Neurofilament proteins are vital structural components of nerve cells, helping to maintain their shape and function. Of these, neurofilament light chain (NfL) has emerged as a clinically important biomarker. When neurons are damaged or undergoing degeneration, NfL is released into the cerebrospinal fluid (CSF) and blood, where it can be measured. Elevated NfL levels are a highly sensitive indicator of neuroaxonal injury, though it is important to note that NfL is not specific to any single disease—it reflects neuronal damage from a variety of causes.
NfL is increasingly used in both research and clinical practice to detect, monitor, and sometimes predict the course of various neurological conditions. Its applications include:
Multiple Sclerosis (MS): NfL rises with disease activity, progression, and treatment response. It can detect subclinical inflammation and axonal damage, sometimes even earlier than MRI.
Alzheimer’s Disease: Elevated NfL is associated with cognitive decline, amyloid-beta pathology, and overall progression.
Parkinson’s Disease: NfL levels correlate with cortical neurodegeneration, worsening motor symptoms, cognitive changes, and disease severity.
Amyotrophic Lateral Sclerosis (ALS): NfL is often elevated before clinical symptoms appear, offering diagnostic and prognostic insights and helping distinguish ALS from other conditions.
Huntington’s Disease: NfL can rise before symptom onset, aiding early detection in genetically at-risk individuals.
Frontotemporal Dementia (FTD), Dementia with Lewy Bodies (DLB), and Peripheral Neuropathies: NfL reflects disease severity and tracks cognitive and functional decline.
Spinocerebellar Ataxias (SCAs): NfL helps stratify pre-symptomatic individuals and monitor early neurodegenerative changes.
Traumatic Brain Injury (TBI) and Stroke: Both acute and chronic brain injuries lead to elevated NfL, which correlates with the extent of neuronal damage and recovery outcomes.
Hereditary Transthyretin-Mediated (hATTR) Amyloidosis: NfL reflects the severity of nerve damage (polyneuropathy) and helps monitor response to therapy.
Concussion and Sports Medicine: NfL is being explored as an objective tool to guide safe return-to-play decisions after mild traumatic brain injury.
Note: Because NfL reflects general neuroaxonal injury, elevated levels should always be interpreted in the context of the patient’s clinical history and other diagnostic findings.
NfL levels naturally increase with age, even in healthy individuals. For accurate interpretation, age-specific reference intervals (serum/plasma, pg/mL) are used, such as those provided by Labcorp:
| Age (years) | Reference Range (pg/mL) |
|---|---|
| 0–4 | < 1.97 |
| 5–9 | < 1.64 |
| 10–14 | < 1.43 |
| 15–19 | < 1.60 |
| 20–29 | < 1.65 |
| 30–39 | < 1.88 |
| 40–49 | < 2.14 |
| 50–59 | < 3.79 |
| 60–69 | < 4.62 |
| 70–79 | < 7.65 |
| 80+ | < 11.56 |
Neurofilament light chain is a sensitive and versatile biomarker for detecting and monitoring neurodegenerative and neurological diseases. Its elevation signals ongoing neuroaxonal injury and can provide diagnostic, prognostic, and therapeutic guidance across a wide spectrum of conditions—from MS and Alzheimer’s to concussion and peripheral neuropathies. As research advances, NfL is becoming an integral, non-invasive tool in neurological care, offering objective insights into neuronal health and disease progression.
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Elevated levels of neurofilament light chain (NfL) in the blood or cerebrospinal fluid are a clear indicator of increased neuroaxonal injury or degeneration. As a structural protein released from damaged neurons, NfL serves as a highly sensitive biomarker of neuronal damage, rising in response to a wide range of neurological conditions.
In neurodegenerative diseases—such as multiple sclerosis (MS), Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), and various forms of dementia—elevated NfL levels are consistently associated with:
Greater disease severity
Faster clinical progression
In some cases, shortened survival
For example, in MS and ALS, higher NfL concentrations can predict more rapid disability progression and are useful in monitoring treatment response. In Alzheimer’s disease and related dementias, increased NfL levels suggest that cognitive decline is likely driven by underlying neurodegeneration, as opposed to other non-neurodegenerative causes like depression or medication effects.
However, while elevated NfL is a reliable marker of neuronal injury, it is not disease-specific. Levels may also rise in response to acute neurological events, including stroke, traumatic brain injury, and inflammatory or metabolic brain disorders.
Importantly, NfL should be interpreted in the context of the patient's overall clinical picture. Elevated levels reflect the presence and—often—the activity or aggressiveness of neuroaxonal damage, but they do not identify the exact cause. As such, NfL is best used as part of a broader diagnostic or monitoring strategy, guiding clinicians toward further evaluation and helping track disease trajectory over time.
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Anthony
Unlimited Plan Member since 2021
I have been using Healthmatters.io since 2021. I travel all over the world and use different doctors and health facilities. This site has allowed me to consolidate all my various test results over 14 years in one place. And every doctor that I show this to has been impressed. Because with any health professional I talk to, I can pull up historical results in seconds. It is invaluable. Even going back to the same doctor, they usually do not have the historical results from their facility in a graph format. That has been very helpful.
Karin
Advanced Plan Member since 2020
What fantastic service and great, easy-to-follow layouts! I love your website; it makes it so helpful to see patterns in my health data. It's truly a pleasure to use. I only wish the NHS was as organized and quick as Healthmatters.io. You've set a new standard for health tracking!
Paul
Healthmatters Pro Member since 2024
As a PRO member and medical practitioner, Healthmatters.io has been an invaluable tool for tracking my clients' data. The layout is intuitive, making it easy to monitor trends and spot patterns over time. The ability to customize reports and charts helps me present information clearly to my clients, improving communication and outcomes. It's streamlined my workflow, saving me time and providing insights at a glance. Highly recommended for any practitioner looking for a comprehensive and user-friendly solution to track patient labs!
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