BlueCross BlueShield of Tennessee Medical Policy Manual

Biochemical Markers for Alzheimer’s Disease

DESCRIPTION

The clinical diagnosis of Alzheimer disease (AD) focuses on the exclusion of other causes of dementia. Because diagnosis of AD can be difficult, there has been considerable interest in identifying an accurate laboratory test for AD, particularly for use early in the course of disease.

Several cerebrospinal fluid (CSF) peptide markers and urine markers have been investigated as possible predictors of AD and include:

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

Evidence to support testing for AD-related biomarkers is lacking. For the diagnosis of AD, evidence does not demonstrate incremental improvement in diagnostic accuracy over clinical testing.

SOURCES

Bateman, R. J., Xiong, C., Benzinger, T. L. S., Fagan, A. M., Goate, A., Fox, N. C, et al. (2012). Clinical and biomarker changes in dominantly inherited Alzheimer’s disease. New England Journal of Medicine, 367 (9), 795-804. (Level 2 evidence)

BlueCross BlueShield Association. Medical Policy Reference Manual. (12:2016). Cerebrospinal fluid and urinary biomarkers of Alzheimer disease (2.04.14). Retrieved June 23, 2017 from BlueWeb. (42 articles and/or guidelines reviewed)

Jack, C., Albert, M., Knopman, G., Sperling, R., Carrillo, M., Thies, B. et al. (2011). Introduction to the recommendations from the National Institute on Aging and the Alzheimer’s Association workgroup on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association, 7 (3), 257-262. (Level 4 evidence)

McKhann, G., Knopman, D., Chertkow, H., Hyman, B., Jack, C., Kawas,C., et al. (2011), The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging and the Alzheimer’s Association workgroup. Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association, 7 (3), 263-269. (Level 2 evidence)

Miller, A., Begley, E., Coen, R., Doyle, M., Dunne, J., Hutchinson, S. (2016). Clinical consensus guidelines on the application of cerebrospinal fluid biomarkers for Alzheimer’s disease diagnosis: recommendations of the Irish network for biomarkers in neurodegeneration. Irish Medical Journal, 109 (10), 483. (Level 2 evidence)

National Institute on Aging & Alzheimer’s Association. (2011). The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute of Aging - Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Retrieved June 26, 2017 from http://www.alz.org/documents_custom/Diagnositic_Recommendations_MCI_due_to_Alz_proof.pdf.

Olsson, B., Schott, J., Blennow, K., & Zetterberg, H. (2017). The use of cerebrospinal fluid biomarkers to measure change in neurodegeneration in Alzheimer’s disease clinical trials. Expert Review of Neurotherapeutics, 2017 Jun 19:1-9. Doi: 10.1080/14737175.2017.1341311. [Epub ahead of print]. Abstract retrieved June 26, 2017 from PubMed database.

ORIGINAL EFFECTIVE DATE:  12/10/2011

MOST RECENT REVIEW DATE:  8/10/2017

ID_BA

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.