine transporter uptake deficits and lower fractional anisotropy in diffusion tensor imaging of several axonal tracts. CONCLUSIONS cNfL shows usefulness as a biomarker of disease severity and to predict survival in PD. The present results indicate that the cNfL concentration reflects the intensity of the neurodegenerative process, which could be of importance in future clinical trials. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with PD, cNFL concentrations are associated with more severe disease and shorter survival.