Table 2

Clinical indications for appropriate use of lumbar puncture and cerebrospinal fluid testing in the diagnosis of AD, as detailed by the Alzheimer’s Association’s appropriate use criteria

Clinical indication	Alzheimer’s Association’s appropriate use criteria
Meeting core clinical criteria for probable AD dementia with typical age of onset	Appropriate
Symptoms suggesting possible AD dementia*
Dementia with onset age below 65 years*
Mild cognitive impairment with onset age below 65 years
Persistent, progressing or unexplained mild cognitive impairment
Subjective cognitive decline but considered to be at high risk of AD (persistent decline in memory rather than other cognitive domains; onset in the last 5 years, age at onset >60 years, worries associated with subjective cognitive decline, feeling of worse performance than others of the same age group, confirmation of cognitive decline by an informant; carriage of APOE ε 4)
Dominant symptom of change in behaviour, where AD diagnosis is being considered*
Determining disease severity in patients who have already received a diagnosis of AD	Inappropriate
Subjective cognitive decline not considered to be at high risk of AD
Symptoms of rapid eye movement sleep behaviour disorder
Carriers of autosomal dominant AD mutations, with or without symptoms
In lieu of genotyping for suspected carriers of autosomal dominant AD mutations
Carriers of APOE ε 4 with no cognitive impairment
Cognitively unimpaired on objective testing and no subjective cognitive decline but considered as high risk due to family history of AD
Cognitively unimpaired on objective testing, no subjective cognitive decline, no expressed concern about developing AD and no condition suggesting high risk

Reproduced with minor reformatting from Shaw et al 7 with the publisher’s permission.
*Indications that would be considered appropriate according to the current NICE guideline.6
AD, Alzheimer’s disease; APOE, apolipoprotein E gene; NICE, National Institute for Health and Care Excellence.