Amyotrophic Lateral Sclerosis vs Alzheimer's Disease: NFL (CSF)


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The levels of nerurofilament light chain in the cerebrospinal fluid of people with amyotrophic lateral sclerosis were found to be more than 4 times those of people with Alzheimer's disease (effect size = 4.503, p <0.0001). Although based on only two studies, the result of our meta-analysis is consistent with other reports of highly elevated levels of NFL in people with ALS—in fact, meta-analyses comparing ALS patients to control subjects have found increases on the order of 8- to 10-fold (Bridel et al., 2019; Forgrave et al., 2019; Wang et al., 2019; Xu et al., 2016).

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How to interpret a forest plot: Each individual effect size (ES) is a ratio of the mean biomarker level in one condition over the mean level in another condition. An ES equal to 1 means that the two conditions had identical mean values. An ES > 1 indicates higher levels in the first condition, whereas an ES < 1 indicates lower levels in the first condition. The overall ES, indicated by a black diamond, is a weighted average of the individual effect sizes. The weight of each data point was determined by the inverse of the variance and is reflected in the size of each square. The width of the overall ES diamond is determined by the 95 percent confidence interval. Data out of range of the scale, including ES and confidence intervals, are indicated by an arrowhead at the edge of the plot, when applicable. 

Version 3.0, July 2021.