Table 3.

Clinical indications for appropriate use of LP and CSF testing in the diagnosis of AD.

No.	Indication	Rating
1	Cognitively unimpaired and within normal range functioning for age by objective testing; no conditions suggesting high risk and no SCD or expressed concern about developing AD.	Inappropriate
2	Cognitively unimpaired patient based on objective testing, but considered by patient, family informant, and/or clinician to be at risk for AD based on family history.	Inappropriate
3	Patients with SCD who are considered to be at increased risk for AD	Appropriate
4	Patients with SCD who are not considered to be at increased risk for AD	Inappropriate
5	MCI that is persistent, progressing, and unexplained	Appropriate
6	Patients with symptoms that suggest possible AD	Appropriate
7	MCI or dementia with an onset at an early age (<65)	Appropriate
8	Meeting core clinical criteria for probable AD with typical age of onset	Appropriate
9	Symptoms of REM sleep behavior disorder	Inappropriate
10	Patients whose dominant symptom is a change in behavior (e.g. Capgras Syndrome, paranoid delusions, unexplained delirium, combative symptoms, and depression) and where AD diagnosis is being considered	Appropriate
11	Use to determine disease severity in patients having already received a diagnosis of AD	Inappropriate
12	Individuals who are apolipoprotein E (APOE) ε4 carriers with no cognitive impairment	Inappropriate
13	Use of LP in lieu of genotyping for suspected ADAD mutation carriers	Inappropriate
14	ADAD mutation carriers, with or without symptoms	Inappropriate

Abbreviations: AD, Alzheimer’s disease; LP, lumbar puncture; REM, rapid eye movement; SCD, subjective cognitive decline; ADAD, autosomal dominant Alzheimer’s disease; MCI, mild cognitive impairment.

^*Table adapted from reference #9.