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A large proportion of AD patients shows concomitant Lewy bodies\u2019 pathology post mortem. Total \u03b1 Synuclein (\u03b1Syn) concentrations are frequently increased in the cerebrospinal fluid (CSF) of AD patients, but are decreased in Parkinson\u2019s Disease (PD) and Dementia with Lewy Bodies (DLB). \u03b1Syn CSF concentrations in AD patients with EP (EP+) have not been reported so far. \u03b1Syn and the four Neurochemical Dementia Diagnostics (NDD) CSF biomarkers, (A\u03b21-42, A\u03b242\/40, Tau, and pTau181), interpreted according to the Erlangen Score algorithm, were measured in patients with positive NDD results and presence of extrapyramidal symptoms (NDD\u2009+\u2009\/\u00a0EP+; <jats:italic>n<\/jats:italic>\u2009=\u200926), in patients with positive NDD results and absence of extrapyramidal symptoms (NDD+\u2009\/\u00a0EP\u2212; <jats:italic>n<\/jats:italic>\u2009=\u200954), and in subjects with negative NDD results (NDD\u2212; <jats:italic>n<\/jats:italic>\u2009=\u200934). Compared to the NDD\u2212 controls (379.8\u2009\u00b1\u2009125.2\u00a0pg\/mL), NDD+\u2009patients showed, on average, highly significantly increased CSF \u03b1Syn (519\u2009\u00b1\u2009141.3\u00a0pg\/mL, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), but without differences between NDD+\u2009\/\u00a0EP+\u2009and NDD+\u2009\/\u00a0EP\u2212 subgroups (<jats:italic>p<\/jats:italic>\u2009=\u20090. 38). Moderate but highly significant association was observed between concentrations of \u03b1Syn and Tau (r\u2009=\u20090.47, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) and pTau181 (r\u2009=\u20090.65, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Adjusted for diagnoses, age, and sex, subjects with more advanced neurodegeneration on neuroimaging showed significantly lower \u03b1Syn concentrations (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.02). In the setting AD versus controls, the area under the receiver operating characteristic (ROC) curve was 0.804 [0.712; 0.896] with the sensitivity and the specificity of 0.863 and 0.618, respectively. \u03b1Syn in AD patients does not differentiate between subjects with- and without EP. Its increased average concentration reflects probably neurodegenerative process, and is not specific for any pathophysiologic mechanisms. Further studies are necessary to explain the role of CSF \u03b1Syn as a potential biomarker.<\/jats:p>","DOI":"10.1007\/s00702-021-02351-x","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T19:02:37Z","timestamp":1621969357000},"page":"817-825","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Cerebrospinal fluid \u03b1 synuclein concentrations in patients with positive AD biomarkers and extrapyramidal symptoms"],"prefix":"10.1007","volume":"128","author":[{"given":"Izabela","family":"Winkel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Ermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnieszka","family":"\u017belwetro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo\u017cydar","family":"Sambor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Mroczko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Kornhuber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogus\u0142aw","family":"Paradowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8101-6535","authenticated-orcid":false,"given":"Piotr","family":"Lewczuk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,25]]},"reference":[{"issue":"2","key":"2351_CR1","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/s0006-8993(00)03082-1","volume":"888","author":"Y Arai","year":"2001","unstructured":"Arai Y, Yamazaki M, Mori O, Muramatsu H, Asano G, Katayama Y (2001) Alpha-synuclein-positive structures in cases with sporadic Alzheimer\u2019s disease: morphology and its relationship to tau aggregation. 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