The degenerative process in AD probably begins 20–30 years before the first clinical symptoms become apparent; therefore, the possibility to discriminate individuals carrying incipient AD is utmost important, in view of the availability of drugs that may slow or even halt the progression of the disease. Two AD biomarkers extensively reported in literature are Aβ1-42 and isoforms of tau protein, which are the major components of brain senile plaques and neurofibrillary tangles. Levels of these proteins in cerebrospinal fluid (CSF) are commonly used both in Europe and in the United States for research and diagnostic purposes; the highest performance of these tests is for discriminating AD, even in early phases, from normal subjects. Up till now, thousands of subjects have been studied either in research or routine setting, giving sensitivity and specificity values invariably above 80%. Despite such results, CSF analysis is still considered only a supportive exam in AD diagnostic work-up. We think there is a great need to improve the medical awareness about the importance to perform lumbar puncture as a routine procedure in the diagnostic assessment of cognitive deterioration. Impressive data coming from recent large multicentre studies across several laboratories emphasize this need.

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